Background: End-stage renal disease (ESRD) patients undergoing dialysis are susceptible to declined bone mineral density leading to osteoporosis or fractures. The association between dialysis modality and posttransplant osteoporotic fractures wasn’t addressed. OBJECTIVES: To compare post-TX osteoporotic fractures between pretransplant HD and PD for adults with ESRD in the US. METHODS: A propensity-matched retrospective study of renal recipients between January 2007 and December 2011, following ≥60 days of maintenance dialysis. All the data were obtained from the USRDS for the period 2006 to 2012. Adults who received either kidney or kidney/pancreas, with ≥6 months of pre-TX history were included. Patients with fracture diagnosis that occurred the same date or after osteoporosis diagnosis were classified as osteoporotic. Incidence density rates (IDR) and rate differences (R-Diff.) along with Cox proportional hazard analysis were used. Our p-value was adjusted using Bonferroni correction for multiple comparisons. RESULTS: out of 19,612 renal recipients (9,806 pairs) a total of 5313 patients diagnosed with post-TX osteoporosis. In the 6-year period, 296 (11%) of HD and 320 (12%) of PD patients developed an osteoporotic fracture. Lower-limbs accounted for 69% of fractures among HD and 85% of PD patients. Vertebrate and hip fractures accounted for 15% of total osteoporotic fractures for each dialysis group. PD recipients showed significantly higher IDR of osteoporotic fractures (R-Diff. =2.60/1000 person-year) compared to HD. Cox proportional analysis indicated a higher but nonsignificant hazard of osteoporotic fractures among PD (HR=1.12, p-value 0.1233). Renal recipients who were female, White, publicly insured, and diabetic had significant hazards of osteoporotic fractures in our sample. CONCLUSIONS: PD patients were vulnerable to higher incidence rates of posttransplant osteoporotic fractures than HD patients. The type of pretransplant dialysis was not a significant predictor for the time to osteoporotic fracture onset. Periodic testing and effective management of osteopetrosis among renal recipients is recommended.