1710-P: Fragility Fracture Risk among Patients with Type 2 Diabetes Initiating Treatment with GLP-1 Receptor Agonists vs. Sulfonylureas

Introduction and Objective: Patients with type 2 diabetes (T2D) have an increased risk of bone fractures. Real-world evidence on the effects of GLP-1RAs on fragility fractures remains limited Methods: We conducted a new-user, active-comparator cohort study emulating an intention-to-treat target trial using COSMOS electronic health record (EHR) data. We included adults with T2D who newly initiated a GLP-1RA or a sulfonylurea from 01/01/2018 to 12/01/2025. Patients were matched 1:1 using propensity score matching. Fragility fractures were identified using diagnosis codes. Cox proportional hazards models with inverse probability of treatment weighting were applied to the matched cohort. Subgroup analyses were conducted among patients aged ≥65 years and those with treatment duration exceeding one year Results: The weighted study cohort included 387,102 patients initiating GLP-1 RAs (N=193,551) or sulfonylureas (N=193,551). The median follow-up was 2.75 years. GLP-1 RAs were associated with a significantly lower risk of fragility fracture than SUs (HR 0.86; 95% CI, 0.83-0.89). This association was similar among patients with at least one year of treatment (HR 0.88; 95% CI, 0.85-0.92) and aged ≥65 years (HR 0.90; 95% CI, 0.86-0.94) Conclusion: In this large real-world study, GLP-RAs were associated with a lower risk of fragility fractures than sulfonylureas among patients with T2D Disclosure T. Idrees: Research Support; Current; AbbVie Inc. Y. Shao: None. J. Lee: None. J. Zaino: None. K. Petty: None. G. Umpierrez: Research Support; Current; Abbott, Dexcom, Inc., Bayer AG. Advisory Panel; Ended; Sanofi-Aventis U.S., Dexcom, Inc. Other - Education grant; Current; Lilly Diabetes, Abbott Diabetes. Advisory Panel; Current; Glycare, Glucotrack. Research Support; Current; Corcept Therapeutics. H. Shao: None. Funding Supported by the Building Interdisciplinary Research Careers in Women’s Health of the National Institutes of Health under Award Number: K12AR084234. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.