Diabetes Patients on Semaglutide Had Fewer Fractures, Study Finds

CHICAGO — The GLP-1 receptor agonist semaglutide (Ozempic, Wegovy) was associated with a 15% lower risk for fractures in adults with type 2 diabetes, a review of medical records found.

In a matched analysis involving more than 35,000 patients, fractures occurred in 4.54% of semaglutide users over roughly 3.5 years of follow-up compared with 5.97% of those taking other diabetes or obesity medications (HR 0.85, 95% CI 0.77-0.93, P<0.001), reported Sun Kim, MD, of Stanford University School of Medicine in California.

The findings are “reassuring,” Kim said at ENDO 2026, the annual meeting of the Endocrine Society, “but it would be exciting if these medications were truly bone protective.”

Semaglutide users in the study also had greater yearly reductions in body mass index (BMI) versus the control group (mean 1-year BMI difference -0.72, P<0.001), which included patients receiving the GLP-1 agonist dulaglutide (Trulicity) or the weight-loss medications phentermine-topiramate (Qsymia) or bupropion-naltrexone (Contrave).

Patients with type 2 diabetes carry an elevated risk for fracture despite having normal or even high bone mineral density, said Kim. Furthermore, while weight loss is a fundamental treatment goal for these patients, it traditionally leads to bone loss due to mechanical unloading.

Multiple factors may explain the fracture risk in this population, she said, including type 2 diabetes medications that can lead to hypoglycemia and an increased fall risk, hyperglycemia from the accumulation of advanced glycation end-products, or inflammation.

The findings suggest semaglutide might offer an unexpected, built-in benefit for bone health, said Kim, but more work needs to be done to understand if this is unique to semaglutide or includes other GLP-1 drugs such as the dual GLP-1/GIP receptor agonist tirzepatide (Mounjaro, Zepbound).

“There is interest in whether the GIP component can also have further bone-protective effects,” she said.

A handful of prior studies have hinted at a potential bone-protective effect with GLP-1 receptor agonists, including a recent observational study that looked at 10-year chances of vertebral fractures and another study of older women with diabetes.

Kim’s team also published a comparison last year that showed semaglutide users, with or without diabetes, had a 26% lower risk for fracture compared with sleeve gastrectomy patients over a 3-year span. However, because bariatric surgery patients lose significantly more weight, Kim noted that her group wondered if that disparity was a confounding factor, which ultimately led to the current study.

“This work is an important early step toward understanding the impact of semaglutide-induced weight loss on bone health in patients with type 2 diabetes,” co-author Jairo Noreña Velasquez, MD, of Stanford University Medical Center, said in a statement.

“Bone fractures are painful, expensive, and can seriously affect quality of life — especially as people get older,” he added. “We hope this study encourages monitoring of bone health in weight-loss programs.”

Their new analysis utilized the Atropos Health Eos electronic health record dataset with patients from U.S. community hospitals and academic medical centers from January 2016 to December 2023. Inclusion required a diagnosis of type 2 diabetes with no prior history of fracture or use of osteoporosis medications. Patients must have received one of the treatments of interest within 1 year of their diabetes diagnosis, followed by a second refill 9 to 15 months later.

Average patient age was 54 years, a majority were women (54-55%) and white (54%), with a mean BMI of 38. The average comorbidity score was 3, and roughly 15% of the cohort had diabetes with complications.

To confirm the findings and clarify the underlying cellular mechanisms, Kim suggested a randomized controlled trial should be the next step. Ideally, future research will utilize advanced imaging, like dual-energy x-ray absorptiometry or high-resolution peripheral quantitative CT, alongside bone turnover markers.

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