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Weight Loss Medications Decrease the Risk of Distal Radius Fractures in Obese Individuals
Daniel Yang, MD
1, Daniel Whitney, PhD
1, Alan H Daniels, MD
2, Jeffrey N Lawton, MD
3, T.K. Kevin Chan, MD
1; Miranda J. Rogers, MD, MS
1(1)University of Michigan, Ann Arbor, MI, (2)Brown University, Providence, RI, (3)Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
Introduction:Weight-loss medication has been associated with amelioration of obesity-related conditions and thus improvements in quality of life and longevity. However, weight loss-induced bone loss is a theoretical concern particularly in older adults as bone loss following weight loss can be associated with increased bone turnover and decreased bone mineral density (BMD). Nevertheless, glucagon-like peptide (GLP)-1 agonists have also been found to directly regulate bone turnover to increase BMD in obese women. The effect of weight loss medication on rates of fragility fracture itself, such as distal radius fracture (DRF) remains unstudied.
Materials and Methods:The PearlDiver Patient Records Database was queried from 2010-2023 to identify three groups of patients age >18: (1) on weight loss medication (2) had obesity eligible for weight loss medication (BMI>30 or BMI>27 with medical comorbidity) but was not on medication, and (3) non-obese controls. Weight loss medications were specifically the intragastrointestinal medication, orlistat; centrally-acting medications, phentermine, phentermine-topiramate, naltrexone-buproprion; and nutrient-stimulated hormone-based medications (GLP-1 agonists) liraglutide, semaglutide, and tirzepatide. Each cohort was matched by age, sex, and nine comorbidities that qualify a patient for weight-loss medication. Multivariable logistic regression controlling for Elixhauser comorbidity index was performed to compare odds ratios of DRF at 3 years after medication initiation.
Results: After matching, a total of 225,322 patients on weight loss medication, 225,322 patients with obesity eligible for weight loss medication but not on the medication, and 283,198 non-obese patients were included in the study. Those who were on weight loss medication had more than two-fold lower odds of DRF at 3 years compared to obese patients eligible for weight loss medication but were not on medication (0.30% vs. 0.77%, OR=0.38, 95%CI 0.35-0.42, p<0.001). This association was also observed in subgroup analysis of patients on intragastrointestinal medication (OR=0.35, 95%CI 0.14-0.83, p<0.001), centrally-acting medication (OR=0.41, 95%CI 0.36-0.45, p<0.001), and hormone-based medication GLP1 agonists (OR=0.33, 95%CI 0.29-0.37, p<0.001). Both obese individuals on weight loss medication (0.30% vs. 0.07%, OR=4.40, 95%CI 3.74-5.16, p<0.001) and obese individuals eligible for but not on weight loss medication (0.77% vs. 0.07%, OR=11.4, 95%CI 9.79-13.2, p<0.001) had higher odds of DRF at 3 years compared to non-obese patients.
Conclusions: Despite purported increased bone turnover associated with weight loss, weight-loss medications regardless of mechanism of action are associated with decreasing an obese patient's odds of DRF. Hand surgeons could counsel patients on these medications as strategy to reduce morbidity of obesity, including DRF risk.
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