Association of tirzepatide use with risk of osteoporosis compared with other GLP-1 receptor agonists: A retrospective cohort study using the TriNetX database
Main finding · New-onset osteoporosis or fragility fractureResult — go to the resultHazard ratio 1.44 95 % CI 1.22–1.69Authors' conclusion
In this large real-world cohort study, initiation of tirzepatide was associated with a significantly higher risk of osteoporosis or fragility fractures compared to other GLP-1 RAs.
Study context
- Population
- Patients with T2D or obesity who initiated tirzepatide or other GLP-1 RAs between June 2022 and May 2024, TriNetX networkeligible before matching
- Participants
- 459,886 patients
- Exposure
- Tirzepatide vs other GLP-1 RAs
- Tirzepatiden = 66,329
- Other GLP-1 RAsn = 66,329reference
- Outcome
- Composite of:
- New-onset osteoporosis
- Fragility fracture
- Follow-up
- 14-month follow-up
Methodological details1:1 propensity score matched, TriNetX network
- 1:1 propensity score matched
- TriNetX network
Main finding
New-onset osteoporosis or fragility fracture · 14 months
Hazard ratio
1.44
95 % CI 1.22–1.69
Tirzepatidevs Other GLP-1 RAs
HR 1.44 (95 % CI 1.22–1.69)
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | HR (95 % CI) | |
|---|---|---|
| Initiating osteoporosis therapy | 1.61 (1.22–2.12) | |
| Osteoporosis or fragility fracture vs nonusersTirzepatidevs Nonusers | 1.48 (1.26–1.75) | |
| Osteoporosis or fragility fracture vs nonusersOther GLP-1 RAsvs Nonusers | 1.07 (1.00–1.15) | |
| 0.512Hazard ratio (log scale) |
Original publication
Association of tirzepatide use with risk of osteoporosis compared with other GLP-1 receptor agonists: A retrospective cohort study using the TriNetX database. Diabetes Res Clin Pract. Published 9 November 2025. doi:10.
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