---
title: "SGLT2 inhibitors and bone health in chronic kidney disease: systematic review findings"
id: "pubmed-42301927"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42301927"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42301927/"
doi: "10.1093/joneph/aajag035"
published_at: "2026-10-10T00:00:00.000Z"
evidence_level: "Systematic Review"
license: "CC-BY-NC-4.0 / Informational Use"
---
# SGLT2 inhibitors and bone health in chronic kidney disease: systematic review findings
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42301927
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42301927/)
- **DOI:** [10.1093/joneph/aajag035](https://doi.org/10.1093%2Fjoneph%2Faajag035)
- **Published At:** 2026-10-10T00:00:00.000Z
- **Evidence Rating:** Systematic Review
## Executive GIST (TL;DR)
- Sodium-glucose co-transporter-2 inhibitors (**SGLT2i**) are widely used in chronic kidney disease (**CKD**) but concerns exist about effects on **bone health**, including fractures and amputations. - This article is a systematic review of randomized controlled trials (RCTs) and observational cohort studies examining skeletal safety and bone metabolism outcomes in patients with CKD. - The review summarized study design, population characteristics, baseline kidney function, bone-related comorbidities, and outcomes such as osteoporosis, **fractures**, falls, amputations, and bone mineral markers. - One RCT and one cohort study reported a statistically significant increase in fracture and amputation risk; however, most other RCTs and cohort studies showed no significant differences in these outcomes. - Reporting of bone-related outcomes across studies was inconsistent, limiting comparability and interpretation of skeletal risk. - Much of the available evidence comes from trials conducted in patients with type 2 diabetes, often including participants with early-stage CKD rather than moderate-to-advanced CKD. - One included study suggested potential beneficial modulation of markers of CKD–mineral and bone disorder (CKD–MBD), reporting lower risks of hyperphosphatemia, hypocalcemia, elevated parathyroid hormone, and low vitamin D with SGLT2i. - The review primarily evaluated data for empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin. - Overall, the review concludes that SGLT2i generally demonstrate a possibly reassuring skeletal safety profile in CKD, but evidence is limited for moderate-to-advanced CKD and long-term, prospectively collected bone outcomes are needed to confirm safety and clarify class effects. - The authors declared no conflicts of interest related to the work.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42301927/#linkout) Title & authors Abstract Conflict of interest statement Publication types MeSH terms Substances Grants and funding LinkOut - more resources J Nephrol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Nephrol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Nephrol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) . 2026 Oct 10;39(6):1116-1128. doi: 10.1093/joneph/aajag035. # Effects of gliflozins on bone health of patients with chronic kidney disease: a systematic review [Mariana Cassani de Oliveira](https://pubmed.ncbi.nlm.nih.gov/?term=Cassani+de+Oliveira+M&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Lorena Rufino](https://pubmed.ncbi.nlm.nih.gov/?term=Rufino+L&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Ana Laura Mendes Lourenço](https://pubmed.ncbi.nlm.nih.gov/?term=Mendes+Louren%C3%A7o+AL&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Eric Aragão Corrêa](https://pubmed.ncbi.nlm.nih.gov/?term=Corr%C3%AAa+EA&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Fabrice Mac-Way](https://pubmed.ncbi.nlm.nih.gov/?term=Mac-Way+F&cauthor_id=42301927)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-2 "CHU de Québec Research Center, L'Hôtel-Dieu-de-Québec Hospital, Endocrinology and Nephrology Axis, Quebec City, Quebec, Canada."), [Lauter Eston Pelepenko](https://pubmed.ncbi.nlm.nih.gov/?term=Pelepenko+LE&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Niels Olsen Saraiva Câmara](https://pubmed.ncbi.nlm.nih.gov/?term=C%C3%A2mara+NOS&cauthor_id=42301927)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-3 "Department of Immunology, Institute of Biomedical Science - ICB of the University of São Paulo-USP, São Paulo, Brazil."), [Rodrigo Bueno de Oliveira](https://pubmed.ncbi.nlm.nih.gov/?term=de+Oliveira+RB&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#full-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil.") Affiliations Expand ### Affiliations * 1 Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology (LEMON), School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil. * 2 CHU de Québec Research Center, L'Hôtel-Dieu-de-Québec Hospital, Endocrinology and Nephrology Axis, Quebec City, Quebec, Canada. * 3 Department of Immunology, Institute of Biomedical Science - ICB of the University of São Paulo-USP, São Paulo, Brazil. * PMID: **42301927** * DOI: [ 10.1093/joneph/aajag035 ](https://doi.org/10.1093/joneph/aajag035) Item in Clipboard # Effects of gliflozins on bone health of patients with chronic kidney disease: a systematic review Mariana Cassani de Oliveira et al. J Nephrol. 2026. Show details Display options Display options Format Abstract PubMed PMID J Nephrol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Nephrol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Nephrol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) . 2026 Oct 10;39(6):1116-1128. doi: 10.1093/joneph/aajag035. ### Authors [Mariana Cassani de Oliveira](https://pubmed.ncbi.nlm.nih.gov/?term=Cassani+de+Oliveira+M&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Lorena Rufino](https://pubmed.ncbi.nlm.nih.gov/?term=Rufino+L&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Ana Laura Mendes Lourenço](https://pubmed.ncbi.nlm.nih.gov/?term=Mendes+Louren%C3%A7o+AL&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Eric Aragão Corrêa](https://pubmed.ncbi.nlm.nih.gov/?term=Corr%C3%AAa+EA&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Fabrice Mac-Way](https://pubmed.ncbi.nlm.nih.gov/?term=Mac-Way+F&cauthor_id=42301927)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-2 "CHU de Québec Research Center, L'Hôtel-Dieu-de-Québec Hospital, Endocrinology and Nephrology Axis, Quebec City, Quebec, Canada."), [Lauter Eston Pelepenko](https://pubmed.ncbi.nlm.nih.gov/?term=Pelepenko+LE&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil."), [Niels Olsen Saraiva Câmara](https://pubmed.ncbi.nlm.nih.gov/?term=C%C3%A2mara+NOS&cauthor_id=42301927)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-3 "Department of Immunology, Institute of Biomedical Science - ICB of the University of São Paulo-USP, São Paulo, Brazil."), [Rodrigo Bueno de Oliveira](https://pubmed.ncbi.nlm.nih.gov/?term=de+Oliveira+RB&cauthor_id=42301927)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42301927/#short-view-affiliation-1 "Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology \(LEMON\), School of Medical Sciences, State University of Campinas \(Unicamp\), Campinas, São Paulo, Brazil.") ### Affiliations * 1 Laboratory for Evaluation of Mineral and Bone Disorder in Nephrology (LEMON), School of Medical Sciences, State University of Campinas (Unicamp), Campinas, São Paulo, Brazil. * 2 CHU de Québec Research Center, L'Hôtel-Dieu-de-Québec Hospital, Endocrinology and Nephrology Axis, Quebec City, Quebec, Canada. * 3 Department of Immunology, Institute of Biomedical Science - ICB of the University of São Paulo-USP, São Paulo, Brazil. * PMID: **42301927** * DOI: [ 10.1093/joneph/aajag035 ](https://doi.org/10.1093/joneph/aajag035) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are a crucial therapy for chronic kidney disease (CKD), yet concerns persist regarding their impact on bone metabolism. This systematic review evaluates the skeletal safety and metabolic effects of SGLT2i in patients with CKD. **Methods:** A systematic review of randomized controlled trials (RCTs) and observational cohort studies was conducted. Data on study design, population characteristics, baseline kidney function, bone-related comorbidities, and outcomes (osteoporosis, fractures, falls, amputations, and bone mineral markers) were summarized. Risk of bias was evaluated according to the included category. **Results:** The analysis revealed that while one RCT and a cohort study reported a significantly increased risk of bone fracture and amputation, this finding was not replicated in other subsequent cohort studies and other RCTs, which generally showed non-significant differences. Of note, the reporting of bone-related outcomes was inconsistent throughout the literature, and a substantial proportion of the evidence derives from studies primarily designed for patients with type 2 diabetes, largely involving early-stage CKD subgroups. One study suggests that SGLT2i may favorably modulate markers of CKD-mineral bone disease (MBD), reporting reduced risk of hyperphosphatemia, hypocalcemia, high parathyroid hormone, and low vitamin D levels. The reviewed literature primarily included data on empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin. **Conclusions:** Mostly, SGLT2i demonstrated a possible reassuring skeletal safety profile in CKD. Initial safety concerns regarding fractures have not been consistently supported, although evidence in moderate-to-advanced CKD remains limited. Long-term, prospectively defined skeletal outcomes are needed to confirm these findings and clarify class effects. **Keywords:** SGLT2 inhibitors; bone fracture; chronic kidney disease; safety. © The Author(s) 2026. Published by Oxford University Press on behalf of Societa Italiana Nefrologia/Italian Society of Nephrology; Society ownership. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflicts of interest: The authors declare no conflict of interest related to this work. ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) ## MeSH terms * Bone Density / drug effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Bone+Density%2Fdrug+effects%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Bone+Density) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Bone and Bones* / drug effects Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Bone+and+Bones%2Fdrug+effects%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Bone+and+Bones) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Bone and Bones* / metabolism Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Bone+and+Bones%2Fmetabolism%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Bone+and+Bones) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Chronic Kidney Disease-Mineral and Bone Disorder* / prevention & control Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Chronic+Kidney+Disease-Mineral+and+Bone+Disorder%2Fprevention+and+control%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Chronic+Kidney+Disease-Mineral+and+Bone+Disorder) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Diabetes Mellitus, Type 2* / diagnosis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Diabetes+Mellitus%2C+Type+2%2Fdiagnosis%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Diabetes+Mellitus%2C+Type+2) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Diabetes Mellitus, Type 2* / drug therapy Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Diabetes+Mellitus%2C+Type+2%2Fdrug+therapy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Diabetes+Mellitus%2C+Type+2) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Fractures, Bone / chemically induced Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Fractures%2C+Bone%2Fchemically+induced%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Fractures%2C+Bone) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Fractures, Bone / epidemiology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Fractures%2C+Bone%2Fepidemiology%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Fractures%2C+Bone) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42301927/) * Humans Actions * [ Search in PubMed
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