Researchers have found in a new cohort study that semaglutide offers significant protection against osteoporosis and gout in individuals with obesity and type 2 diabetes, outperforming traditional glucose-lowering treatments and contributing to improved metabolic health. This study was published in Endocrine Abstracts by Jo-ching Chen and colleagues.Although increasingly popular for weight loss, the bone safety profile of semaglutide remained unclear particularly in individuals with different metabolic conditions. This five-year cohort study offers solid evidence that semaglutide can provide additional skeletal benefits, most notably in patients with both obesity and T2D.The two patient groups were followed over a five-year period.Overweight adults with T2D who receive either semaglutide or standard glucose-lowering therapy (sitagliptin, empagliflozin, glipizide)Overweight adults without T2D who receive either semaglutide or usual anti-obesity drugs (Contrave, phentermine, Qsymia)The objective was to evaluate the risk of skeletal outcomes such as osteoporosis, osteoarthritis (hip and knee), gout, and other bone density disorders. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards models. The results were adjusted for the potential confounders, and Bonferroni correction was performed to adjust for multiple comparisons among nine skeletal outcomes. E-values were employed to determine the likelihood of unmeasured confounding.Key FindingsIn obese patients with type 2 diabetes:Risk of osteoporosis was lowered by 39% with semaglutide compared to sitagliptin HR: 0.61; 95% CI: 0.38–0.97Risk of gout was lowered by 37% with semaglutide compared to sitagliptin HR: 0.63; 95% CI: 0.44–0.90E-value for gout: 2.51, suggesting strong and robust relationshipNo difference was found significantly in risk of knee osteoarthritis HR: 1.05; 95% CI: 0.84–1.30No difference was found significantly in risk of hip osteoarthritis HR: 0.88; 95% CI: 0.65–1.18Several sensitivity analyses were undertaken to confirm the accuracy of the findings, and results persisted, indicating the strength of the data.Semaglutide demonstrated unambiguous skeletal advantages for type 2 diabetics with obesity, with a 39% decrease in osteoporosis incidence and a 37% decrease in gout incidence relative to traditional glucose-lowering therapy. Hip or knee osteoarthritis showed no major differences. Such results suggest semaglutide therapeutic utility beyond weight and diabetes control to maintaining healthy bones. These advantages should be taken into account by clinicians when choosing anti-obesity treatments for patients with metabolic syndromes, particularly when skeletal status is a factor.Reference:Chen, J.-C., Huang, Y.-N., Tsou, M.-Y., Chen, S.-C., Yang, S.-F., Liu, Y.-L., & Su, P.-H. (2025). Comparative analysis of GLP-1 receptor agonists, traditional glucose-lowering medications and traditional anti-obesity medications on skeletal outcomes in obese individuals with and without type 2 diabetes: a five-year propensity-score matched cohort study. Endocrine Abstracts, 110. https://doi.org/10.1530/endoabs.110.p684