The findings were presented Sunday at ENDO 2026, the Endocrine Society's annual meeting in Chicago, Illinois.

According to the study, semaglutide use was linked to a 15% lower risk of bone fractures compared with alternative weight-loss medications. Although the results point to a possible protective effect on bone health, researchers say additional prospective studies are needed to confirm the association.

Semaglutide, Weight Loss, and Bone Health

Semaglutide belongs to a class of medications called glucagon-like peptide-1 receptor agonists (GLP-1s), which are commonly prescribed to treat obesity and type 2 diabetes.

Earlier research has raised concerns that rapid weight loss associated with GLP-1 medications may contribute to bone thinning and increase fracture risk. In contrast, slower and more gradual weight loss may help preserve bone density. While semaglutide is known to produce greater weight loss than many older anti-obesity medications, its effects on bone health compared with other weight-loss drugs had not been well studied.

To explore that question, researchers led by Jairo Noreña, M.D., a former endocrinology fellow at Stanford University Medical Center in Palo Alto, California, examined changes in body mass index (BMI) and fracture rates among people with type 2 diabetes. Participants were treated with semaglutide, dulaglutide, or the 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."

Analysis of More Than 59,000 Patients

The researchers conducted a retrospective cohort study using the Atropos Health Eos electronic health record database, which includes data from 161 million patients treated at U.S. community hospitals and academic medical centers between January 2016 and December 2023.

The analysis included adults age 18 and older with type 2 diabetes who had no previous fractures and had not taken osteoporosis medications. The semaglutide group included 26,324 patients (n = 26,324). The comparison group included 33,555 patients (n = 33,555) who received dulaglutide, phentermine/topiramate, or bupropion/naltrexone and had no prior history of semaglutide use.

Fewer Fractures and Greater BMI Reduction

Patients treated with semaglutide experienced a larger reduction in BMI than those in the comparison group. They also experienced fewer fractures overall.

Among semaglutide users, researchers recorded 794 fractures, compared with 1,045 fractures in the control group.

"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.