Hormonal
Recent safety data from the SELECT trial indicates a higher incidence of hip and pelvic fractures in female patients and those aged 75+ taking semaglutide 2.4 mg weekly compared to placebo.
If you are over 75 or a postmenopausal woman taking semaglutide for heart health, be aware that your risk of hip or pelvic fractures may be slightly higher than if you were not taking the drug. This risk is likely linked to the weight and muscle loss. Ensure you are doing strength training, getting enough calcium/Vitamin D, and discussing bone density scans (DEXA) with your doctor.
Notably, the cardiovascular outcomes study conducted on adults (SELECT study) revealed a higher incidence of hip and pelvic fractures among female patients receiving semaglutide compared to those on placebo: 1.0% (24/2448) versus 0.2% (5/2424)... Similarly, in participants aged 75 years and above, the fracture rates were 2.4% (17/703) for semaglutide and 0.6% (4/663) for placebo.
Why this rating
Based on a large, randomized controlled trial (SELECT, n=17,604), though the fracture data was a secondary/safety finding.
Source
Effects of Glucagon-Like Peptide-1 receptor agonists on bone health in people living with obesity
Léa Karam et al. · Osteoporosis International · 2025
DOI 10.1007/s00198-025-07664-1
More from this paper
- GLP-1 receptor agonists (semaglutide 2.4 mg weekly, liraglutide 3.0 mg daily) cause modest bone mineral density (BMD) reduction and increase bone turnover markers (favoring resorption) in people living with obesity, mirroring the effects of calorie restriction.Moderate
- In specific preclinical models (OVX rats, T2D mice), high-dose GLP-1 agonists can improve bone mass and microarchitecture, but these effects require doses much higher than those approved for human obesity treatment.Limited
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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