Investigators presented an analysis at ENDO 2026 examining the association between semaglutide use and bone fracture incidence among people with type 2 diabetes. Semaglutide belongs to the class of glucagon-like peptide-1 receptor agonists (GLP-1s) used to treat type 2 diabetes and obesity. Prior studies have given mixed signals: rapid weight loss on GLP-1s has been linked to thinner bone and increased fractures, while more moderate or slower weight loss may help preserve bone mass. The authors set out to compare semaglutide’s real-world bone outcomes with those of other anti-obesity therapies.
The team performed a retrospective cohort analysis using the Atropos Health Eos electronic health record dataset. The dataset represents approximately 161 million patients seen in U.S. community hospitals and academic medical centers between January 2016 and December 2023. Study inclusion criteria were adults aged 18 years and older with a diagnosis of type 2 diabetes, no history of prior fractures, and no prior use of osteoporosis medications. The analysis focused on real-world prescribing and outcomes captured in the EHR dataset.
Participants were grouped by the anti-obesity or GLP-1 therapy they received. The intervention group comprised patients who received semaglutide (n = 26,324). The control group included patients who received dulaglutide or alternative oral weight-loss therapies—specifically phentermine/topiramate and bupropion/naltrexone—but who had no prior semaglutide use (n = 33,555). The investigators compared changes in body mass index (BMI) and incidence of bone fractures across these treatment groups.
The analysis found that semaglutide treatment was associated with a greater reduction in BMI compared with the control therapies. In addition, the semaglutide group had fewer documented fractures: 794 fractures in the semaglutide cohort versus 1,045 fractures in the control cohort. These numeric differences were highlighted by the study team as evidence that semaglutide use correlated with a lower observed rate of bone fractures in this retrospective sample of people with type 2 diabetes.
Investigators framed their results as an initial step toward understanding how semaglutide-induced weight loss affects bone health in patients with type 2 diabetes. Jairo Noreña, MD, and colleagues noted clinicians should be mindful of the potential effects of weight-loss therapies on bone. The authors emphasized that bone fractures are important clinical events: they are painful, costly to treat, and can substantially reduce quality of life, particularly in older adults. These considerations suggest monitoring bone health in patients undergoing weight-loss programs, especially those using pharmacologic therapies for obesity or diabetes.
The report is based on a retrospective cohort analysis of electronic health record data. As the authors state, these findings are an early step and do not establish causality. The article notes that prior literature shows differing effects of GLP-1–related weight loss on bone depending on the rate and magnitude of weight loss, and that semaglutide produces larger weight loss than earlier anti-obesity medications. The study team recommends prospective studies be conducted to confirm whether semaglutide has a bone-protective effect relative to other therapies.
In this retrospective EHR analysis of adults with type 2 diabetes, patients treated with semaglutide experienced greater BMI reduction and had fewer recorded fractures than those treated with dulaglutide or the oral weight-loss agents phentermine/topiramate and bupropion/naltrexone.
The total cohort sizes reported were semaglutide n = 26,324 and control n = 33,555, with 794 fractures in the semaglutide group and 1,045 fractures in the control group.
Study authors, including those interviewed in a video summary at ENDO 2026, advise that these retrospective observations should be followed by prospective research to confirm any bone-protective effect.
Given the clinical burden of fractures, the investigators suggest monitoring bone health in patients enrolled in weight-loss programs and in those receiving GLP-1 therapies.
This article summarized an abstract presented at ENDO 2026 and a related video interview with Sun Kim, MD, MS. The authors urge further prospective study to validate these retrospective findings.