Lower fall and femoral fracture risks with semaglutide and tirzepatide compared with DPP-4 inhibitors in older adults with type 2 diabetes
Authors' conclusion
In older adults with T2DM and overweight/obesity, semaglutide and tirzepatide were associated with significantly lower risks of femoral fracture and falls compared with DPP-4 inhibitors
Study context
- Population
- Adults aged ≥ 65 with T2DM and BMI ≥ 25 kg/m²27,896 semaglutide/DPP-4
- Exposure
- Semaglutide or tirzepatide vs DPP-4 inhibitors
- Outcome
- Femoral fracture
- Follow-up
- 1 year
Methodological details1:1 propensity score matching, TriNetX database (2018-2025)
- 1:1 propensity score matching
- TriNetX database (2018-2025)
Main finding
As reported in the abstract
Each group vs DPP-4 inhibitorsHazard ratio (95% CI)P value
Semaglutide0.3% vs. 0.5%
0.488(0.367–0.649)
P < 0.0001Tirzepatide0.2% vs. 0.4%
0.452(0.280–0.729)
P = 0.0008Observational data: associations, not effects.
Secondary outcomes
| Outcome | Semaglutide | Tirzepatide | DPP-4 inhibitors | HR (95% CI) | P value | |
|---|---|---|---|---|---|---|
| Falls · 1 yearSemaglutidevs DPP-4 inhibitors | 3.6% | — not stated in the abstract | 5.4% | 0.663 (0.612–0.718) | P < 0.0001 | |
| Falls · 1 yearTirzepatidevs DPP-4 inhibitors | — not stated in the abstract | 3.6% | 5.7% | 0.664 (0.591–0.747) | P < 0.0001 | |
| 0.512Hazard ratio (log scale) |
— not stated in the abstract
Subgroups
- Consistent fall reduction across categories; fracture reduction more pronounced with BMI ≥ 30 kg/m²
Original publication
Lower fall and femoral fracture risks with semaglutide and tirzepatide compared with DPP-4 inhibitors in older adults with type 2 diabetes. Osteoporos Int. Published 11 July 2026. doi:10.
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