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TOPLINE:

In adults with obesity and without diabetes, using GLP-1s vs other antiobesity medications was significantly associated with a decreased risk for osteoporosis, major osteoporotic fractures, degenerative disk disorders, and osteoarthritis.

METHODOLOGY:

• GLP-1s are widely used in managing obesity; however, their long-term effects on the risks for osteoporosis, fractures, and degenerative musculoskeletal diseases remain unclear.
• Researchers conducted a retrospective cohort study using real-world data from the global TriNetX Research Network to compare the musculoskeletal benefits of GLP-1s vs other antiobesity medications among adults with obesity and without diabetes.
• They included 18,062 patients (mean age, 57.6 years; 72.76% women; mean BMI, 37.99) who received GLP-1s (liraglutide, semaglutide, or tirzepatide) and 18,062 matched patients who received other non-GLP-1 antiobesity medications (orlistat, phentermine, naltrexone-bupropion, topiramate, or setmelanotide); individuals were required to have two or more prescriptions for the respective medication class.
• The primary outcome was new-onset osteoporosis after the index date (defined as the date of the first qualifying prescription). Secondary outcomes were major osteoporotic fractures (hip or vertebrae), cervical and thoracolumbar disk disorders, and osteoarthritis at any site.
• The maximum follow-up duration of this study was 10 years, and a 3-month lag window was applied to include only incident events occurring ≥ 3 months after treatment initiation.

TAKEAWAY:

• The use of GLP-1s was associated with a 52% lower risk for new-onset osteoporosis than using non-GLP-1 antiobesity medications (relative risk [RR], 0.48; 95% CI, 0.43-0.52).
• The risk for major osteoporotic fractures was also significantly lower in the GLP-1 vs non-GLP-1 group (RR, 0.15; 95% CI, 0.11-0.22).
• The GLP-1 group also had reduced risks for cervical disk degeneration (RR, 0.34; 95% CI, 0.28-0.41), thoracolumbar disk disorders (RR, 0.36; 95% CI, 0.33-0.40), and osteoarthritis (RR, 0.45; 95% CI, 0.43-0.48).
• Subgroup analysis found that protective associations remained consistent across age groups (50-64, 65-74, and ≥ 75 years), sex, BMI categories, and GLP-1 subtypes, with the greatest risk reduction observed with tirzepatide.

IN PRACTICE:

“GLP-1s are uniquely positioned to achieve sustained weight loss without compromising — and possibly enhancing — bone integrity. They may be particularly suitable for individuals with preexisting risk factors for osteoporosis or degenerative joint disease, in whom other obesity agents may exacerbate skeletal fragility. Incorporating bone health assessment into obesity management may aid in optimizing therapeutic selection and improving comprehensive patient care,” the authors wrote.

SOURCE:

This study was led by Jie-Syuan Wu, College of Medicine, Taipei Medical University, Taipei, Taiwan. It was published online in Obesity.

LIMITATIONS:

The observational study design prevented causal inference. Outcomes were identified using diagnosis codes, which may have resulted in misclassification or underestimation of subclinical disease. Additionally, data on bone mineral density, vitamin D and calcium intake, physical activity, and medication adherence were not available.

DISCLOSURES:

This study did not report any source of funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.