Over three years, people beginning GLP-1 medicines were less likely to suffer fragility fractures than similar patients beginning DPP-4 inhibitors. Even a relatively small change in fracture risk could matter when millions of people use a medicine. The lower fracture risk was associated only with participants who had type 2 diabetes compared with a matched group without diabetes. Researchers also need studies that directly measure bone health rather than relying mainly on diagnoses recorded in health systems. Measurements of bone density, bone structure, muscle mass, nutrition, and physical function could reveal whether GLP-1 medicines change the skeleton itself.