Eligible participants were adults who had type 2 diabetes and no previous fractures. Participants were also not on medications to treat osteoporosis.

Researchers looked at body mass index (BMI) at baseline, after 1 year’s time, and how BMI changed in the interim.

Baseline characteristics like age and BMI were similar between the two groups after researchers conducted matching.

There were 17,506 participants in each group, and 4,191 pairs had available information on BMI.

The control group used three other medication options: phentermine and topiramate, bupropion and naltrexone, or dulaglutide. The intervention group received semaglutide. The semaglutide group had the best results.

Study author Sun H Kim, MD, MS, Associate Professor of Medicine in the Division of Endocrinology, Gerontology, and Metabolism at Stanford, summarized the findings to to Medical News Today, saying:

“We found that semaglutide compared to other weight loss medications, including another GLP-1 medication called dulaglutide, reduced risk of future fractures despite being associated with greater weight loss.”

Overall, semaglutide was linked to a bigger decrease in BMI. The semaglutide group also experienced fewer fractures than the control group. The average follow-up time looking at fractures was over 3 and a half years.

The group on semaglutide only experienced 794 fractures, while the control group experienced 1,045. Researchers concluded that “semaglutide was associated with a 15% reduction in fracture incidence.”

The full research has not been published yet, so the full limitations are not clear at this time. However, it is possible that researchers did not account for factors that played into the observed results.

Since researchers used electronic health record data, missed information is also a possibility. Furthermore, the data they had access to only included individuals seen at academic medical centers and community hospitals.

Additionally, researchers did not have data on BMI for many participants, which also limits the findings. And using BMI as a way to measure weight loss also comes with its own limitations.

This research specifically focused on people with type 2 diabetes, so more research is needed in other groups, and the results should not be generalized.

Burak Altintas, MD, an orthopedist with UTMB, who was not involved in this study, further highlighted the following limitations of the research:

“The limitations include retrospective design and likely residual confounding despite matching as fracture risk is influenced by many variables that are not reported […] Further, the comparison group is heterogeneous, combining another GLP-1 receptor agonist (dulaglutide) with two mechanistically different weight-loss medications. The relatively small BMI-analysis cohort (4,191 matched pairs) compared with the overall matched cohort raises concerns regarding missing data and potential selection bias. In addition, the fractures were analyzed as a composite outcome. Thus, it is unclear whether effects differed between hip, vertebral, wrist, or other fractures.”

Mir Ali, MD, a bariatric surgeon, bariatric medicine specialist and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, likewise not involved in this study, also noted that “this research shows a benefit of semaglutide over other diabetes treatment approaches.“

“However,“ Ali cautioned, “it is difficult to attribute the improvement solely to semaglutide based on this study alone. Additional research is necessary to examine fracture reduction independent of weight loss.”

This research may also mainly pave the way for more research, rather than giving definite answers. Altintas stressed that “The findings should be viewed as hypothesis-generating rather than practice-changing.“

“The study suggests that semaglutide does not appear to increase fracture risk and may potentially reduce it, but randomized prospective studies with bone mineral density, bone turnover markers, and fracture endpoints will be needed before concluding that semaglutide has true bone-protective properties,” he told us.

The results indicate that semaglutide might help protect bones. “Our study suggests that semaglutide may have bone protective effects despite its effect on weight loss,” explained Kim.

Altintas also noted that “if these findings are confirmed by prospective studies, several important clinical implications emerge.“

“First, clinicians may be less concerned that semaglutide-induced weight loss inherently increases fracture risk in patients with type 2 diabetes. Second, for diabetic patients at elevated fracture risk, semaglutide could become a preferred weight-loss agent compared with alternatives that may have less favorable skeletal effects. Third, as GLP-1 receptor agonists become increasingly utilized, understanding their effects on bone health becomes critical, particularly in older adults and postmenopausal women.”

– Burak Altintas, MD

Still, the results don’t mean that semaglutide is always the best option when it comes to weight loss. Ali also noted that, “if it can be demonstrated that semaglutide improves fracture risk independent of weight loss, it would provide another clear indication for its prescription.“

“However,“ he said, “I do not believe that conclusion can be made based on this specific study. While numerous studies have shown the benefits of semaglutide, we often see similar outcomes when patients achieve a healthy weight through other means, such as surgery.“

“Further research into semaglutide and other hormone agonist medications is needed to determine which effects are independent of weight loss,” advised Ali.

It is important for anyone interested in using semaglutide or other weight loss medications to talk with their doctors about options and form an appropriate weight loss plan.