GLP-1 Agonists and Bone Health: What You Need to Know

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as tirzepatide (Zepbound), semaglutide (Ozempic, Wegovy), and liraglutide (Saxenda, Victoza), have gained significant popularity for their ability to aid in weight loss and improve blood sugar control in people with type 2 diabetes.

While these medications are very effective, there is growing concern about their potential impact on bone health. If you’re using a GLP-1 agonist—or considering it—it’s essential to understand how these drugs may influence your bones and what you can do to protect them.

How GLP-1 Agonists Affect Bone Health

GLP-1 agonists work by mimicking a natural hormone that helps regulate blood sugar, appetite, and digestion. However, their effect on bone health is complex and not yet fully understood.

Research has shown mixed results:

• Potential Benefits: Some studies suggest that GLP-1 agonists may have a protective effect on bones by promoting osteoblast activity (cells that build bone) and reducing osteoclast activity (cells that break down bone). This could be particularly beneficial for individuals with diabetes, who often experience compromised bone health.
• Concerns About Bone Loss: Other studies indicate that GLP-1 agonists may contribute to bone loss, particularly in individuals who experience rapid weight loss while using these drugs. Weight loss itself is associated with decreased bone mineral density (BMD), as fat and muscle mass play roles in maintaining bone strength. Additionally, some animal studies suggest that prolonged use of GLP-1 agonists may interfere with normal bone remodeling, increasing the risk of fractures, particularly in older adults.

Who Is Most at Risk?

Some groups of women may be more vulnerable to bone loss while taking GLP-1 agonists:

• Postmenopausal women: Estrogen plays a crucial role in maintaining bone density. Women in menopause already experience increased bone loss, and adding a GLP-1 agonist without proper bone health management may exacerbate the issue.
• Individuals with osteoporosis or low bone density: If you’ve been diagnosed with osteopenia or osteoporosis, you should be particularly cautious.
• Those who experience rapid weight loss: Losing weight too quickly can lead to increased bone resorption, meaning your body breaks down bone faster than it can rebuild it.
• People with inadequate calcium and vitamin D intake: Bone health relies on adequate levels of these nutrients.

When to Get a Bone Density Test

A bone mineral density (BMD) test, commonly performed using a DEXA scan, can help assess your risk of osteoporosis and fractures. Consider getting tested if:

• You are a postmenopausal woman, especially if you are over 50.
• You have a family history of osteoporosis or fractures.
• You have had unexplained fractures or a history of fractures with minor falls.
• You are experiencing rapid weight loss due to GLP-1 agonist use.
• You have been on a GLP-1 agonist for an extended period (more than 1 year) and have other risk factors for bone loss.

How to Protect Your Bones While Using GLP-1 Agonists

If you’re using or considering a GLP-1 agonist, here are steps you can take to maintain bone strength and reduce your fracture risk:

1. Get Adequate Calcium and Vitamin D Intake

• Aim for 1,200 mg of calcium daily from food sources like dairy, leafy greens, almonds, and fortified foods. If needed, consider supplements, although the use of these is controversial.
• Make sure your Vitamin D levels are optimal. Your blood test results should be between 50-70. Most women require 2000-5000IU/day to maintain this level. Use Vitamin D3 in combination with Vitamin K2. It needs to be taken with a meal that contains fat for best absorption.

2. Supplement with magnesium since Vitamin D depletes magnesium.

A bonus here is that magnesium (in the form of glycinate, taurate, or threonate) can help with sleep, muscle pain, and heart palpitations.

3. Add Strength Training and Weight-Bearing Exercise

• Strength training (lifting weights, resistance bands) helps stimulate bone formation.
• Weight-bearing exercises (walking, dancing, jogging) encourage bone remodeling and increase density.

4. Monitor Your Weight Loss Pace

Rapid weight loss can accelerate bone loss. Aim for a gradual reduction of 1-2 pounds per week.

5. Limit Bone-Damaging Bad Habits

• Avoid smoking: Nicotine interferes with bone remodeling.
• Reduce alcohol intake: Excessive alcohol consumption weakens bones.
• Limit excessive caffeine: While moderate coffee consumption is fine, excessive intake may reduce calcium absorption.

6. Discuss Bone Health with Your Doctor

If you have risk factors for osteoporosis, your doctor may recommend periodic DEXA scans to monitor bone density.

Final Thoughts

While GLP-1 agonists offer powerful benefits for weight management and diabetes control, it’s crucial to be proactive about bone health. If you’re using these medications, make sure to support your bones with proper nutrition, exercise, and medical monitoring. Discuss any concerns with your healthcare provider to ensure you’re balancing the benefits of GLP-1 agonists with strategies to maintain strong, healthy bones.

References

• Ma, X., Liu, Y., Zhu, P., & Li, W. (2022). “GLP-1 Receptor Agonists and Bone Metabolism: A Comprehensive Review.” Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 15, 343–357.
• Schwartz, A. V., et al. (2018). “Effects of Weight Loss on Bone Mineral Density and Fracture Risk in Obese Individuals.” The Journal of Clinical Endocrinology & Metabolism, 103(10), 3697–3706.
• Vilsbøll, T., et al. (2021). “GLP-1 and Skeletal Health: Benefits and Considerations in Diabetes Management.” Current Osteoporosis Reports, 19(4), 213-221.