Associations of Semaglutide With Skeletal Outcomes in People With Obesity, With and Without Type 2 Diabetes: A Target Trial Emulation
Authors' conclusion
Among people with obesity and T2D, semaglutide initiation was associated with a lower risk of MOF over 3 years compared with other glucose-lowering agents and usual care. This association was not observed in people with obesity without T2D.
Study context
- Population
- People with obesity, stratified by T2D status; with-T2D cohort (n = 19,824–93,519 matched pairs per comparison) followed 3 years, without-T2D cohort (n = 10,323–56,225 pairs) followed 2 years1:1 matched pairs
- Exposure
- Semaglutide initiation vs active comparators or usual care
- Outcome
- Major osteoporotic fracture (MOF)
- Follow-up
- 3 years (with T2D); 2 years (without T2D)
Methodological detailstarget trial emulation, propensity-score matched 1:1 (215 covariates), TriNetX federated electronic health record network
- Target trial emulation
- Propensity-score matched 1:1 (215 covariates)
- TriNetX federated electronic health record network
Main finding
As reported in the abstract
MOF, with-T2D cohort · 3 years
Hazard ratio (95% CI)
Semaglutidevs Empagliflozin
0.69(0.61–0.77)
Semaglutidevs Glipizide
0.72(0.63–0.83)
Semaglutidevs Usual care
0.84(0.76–0.93)
Observational data: associations, not effects.
Secondary outcomes
Major osteoporotic fracture (MOF), without-T2D cohort · 2 years
- No significant associations with MOF across any comparison
- all p > 0.05
Osteoporosis
- Osteoporosis risk did not differ significantly in most comparisons in either cohort
Osteoarthritis and gout (exploratory)
- Inconsistent patterns across comparators
Original publication
Associations of Semaglutide With Skeletal Outcomes in People With Obesity, With and Without Type 2 Diabetes: A Target Trial Emulation. Diabetes Obes Metab. Published 20 April 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →