Evidence mapPaperPMID 40342008Full record

ReviewEndocrine2025

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) for the treatment of type 2 diabetes mellitus: friends or foes to bone health? a narrative review of clinical studies.

Antonella Al Refaie, Leonardo Baldassini, Caterina Mondillo, Sara Gonnelli, Elena Ceccarelli, Roberto Tarquini, Stefano Gonnelli, Luigi Gennari, Carla Caffarelli

Abstract readReview
In one paragraph

Review in Endocrine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Observational
  2. Review
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Antonella Al RefaieSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Leonardo BaldassiniSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Caterina MondilloSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Sara GonnelliSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Elena CeccarelliSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Roberto TarquiniDivision of Internal Medicine I, San Giuseppe Hospital, Empoli, Italy.
Stefano GonnelliSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Luigi GennariSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
Carla CaffarelliSection of Internal Medicine, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy. carla.caffarelli@unisi.it.ORCID 0000-0003-4163-7289

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a relatively new class of drugs for treatment of Type 2 Diabetes mellitus (T2DM). They have proven to be excellent drugs not only for the results on glycemic control but also for weight loss, cardiovascular protection and several other potential metabolic effects. In contrast, the effects of GLP-1RAs drugs on bone metabolism and bone mineral density (BMD) remain less clearly defined. This narrative review aimed to explore the relationship between GLP-1RAs and bone in T2DM patients by reviewing clinical studies which assessed the effects of GLP-1RAs on BMD, markers of bone turnover and fragility fractures. In vitro and animal studies have demonstrated that GLP-1RAs treatment promotes bone formation and inhibits bone resorption. However, in humans, GLP-1RAs therapy has been shown to primarily stimulate bone resorption, as evidenced by a significant increase in type I collagen C-terminal cross-linked telopeptide levels, while promoting new bone formation to a lesser extent. Clinical studies indicate that GLP-1RAs therapy, in both diabetic and non-diabetic patients, results in a reduction in BMD, which is more pronounced at skeletal sites subjected to higher mechanical loading, such as the femur and tibia, and appears to correlate with the degree of weight loss. Furthermore, in the studies reviewed, parameters related to bone quality and strength, such as Trabecular bone score (TBS), microindentation, High-resolution peripheral Quantitative Computed Tomography (HR-pQCT), and Radiofrequency Echographic Multi Spectrometry (REMS) remain unaffected by GLP-1RAs. Additionally, the incidence of fragility fractures does not increase.

Indexed as

Bone and BonesBone DensityDiabetes Mellitus, Type 2Glucagon-Like Peptide-1 Receptor AgonistsHypoglycemic AgentsAnimalsBone RemodelingHumansGlucagon-Like Peptide-1 Receptor AgonistsHypoglycemic AgentsBone mineral density (BMD)Bone turnover markers (BTMs)Fragility fracturesGlucagon-like peptide-1 receptor agonists (GLP-1RAs)Trabecular bone score (TBS)Type 2 diabetes mellitus (T2DM)

Identifiers

PMID40342008
PMCPMC12227486

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.