New Studies Link GLP‑1 Diabetes and Obesity Drugs to Higher Fracture and Bone‑Disease Risks in Older Adults
New observational studies suggest GLP‑1 diabetes and obesity drugs are associated with higher rates of fractures, osteoporosis and gout in older adults. Separately, a BMJ analysis of more than 600,000 U.S. veterans found GLP‑1 initiators had roughly a 15–20% lower risk of developing substance use disorders and, among those with prior SUD, about 25–50% lower risk of drug‑related emergency visits, hospitalizations, overdoses, suicide‑related events and death; investigators propose a shared "biologic signal," but outside experts caution that these are observational findings and randomized trials of GLP‑1s for addiction are underway.
📌 Key Facts
- A BMJ study of more than 600,000 U.S. veterans with diabetes found that people who start GLP‑1 drugs have about a 15–20% lower risk of developing substance use disorders involving alcohol, nicotine, cannabis, cocaine and opioids compared with peers on other diabetes medications.
- Among patients with a prior history of substance use disorder, GLP‑1 users had roughly a 25–50% lower risk of emergency department visits, drug‑related hospitalizations, overdoses, suicide attempts or suicidal ideation, and drug‑related death.
- Study author Dr. Ziyad Al‑Aly described the cross‑substance protective effect as evidence of a shared “biologic signal” involved in addictive disorders that GLP‑1 drugs appear to modulate.
- Outside experts, including NIH addiction researcher Dr. Lorenzo Leggio and UNC endocrinologist Dr. Klara Klein, cautioned that these are observational results and are not a substitute for randomized clinical trials—particularly in people without diabetes or obesity.
- Several randomized clinical trials of GLP‑1s as treatments for specific addictions are currently underway, with results expected within about a year.
📊 Relevant Data
In 2021, the prevalence of past-year substance use disorder among people aged 12 or older was highest among American Indian or Alaska Native people at 12.8%, followed by multiracial people at 10.6%, White people at 8.5%, Black people at 8.1%, Hispanic people at 7.8%, Native Hawaiian or Other Pacific Islander people at 7.2%, and Asian people at 3.8%.
Among U.S. veterans, approximately 7.9% had a substance use disorder diagnosis in a 2025 study of over 5 million independently housed veterans, with alcohol use disorder being the most common at 5.8%.
Multimorbidity of mental health and substance use disorders among independently housed veterans: a systematic review and meta-analysis — Nature Scientific Reports
A 2023 NIH study identified shared genetic markers underlying substance use disorders, with genomic analysis revealing one SNP associated with general addiction risk in African ancestry samples and substance-specific SNPs for alcohol, tobacco, and opioid risks across ancestries.
New NIH study reveals shared genetic markers underlying substance use disorders — National Institute on Drug Abuse (NIDA)
In a 2025 study, higher levels of ethnic discrimination were associated with greater odds of substance use susceptibility and actual use among all racial/ethnic groups, with odds ratios ranging from 1.2 to 2.5 depending on the substance and group.
Ethnic Discrimination's Role on Increased Substance Susceptibility Among U.S. Racial/Ethnic Minority Adolescents — American Journal of Preventive Medicine
Younger U.S. veterans aged 18-25 have the highest rates of substance use disorders at 56.8%, compared to lower rates in older age groups, influenced by factors like low income and lack of insurance.
Substance Use Disorders in the Veteran Population — R Street Institute
📰 Source Timeline (2)
Follow how coverage of this story developed over time
- Reports on a new BMJ study of more than 600,000 U.S. veterans with diabetes showing those who start GLP-1 drugs have roughly a 15–20% lower risk of developing substance use disorders involving alcohol, nicotine, cannabis, cocaine and opioids compared with peers on other diabetes medications.
- Finds that among patients with a prior history of substance use disorder, GLP-1 users have approximately 25–50% lower risk of emergency department visits, drug-related hospitalizations, overdoses, suicide attempts or suicidal ideation, and drug-related death.
- Quotes study author Dr. Ziyad Al-Aly describing the cross-substance effect as evidence of a shared "biologic signal" involved in addictive disorders that GLP-1 drugs appear to modulate.
- Includes caution from outside experts such as NIH addiction researcher Dr. Lorenzo Leggio and UNC endocrinologist Dr. Klara Klein that these observational results, while promising, are not yet a substitute for randomized clinical trials, particularly in people without diabetes or obesity.
- Notes that several randomized clinical trials of GLP-1s as treatments for specific addictions are underway, with results expected within about a year, underscoring that the addiction-indication question is actively being tested.