Glucagon-Like Peptide-1 Receptor Agonists and Fragility Fracture Risk in Type 2 Diabetes

What is the association of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) with fragility fracture risk in patients with type 2 diabetes? In this comparative effectiveness study using target trial emulation of 133 606 adults with type 2 diabetes mellitus, GLP-1 RA initiation was associated with a statistically significant 21% lower 3-year risk of fragility fracture compared with dipeptidyl peptidase-4 inhibitor initiation. These findings suggest that GLP-1 RAs may reduce fragility fracture risk through mechanisms independent of weight loss and glycemic control, highlighting the need for prospective studies to establish causality and define long-term skeletal effects.

Corresponding Author: Christopher D. Hamad, MD, Department of Orthopaedic Surgery, University of California, Los Angeles, 1225 15th St, Ste 3144B, Santa Monica, CA 90404 (chamad@mednet.ucla.edu).

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