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In 2017, a randomized cardiovascular safety trial showed a higher incidence of fractures in patients with diabetes who were taking canagliflozin (Invokana; a sodium-glucose cotransporter-2 inhibitor) than in placebo patients; the difference was evident within 12 weeks of drug initiation (NEJM JW Gen Med Aug 1 2017 and N Engl J Med 2017; 377:644). A systematic review of three clinical trials of canagliflozin showed no influence of canagliflozin on fractures (NEJM JW Gen Med Jan 15 2019 and Lancet 2019; 393:31).
Using two insurance claims databases, independent researchers compared the incidence of pelvic, hip, and upper extremity fractures in almost 80,000 propensity-matched pairs of adults (mean age, 55; no previous fractures at relevant sit…