Chicago—In people with type 2 diabetes, semaglutide was associated with a 15% reduction in bone fractures and greater weight loss compared to other anti-obesity medications, according to a study being presented Sunday at ENDO 2026, the Endocrine Society's annual meeting in Chicago, Ill.
While these results highlight the potential bone-protective effects of semaglutide, the authors recommend that prospective studies be done to confirm the findings.
Semaglutide is part of a group of medicines known as glucagon-like peptide-1 receptor agonists (GLP-1s), which treat type 2 diabetes and obesity. Previous studies had shown that rapid weight loss using GLP-1s can lead to thinner bones and fractures, while more moderate and slower weight loss may preserve bone mass. Scientists at Stanford University knew semaglutide helped people lose more weight than previous generations of anti-obesity medications, but they lacked evidence that compared semaglutide's effect on bone health to other anti-obesity medications.
Jairo Noreña, M.D., former endocrinology fellow at Stanford University Medical Center in Palo Alto, California, and his colleagues evaluated changes in body mass index (BMI) and fracture incidence in people with type 2 diabetes taking semaglutide, dulaglutide or alternative oral weight-loss therapies phentermine/topiramate and bupropion/naltrexone.
"Bone fractures are painful, expensive and can seriously affect quality of life — especially as people get older," Noreña said. "We hope this study encourages monitoring of bone health in weight-loss programs."
The team conducted a retrospective cohort analysis using the Atropos Health Eos electronic health record dataset representing 161 million patients seen in U.S. community hospitals and academic medical centers from January 2016 to December 2023. Participants were adults aged 18 years and older who were diagnosed with type 2 diabetes, with no history of prior fractures or use of osteoporosis medications. The intervention group received semaglutide (n = 26,324), while the control group received dulaglutide, phentermine/topiramate, or bupropion/naltrexone, without prior history of semaglutide use (n = 33,555).
The data indicated semaglutide treatment was associated with greater reduction in BMI compared to the control group. The semaglutide group also had fewer fractures (794) compared to the control group (1045).
"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," Noreña said.
