Millions of people have benefited from weight-loss medications including Ozempic, Wegovy, and Zepbound by losing weight and improving their metabolic health.
However, potential negative or downstream effects become increasingly apparent as time goes on after their explosive arrival into the weight-loss market.
Innovative GLP-1 medications imitate a hormone in the body that slows stomach emptying and tells the brain when to stop eating. As a result, fewer calories and nutrients that strengthen bones are consumed throughout the day.
A person who restricts their caloric intake loses important dense bone structure in addition to fat and muscle.
Additionally, the body loses important reserves of the bone-protective hormone estrogen as adipose tissue decomposes. Bones deteriorate more quickly without it.
However, given the amount of GLP-1 patients who have problems with bone density, the notion that the medications themselves may be the cause is being investigated.
In one study, the risk of fracture was 9% higher in obese GLP-1 users than in non-users.
“Long-term side effects like loss of bone mass or increased risk of fractures are typically not considered when the goal is losing weight,” “Weight loss patients should be asking about ways to lose weight slowly and preserve bone density,” Chicago-based orthopedic specialist Dr. Daniel Ivankovich told the Daily Mail.
The body goes into famine mode and breaks down fat, muscle, and bone when weight loss occurs too quickly—more than two pounds per week. It removes calcium from the skeleton more quickly than the bone can regenerate (stock).
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He advised avoiding taking GLP-1 drugs if you want to lose weight quickly.
The body enters famine mode and starts to break down not only fat but also muscle and bone when weight loss occurs too quickly—more than two pounds per week.
In particular, the body starts to extract calcium from the skeleton in order to maintain the health of essential organs. The body’s capacity to create new bone is outpaced by this process, known as bone resorption.
Bones become weaker, thinner, and more vulnerable to fractures with time. This is especially problematic for those who take GLP-1 medications because these therapies might result in extremely rapid weight loss.
The skeleton can adjust and retain its density if weight loss is kept to one to two pounds each week.
Additionally, Ivankovich stated that protein is a must. It supplies the components that make up bone tissue.
The body cannot create enough collagen matrix, the flexible structure that provides bones their strength and resilience, without enough protein.
A consistent supply of protein throughout the day, as opposed to a single surge, is ensured by distributing it among all meals.
Experts advise eating 1.2 to 1.5 grams of protein per kilogram of body weight daily to maintain strong bones while decreasing weight. A person weighing 200 pounds, or around 91 kilograms, would need between 110 and 135 grams of protein each day.
Use items like eggs, Greek yogurt, chicken, fish, beans, or tofu to spread that out over three meals, with about 30 to 45 grams per meal.
Even if calories are reduced, this consistent intake provides the body with the building blocks required to maintain bone structure.
Eating too little protein causes the body to break down bone and muscle in addition to fat, which is precisely what people taking weight-loss medications want to avoid.
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“Loss of flexibility or mobility, such as difficulty bending, walking, or squatting, is indicative of bone loss,” Ivankovich stated.
“Loss of hand or leg strength is another symptom, along with broken or fractured bones following minor falls.”
A person on GLP-1 drugs loses access to vital elements that maintain bone, such as calcium and vitamin D, when they lose weight.
For bones to retain their density and structural integrity, they require these nutrients.
When the body doesn’t have enough calcium, it starts to take calcium directly from the skeleton to sustain vital processes like muscle contraction and nerve communication, which results in bone resorption.
The issue is made worse by vitamin D insufficiency, which restricts the absorption of calcium from the meager amount of food consumed.
A person might lose weight quickly over several months while gradually weakening their bones, which increases the risk of fracture from little falls or even daily activities.
Dr. Daniel Ivankovich, an orthopedic specialist in Chicago, told the Daily Mail that most individuals are unaware that drastic weight loss can weaken bones and increase the chance of fracture.
Supplements can help some GLP-1 users avoid these deficits.
Plastic surgeon Dr. James Chao of San Diego told the Daily Mail: “Aim for 1,000–1,200 mg of calcium and 1,000–2,000 [international units] of vitamin D3 per day for bone health.”
“I’ll let you talk to your doctor about supplementation, but magnesium and vitamin K2 are also important.”
Exercise is also crucial for individuals on GLP-1 drugs.
But when it comes to bone health, not all forms of activity are created equal. The best exercises are weight-bearing and resistance because they make the skeleton struggle against gravity, which encourages osteoblasts, which are cells that generate new tissue.
Walking, jogging, climbing stairs, and dancing are examples of activities where the feet and legs bear the entire weight of the body.
Running, skipping rope, and jumping jacks are examples of high-impact exercises that produce the greatest bone-building signal. Walking quickly on an elevation or ascending stairs can still be beneficial for those who are unable to perform high-impact exercises.
By strengthening the muscles that pull on bones, resistance exercise enhances bone density and provides an additional layer of protection.
Squats, lunges, deadlifts, and overhead presses with free weights, resistance bands, or weight machines are suggested exercises.
Experts advise concentrating on key muscle groups, increasing the weight gradually over time, and aiming for two to three sessions per week.
This graph displays changes in hip bone density prior to, throughout, and following a year of treatment with a low-calorie diet (shaded region). Hip bone density was maintained in the exercise + liraglutide group (blue triangle). Compared to the exercise (yellow square) and placebo groups (gray circle), the liraglutide-alone group (dark blue diamond) lost noticeably more hip bone density.
This graph displays changes in lower spine bone density prior to, during, and following a year of treatment with a low-calorie diet (shaded area). Spine bone density was maintained in the combination group. Compared to the exercise and placebo groups, the liraglutide-alone group saw a considerably greater loss in spine bone density.
Combining weight-bearing exercise with strength training is especially crucial for individuals on GLP-1 medicines who are losing weight quickly. The body has little motivation to maintain bone mass in the absence of these mechanical forces, and density can deteriorate even more quickly than fat.
In order to determine whether exercise, the GLP-1 drug liraglutide, or both can maintain bone density after weight loss, a randomized clinical trial was carried out in Denmark and published in JAMA Network Open.
After an initial eight-week low-calorie diet, researchers monitored 195 obese adults, with an average age of 43, for a year. Exercise alone, liraglutide alone, a combination of both, or a placebo were the four groups into which the participants were split.
With an average weight loss of 16.9 kilos, or around 37 pounds, the combination group shed the most weight. The exercise-alone group lost 24.6 pounds (11.2 kg), the liraglutide-alone group lost 30 pounds (13.7 kg), and the placebo group lost 15 pounds (7 kg).
The combination group maintained bone mineral density at the hip, spine, and forearm despite losing more weight.
In contrast to the placebo and exercise-alone groups, the liraglutide-alone group displayed notable decreases in hip and spine bone density.
Exercise alone conserved bone rather than decreased it, although it produced weight loss comparable to that of liraglutide alone.
The researchers came to the conclusion that the best way to lose a substantial amount of weight while maintaining bone health is to combine exercise with GLP-1 medication.
