Comparison of Fracture Risk Following Semaglutide Treatment vs Sleeve Gastrectomy
Semaglutide is linked to a lower fracture risk than sleeve gastrectomy in people with obesity
JA Noreña, CW Pike, G Hui, Y Motlaghzadeh, DE Sellmeyer, JY Wu, SH Kim
AACE Endocrinology and Diabetes, 12(4): 308-313 (2025)
Plain-language summary
We compared the risk of bone fractures in people with obesity who lost weight using either semaglutide (a medication that mimics a natural hormone to reduce appetite) or sleeve gastrectomy (a surgical procedure that removes part of the stomach). After matching over 2,800 patients in each group and following them for about three years, we found that those taking semaglutide had a 26% lower chance of breaking a bone. This finding matters because intentional weight loss, while beneficial for overall health, can sometimes weaken bones, and our results suggest that semaglutide may help protect against this side effect better than surgery.
Abstract
BACKGROUND/OBJECTIVE: Weight loss in individuals with obesity offers metabolic benefits but may increase fracture risk, potentially influenced by the modality of weight loss. This study aimed to compare fracture risk in patients with obesity treated with semaglutide or sleeve gastrectomy (SG) using a large, real-world electronic health record dataset. METHODS: We conducted a retrospective cohort analysis from 2016 to 2023, using the Atropos Eos electronic health record dataset, representing over 161 million patients seen in community hospitals and large practices in the U.S. Fracture outcomes were compared between adults with obesity treated with semaglutide or SG, using high-dimensional propensity scoring to reduce confounding and enhance group comparability. RESULTS: We identified 92 405 individuals treated with semaglutide and 16 082 with SG. After high-dimensional propensity score matching, there were 2887 individuals in each group. The mean age was 45 years. Most participants were female (78.5% semaglutide, 77.7% SG) and White (50.3% vs 48.9%, respectively). The Charlson Comorbidity Index was 1.9 for both groups. Over a mean follow-up of 3 years, the semaglutide group experienced 86 fractures (2.98%) compared to 128 (4.43%) in the SG group (hazard ratio 0.74, 95% confidence interval: 0.56-0.98; E-value: 1.2). CONCLUSION: Our results indicate a 26% lower fracture risk for the semaglutide group vs SG, suggesting it may help offset the increased fracture risk typically associated with intentional weight loss. However, further research is needed.
Details
Formatted
JA Noreña, CW Pike, G Hui, Y Motlaghzadeh, DE Sellmeyer, JY Wu, SH Kim. Comparison of Fracture Risk Following Semaglutide Treatment vs Sleeve Gastrectomy. AACE Endocrinology and Diabetes. 2025;12(4):308-313. doi:10.1016/j.aed.2025.10.001BibTeX
@article{pike2025comparison,
title = {Comparison of Fracture Risk Following Semaglutide Treatment vs Sleeve Gastrectomy},
author = {Noreña, JA and Pike, CW and Hui, G and Motlaghzadeh, Y and Sellmeyer, DE and Wu, JY and Kim, SH},
journal = {AACE Endocrinology and Diabetes},
year = {2025},
volume = {12},
number = {4},
pages = {308-313},
doi = {10.1016/j.aed.2025.10.001},
}
RIS
TY - JOUR
AU - Noreña, JA
AU - Pike, CW
AU - Hui, G
AU - Motlaghzadeh, Y
AU - Sellmeyer, DE
AU - Wu, JY
AU - Kim, SH
TI - Comparison of Fracture Risk Following Semaglutide Treatment vs Sleeve Gastrectomy
JO - AACE Endocrinology and Diabetes
PY - 2025
VL - 12
IS - 4
SP - 308
EP - 313
DO - 10.1016/j.aed.2025.10.001
ER -
- Publication Type
- Case Reports
- Journal
- AACE Endocrinology and Diabetes
- Date Published
- October 20, 2025
- Volume
- 12
- Issue
- 4
- Pages
- 308-313
- Digital Object Identifier
- 10.1016/j.aed.2025.10.001
- PubMed Identifier
- 41467149
- PubMed Central Identifier
- PMC12744784