A retrospective study of nearly 1.6 million patients with type 2 diabetes (T2D) suggests that use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may be associated with a reduced risk of vertebral fractures, according to research published in JAMA Surgery.
Researchers from National Cheng Kung University in Taiwan and the Albert Einstein College of Medicine in Fresh York analyzed data from the TriNetX global database, which contains de-identified electronic health records from 151 healthcare organizations worldwide. The study, conducted between January 1, 2015, and January 1, 2022, compared 259,162 patients with T2D who used GLP-1 RAs – specifically semaglutide, liraglutide, or dulaglutide – with nearly 1.3 million who did not.
The analysis excluded patients with potential socioeconomic or psychosocial hazards, those with prior vertebral fractures, inflammatory spondylopathies, malignant neoplasm of the vertebral column, or prior vertebroplasty or kyphoplasty. The index date was defined as the first GLP-1 RA prescription date for users and matched T2D diagnosis date for nonusers. The mean age of participants was 58, and 47.3% were female before propensity score matching.
The study found that GLP-1 RA use was associated with significantly lower risks of vertebral compression fractures and related surgical interventions compared with nonuse, suggesting potential bone-protective benefits. The researchers noted that T2D is a well-established risk factor for vertebral fractures, which can lead to long-term disability and increased mortality.
While GLP-1 RAs have demonstrated therapeutic benefits beyond glycemic control, their role in bone health has remained uncertain, and previous evidence regarding their association with vertebral fracture risk has been inconsistent. The mechanisms underlying the observed association are likely multifactorial, according to the study authors.
A separate systematic review published in Medicina in 2022 examined the impact of GLP1 agonists on bone metabolism, noting the established link between diabetes mellitus and increased risk of bone fractures and the subsequent investigation of antidiabetic drugs’ effects on bone health.
Recent analysis presented at a medical conference in Seattle also indicated a reduction in fragility fractures among older women with type 2 diabetes using GLP-1s, according to reporting from Medscape.
