A large observational study suggests that people with type 2 diabetes who take GLP-1 receptor agonists — drugs such as Ozempic and Mounjaro — have a lower risk of fragility fractures than those taking DPP-4 inhibitors. Fragility fractures are breaks that occur from low-energy events, like a simple fall, because bone strength is compromised.
Researchers analyzed health records for roughly 134,000 U.S. adults ages 50 to 90 over a three-year period. After accounting for measured differences between groups, use of a GLP-1 medication was associated with a 21% lower risk of having a fragility fracture compared with taking DPP-4 inhibitors. The biggest relative risk reductions were seen for hip, femur and spine fractures — injuries that frequently require surgery and can cause lasting loss of mobility and independence. Following a hip fracture, as many as one-third of patients may die within the next year.
Because the study is observational, it cannot prove that GLP-1 drugs directly prevent fractures. Lead author Christopher D. Hamad, MD, emphasized that the findings are an important signal but not definitive proof. He and other investigators say prospective trials and further research are needed to determine whether GLP-1s have a causal bone-protective effect.
Possible explanations for the association
Investigators and external experts offer several possible explanations for the observed link. Laboratory research suggests GLP-1 treatments can influence inflammation and the balance between bone-forming and bone-resorbing cells, which could plausibly improve bone strength. The study itself did not test mechanisms, and researchers are undertaking translational studies to explore these biological effects.
Other factors could also explain the association. Some clinicians note that people on GLP-1s may have better diabetes control, lose weight, or change activity patterns — all of which could affect fracture risk. Diabetic complications such as neuropathy and vision problems can increase fall risk, so improvements in overall health might reduce fractures indirectly rather than through a direct action on bone.
Why fracture risk is higher in type 2 diabetes
Experts point out that people with type 2 diabetes face elevated fracture risk for reasons beyond bone density readings. Diabetes can alter bone quality and turnover, so bone may appear dense on imaging yet be less strong or flexible. Standard tools like DEXA scans can miss these quality changes. In addition, diabetes-related neuropathy and visual impairment increase fall risk, compounding fracture danger.
Clinical context and next steps
GLP-1 receptor agonists are increasingly used for indications beyond glucose control — including weight management, cardiovascular risk reduction, kidney protection and some metabolic liver conditions. As their use expands, clinicians want to understand both benefits and potential effects on other systems such as the skeleton.
To move beyond association, experts recommend larger, longer prospective studies that predefine patient groups and control for confounding factors. Translational and clinical trials could clarify whether GLP-1s have a direct protective effect on bone, or whether the lower fracture rates reflect improved overall health among people taking these drugs.
Bottom line
This large observational study found a 21% lower risk of fragility fractures among older adults with type 2 diabetes who used GLP-1 medications compared with DPP-4 inhibitors, with the largest reductions for hip, femur and spine fractures. The results are encouraging but not conclusive; they point to a potential benefit that merits more rigorous investigation to determine cause, mechanism and clinical implications.
