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doi:10.1007/s00592-025-02468-5 Study period Index events from 1/1/2017 to 10/31/2024 Follow up through 4/1/2025 Study population: inclusion Both populations: Patients must be 30+ years old as of index event Patients must have at least one weight reading within one year before their index event and one weight reading between three months and one year after their index event Diabetic population: Patients must have been diagnosed with type 2 diabetes prior to their index event Control: At least one HbA1c lab within the study period Nondiabetic population: Patients must have been prescribed a GLP-1 or a weight loss medication for the first time in an outpatient context within the study period Study population: exclusion Both populations : Bariatric surgery ever Use of GLP-1 medication in addition to other weight loss medications or weight loss population control medications Use of GLP-1 for the first time outside of the study period Type 1 diabetes: a billing, encounter, or problem list diagnosis with ICD-10-CM code E08*, E09*, E10*, or E13* or SNOMED code 46635009 anywhere on the patients chart Pregnancy between 1/1/2016 and 10/31/2025 Diagnosis of type 2 diabetes after the patients index event date Diagnosis of osteoporosis before index date Diabetic population: Use of a non-GLP-1 weight loss medication ever Use of GLP-1 for the first time before their diabetes diagnosis Nondiabetic population: Diagnosis of type 1 or type 2 diabetes ever Use of a non-GLP-1 weight loss medication at any point for the exposure patients Index event Diabetes population Exposed: First GLP-1 medication order start date Control: Random HbA1c lab within the study period Nondiabetic population Exposed: First GLP-1 medication order start date Control: First medication order start date for a weight loss medication, or bariatric surgery start date Matching Age in years Legal sex Censoring Left censor: The first weight reading between index date plus three months and index date plus one year Right censor: Outcome date or latest face-to-face encounter Outcomes Osteoporosis: A billing or encounter diagnosis with ICD-10-CM code M80* or M81*, SNOMED code 64859006, or an order of an osteoporosis medication Osteoporosis medication A medication with an order type of prescription, reported, or administered and a simple generic name of one of the following: Alendronate Risedronate Ibandronate Zoledronic acid Denosumab Romosozumab Teriparatide Abaloparatide Raloxifene Adjustment factors Legal sex Weight change at least three months after the index date

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Summary of Section 8 (Mini-List) Insurance coverage varies widely and is evaluated individually Manufacturer-direct programs offer safe, affordable access Compounded medications are avoided due to safety and quality concerns Oral medications provide effective, lower-cost alternatives Clear pricing and structured follow-up support long-term treatment success A Structured, Safe Approach to Plateaus and Weight Regain After Bariatric Surgery Why Weight Changes Can Occur Years After Bariatric Surgery Weight loss after bariatric surgery often follows a predictable trajectory

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