The Interplay of GLP-1 Receptor Agonist Use, Chronic Kidney Disease, and Fracture Risk in Obese Patients: A Retrospective Cohort Study

The Interplay of GLP-1 Receptor Agonist Use, Chronic Kidney Disease, and Fracture Risk in Obese Patients: A Retrospective Cohort Study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL British Journal of Clinical Pharmacology This is a preprint and has not been peer reviewed. Data may be preliminary. 30 December 2025 V1 Latest version Share on The Interplay of GLP-1 Receptor Agonist Use, Chronic Kidney Disease, and Fracture Risk in Obese Patients: A Retrospective Cohort Study Authors : Amari Eubanks 0009-0007-0797-4931 [email protected] , Kiana C. Allen 0009-0009-1182-5749 , Dy’Quan Kearney , Brieanna Bell , Anthony Albornoz , Rawan Elkomi 0000-0002-3707-544X , Damon Ross Jr. 0009-0004-1337-9168 , Elizabeth Beyene , Mekdem Bisrat , Syed Fahad Gillani , and Miriam Michael 0000-0002-2478-4650 Authors Info & Affiliations https://doi.org/10.22541/au.176706936.68195055/v1 Published British Journal of Clinical Pharmacology Version of record Peer review timeline 183 views 107 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used to treat type 2 diabetes and slow chronic kidney disease (CKD) progression. Both diabetes and CKD impair bone health, increasing fracture risk. GLP-1RAs may enhance osteoblast activity and renal calcium excretion. This study evaluates the association between GLP-1RA use and fracture risk in patients with CKD. Methods: A retrospective cohort study was conducted using TriNetX, including patients aged 18–50. Two primary cohorts were defined: obese patients with CKD on GLP-1RAs ≥1 year (CKD+/GLP-1RA+) and obese patients with CKD not on GLP-1RAs (CKD+/GLP-1RA-). A prespecified subgroup analysis compared CKD+/GLP-1RA+ patients to obese patients without CKD on GLP-1RAs (CKD-/GLP-1RA+). Primary outcomes were upper and lower limb fractures. Risk analysis and Kaplan-Meier survival analysis assessed fracture incidence over 5 years. Results: After matching, 13,441 patients were included per primary cohort. CKD+/GLP-1RA+ patients had fewer fractures than CKD+/GLP-1RA- patients (Risk Difference: -0.016; RR: 0.196; OR: 0.193), with higher fracture-free survival (99.31% vs. 95.47%; p<0.001). Subgroup analysis (13,723 patients per cohort) showed CKD+/GLP-1RA+ patients had a slightly higher fracture risk than CKD-/GLP-1RA+ patients (Risk Difference: 0.003; RR: 2.357; OR: 2.364), with lower fracture-free survival (98.87% vs. 99.19%; p<0.001). Conclusion: GLP-1RAs are protective for lower and upper extremity fractures for patients who are obese and have CKD. However, when compared to obese patients CKD-/GLP-1RA+, patients CKD+/GLP-1RA+ had a higher fracture risk. These findings suggest a possible CKD-associated modification on the skeletal effects of GLP-1RAs and warrant further mechanistic investigation. Supplementary Material File (glp-1, fx risk, and ckd (2).docx) Download 518.72 KB Information & Authors Information Version history V1 Version 1 30 December 2025 Peer review timeline Published British Journal of Clinical Pharmacology Version of Record 17 Apr 2026 Published Copyright This work is licensed under a Non Exclusive No Reuse License. Collection British Journal of Clinical Pharmacology Authors Affiliations Amari Eubanks 0009-0007-0797-4931 [email protected] Howard University View all articles by this author Kiana C. Allen 0009-0009-1182-5749 Howard University View all articles by this author Dy’Quan Kearney Howard University View all articles by this author Brieanna Bell Howard University View all articles by this author Anthony Albornoz Howard University View all articles by this author Rawan Elkomi 0000-0002-3707-544X Howard University Hospital View all articles by this author Damon Ross Jr. 0009-0004-1337-9168 Howard University View all articles by this author Elizabeth Beyene University of Maryland Medical Center View all articles by this author Mekdem Bisrat University of Maryland Medical Center View all articles by this author Syed Fahad Gillani Howard University Hospital View all articles by this author Miriam Michael 0000-0002-2478-4650 Howard University Hospital View all articles by this author Metrics & Citations Metrics Article Usage 183 views 107 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Amari Eubanks, Kiana C. Allen, Dy’Quan Kearney, et al. The Interplay of GLP-1 Receptor Agonist Use, Chronic Kidney Disease, and Fracture Risk in Obese Patients: A Retrospective Cohort Study. Authorea . 30 December 2025. DOI: https://doi.org/10.22541/au.176706936.68195055/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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