Comparison of Fracture Risk Following Semaglutide Treatment vs Sleeve Gastrectomy

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.

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.

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).

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.