For patients with T2D, fracture risk is increased with insulin use compared with metformin use, according to a study presented at the 2022 annual meeting of the Endocrine Society. Sung Hye Kong, MD, and colleagues examined the risks for major osteoporotic fracture (MOF) and hip fracture among 6,694 patients aged 50 and older with T2D who used the same antidiabetic medications during 1 year. The incidence rates of MOF and hip fracture were 8.36 and 1.53 per 1,000 person-years, respectively, during a median follow-up of 6.1 years. After multivariate adjustments, insulin users had an increased risk for MOF and hip fracture compared with metformin users (HRs [95% CIs], 1.96 [1.28- 3.02] and 3.06 [1.21-7.77], respectively). After covariate adjustments, the risks became insignificant for patients using a combination of insulin and metformin for MOF and hip fracture (HRs [95% CIs], 1.32 [0.77-2.27] and 2.68 [0.56-12.80], respectively). In a subgroup analysis, the risk for MOF was increased significantly for insulin versus metformin users only in those with A1C less than 7% or BMI less than 25 kg/m2