A large US study has found that GLP-1 medicines, including widely prescribed treatments such as Ozempic, may reduce the risk of serious bone fractures in people with type 2 diabetes, challenging concerns that rapid weight loss associated with the drugs could weaken bones.

Researchers reported that patients treated with GLP-1 medicines had a 21% lower risk of fragility fractures over a three-year period compared with similar patients who received DPP-4 medicines, another class of drugs commonly used to manage type 2 diabetes.

The findings are based on an analysis of health records from more than 133,000 adults aged between 50 and 90 in the United States who were treated for type 2 diabetes between 2015 and 2022.

People living with type 2 diabetes face a greater risk of fractures caused by low-energy incidents, such as falls from standing height, even though they often have normal or higher-than-average bone density. Researchers said this may be linked to reduced bone strength, changes in bone structure and faster bone loss rather than bone density alone.

The study found the greatest reductions in vertebral fractures, which declined by 32%, while hip and femur fractures fell by 30% among patients taking GLP-1 medicines.

Researchers also noted that the lower fracture risk appeared to be independent of changes in body weight or blood sugar control. This raises the possibility that the medicines may have a direct effect on bone health rather than reducing fractures simply through weight loss or improved diabetes management.

The results challenge long-standing concerns that rapid weight loss could increase fracture risk by reducing bone density. Those concerns have accompanied the growing use of GLP-1 medicines, which have become increasingly popular for treating both type 2 diabetes and obesity.

Despite the encouraging findings, the researchers stressed that the study does not establish a direct cause-and-effect relationship. Because the research was based on observational health records rather than a randomized clinical trial, other factors may have influenced the results. Differences in physical activity, muscle strength, nutrition and existing bone health could all have contributed to the lower fracture rates.

The study also found no evidence that GLP-1 medicines reduced fracture risk among people who were taking the drugs without having type 2 diabetes. That suggests the apparent benefit may be specific to patients with diabetes and may not extend to those using the medicines solely for weight management.

The authors said additional prospective clinical trials are needed to confirm whether GLP-1 medicines provide direct protection against fractures and to determine whether any benefits continue during longer periods of treatment.

The findings add to growing research into the wider health effects of GLP-1 medicines as their use continues to expand around the world for diabetes care and weight management.

The design and appearance of neighbourhoods may play a bigger role in sleep quality than previously understood, according to new research from Japan that suggests greener surroundings and streets lined with trees or buildings are associated with longer and healthier sleep.

The findings add to growing evidence that the built environment can influence public health beyond physical activity and air quality. Researchers say urban planning decisions could become an important factor in improving residents’ wellbeing as cities continue to expand.

Sleep is widely regarded as a cornerstone of good health, with insufficient or poor-quality sleep linked to an increased risk of heart disease, obesity, depression and lower workplace productivity. As governments and city planners search for ways to create healthier communities, attention is increasingly turning to how neighbourhood design affects daily life.

The study, conducted by researchers at Osaka Metropolitan University, examined the relationship between neighbourhood appearance, perceptions of safety and sleep among employed adults living in Tokyo.

The research focused on 1,089 working adults aged between 40 and 59 who lived on the third floor or below in apartment buildings. Researchers chose lower-floor residents because they are more directly exposed to the surrounding street environment than people living at higher elevations.

To assess neighbourhood characteristics, the research team analysed more than 200,000 Google Street View images using artificial intelligence. The technology identified features such as greenery, tree cover, street layouts and the degree of visual enclosure created by buildings or vegetation. These findings were then compared with participants’ self-reported sleep duration and symptoms of insomnia.

The researchers found that people living on streets framed by trees or buildings tended to report longer sleep and fewer symptoms of insomnia. These neighbourhoods were also more likely to be viewed as safe and lively by residents, factors that appeared to contribute to better sleep outcomes.

“Our results also reinforce a significant positive association between perceived safety and sleep duration,” the researchers wrote.

The study also found that greener neighbourhoods were linked to stronger perceptions of safety, which in turn were associated with longer sleep. In contrast, areas with more pedestrian-friendly street layouts were associated with lower feelings of safety and shorter sleep duration among participants.

While the researchers noted that additional studies are needed to confirm the findings in other cities and population groups, they believe the results offer valuable insights for future urban development.

They said the study expands understanding of how neighbourhood environments can influence sleep health and highlights practical design features that may help planners create healthier communities. The findings suggest that decisions about greenery, streetscapes and neighbourhood layouts may affect not only how cities look, but also how well residents rest.