New medicines called GLP-1 drugs have changed the way doctors treat obesity. Medicines such as semaglutide can help people lose a large amount of weight, something that was once very difficult without weight-loss surgery.
Because obesity increases the risk of diabetes, heart disease, high blood pressure, sleep apnea, and many other illnesses, these medicines are giving hope to millions of people. A new Medicare GLP-1 Bridge program is also expected to make these treatments more affordable and available to more older adults.
However, experts say there is another health issue that should not be ignored. Researchers at Wake Forest University warn that rapid weight loss may also cause the body to lose bone and muscle.
This is especially important for older adults because bones naturally become weaker with age. Their advice and research were discussed in an advisory published in the American Journal of Lifestyle Medicine.
Bones are living tissues that are constantly being rebuilt. As people grow older, they gradually lose bone density. This increases the chance of osteoporosis, a condition in which bones become fragile and break more easily. Even a simple fall can lead to a hip fracture, which may result in surgery, disability, or loss of independence.
Professor Kristen Beavers, an expert in aging, obesity, and bone health, says the problem is becoming more important because nearly 40% of older adults in the United States live with obesity. As more people use GLP-1 medicines, more people may also face the challenge of protecting their bones while losing weight.
Weight loss itself is not harmful. In fact, it can improve blood sugar, reduce pressure on joints, improve movement, and lower the risk of heart disease. The concern is that all forms of weight loss include some loss of muscle and bone. When weight loss is rapid and substantial, the loss of bone may become greater.
One study of semaglutide found that people lost about 10% of their body weight along with about 2.5% of their bone mass. By comparison, people who lost a similar amount of weight through diet and exercise typically lost about 1% to 2% of bone. Although this was only one study, the findings fit with previous research showing that losing weight can reduce bone density.
The concern may become even greater as newer GLP-1 medicines help people lose 20% to 25% of their body weight, an amount once seen mainly after bariatric surgery. Researchers believe that such large weight loss could also lead to greater bone loss.
Evidence from the SELECT clinical trial also supports this concern. According to the prescribing information for Wegovy, women taking the medicine experienced more hip and pelvis fractures than women taking a placebo. The difference was even larger among people aged 75 years and older.
The good news is that older adults do not have to choose between healthy weight loss and healthy bones. Experts recommend planning ahead before starting treatment. A bone density scan can measure bone strength before treatment begins. People with osteoporosis, previous fractures, or frailty may need closer medical monitoring.
Exercise is also very important. Resistance training helps keep muscles strong and reduces bone loss. Eating enough protein, calcium, and vitamin D supports bone health during weight loss. Some people may also benefit from medicines that strengthen bones if recommended by their doctor.
Professor Beavers recently received a five-year grant from the U.S. National Institutes of Health to continue studying how older adults can safely lose weight while protecting muscle and bone.
Overall, this advisory does not argue against GLP-1 medicines. Instead, it encourages doctors and patients to treat obesity while also protecting the skeleton. The findings remind us that successful treatment should focus on the whole body, not simply the number on the scale.
Future research will help determine the safest ways to combine these powerful medicines with nutrition and exercise so older adults can enjoy the benefits of weight loss while lowering the risk of fractures.
The advisory raises an important clinical concern rather than proving that GLP-1 medicines directly cause dangerous bone loss in every patient. Much of the evidence comes from earlier studies and clinical trial observations, so more long-term research is still needed.
Even so, the recommendation to combine these medicines with exercise, good nutrition, and bone monitoring is practical, low-risk, and supported by current knowledge about healthy aging.
If you care about bone health, please read studies that plant-based diets can harm your bone health without these nutrients, and how to ease arthritis with anti-inflammatory foods.
For more health information, please see recent studies that too much of this vitamin may increase your risk of bone fractures, and results showing this type of exercise may protect your bone health, slow down bone aging.
Source: Wake Forest University.
