GLP-1 Drugs And Bone Health
By Derrick Inglut
A smaller waist and stronger bones are not the same outcome. You cannot establish your bone health from your appearance or a bathroom scale.
My original column discussed research linking abdominal fat and bone measures. Today, weight-loss medications such as semaglutide and tirzepatide add another reason to consider bone health alongside changes in body weight.
Bones need their own attention
Weight-bearing activity and resistance exercise are useful parts of supporting bone health. Weight-bearing activities include walking and stair climbing. Resistance exercise includes movements performed against a load, such as weights or bands.
Swimming can be valuable cardio, but it does not provide the same weight-bearing stimulus as activity on land. Different activities serve different purposes within a complete routine.
Semaglutide, tirzepatide, and bone health
Substantial weight loss can be accompanied by bone loss. Researchers are investigating how much this relates to reduced loading on the skeleton, changes in nutrition, and the medications themselves.
A small randomized trial in adults already at increased fracture risk found lower hip and spine bone mineral density after 52 weeks of semaglutide treatment compared with placebo. The researchers noted that the accompanying weight loss could help explain the findings.
Wegovy’s prescribing information also reports more hip and pelvis fractures among women and adults aged 75 and older receiving semaglutide than among those receiving placebo in a cardiovascular outcomes trial.
For tirzepatide, which acts on both GIP and GLP-1 receptors, one large observational study found an association with more diagnoses of osteoporosis or fragility fractures compared with other GLP-1 medications. Observational research cannot establish that the medication caused those outcomes, and findings across studies are mixed.
These concerns deserve attention, particularly if you already have low bone density or other fracture risk factors. They do not establish that everyone taking these medications will develop osteoporosis.
Discuss your individual risk with your prescriber, including whether bone-density testing, nutritional assessment, or changes to your exercise plan are appropriate. Do not stop prescribed treatment based on a blog article.
Find a starting level you can repeat
For a generally healthy person learning strength training, a session might begin with a suitable sit-to-stand or squat variation, a pulling exercise, and a controlled push. Exercise choice and load should fit the person.
Keep a record of the setup and what you managed. Over time, that makes it possible to progress deliberately rather than changing the whole workout whenever it starts feeling familiar.
During weight loss, pay attention to adequate nutrition as well as exercise. Your healthcare team can help assess protein, calcium, vitamin D, and overall food intake.
Osteoporosis changes the conversation
If you have osteoporosis, low bone density, a fracture history, or significant balance problems, get individual guidance before starting. Some movements and loads may need modification.
Menopause is also a reasonable time to discuss bone health with your healthcare provider. Neither weight loss nor lifting performance tells you whether testing or treatment is appropriate.
Keep the goals distinct
You can work on strength and body composition at the same time, but do not use progress in one as proof of progress in the other. Ask what you are measuring and what it can actually tell you.
For everyday function and balance, read Senior Fitness: Train for the Things You Want to Keep Doing.
If you want help developing a consistent strength routine, explore my private personal training in Washington, DC. We can discuss your experience, goals, and any exercise guidance provided by your healthcare team.
Adapted and updated from “Excess belly fat linked to bone loss,” originally published in The Southwester, December 2011, p. 6.
Sources
NIAMS: Exercise for your bone health
NIAMS: Osteoporosis care and exercise
Randomized trial: Semaglutide in adults with increased fracture risk
Wegovy prescribing information
Observational study: Tirzepatide and osteoporosis or fragility fractures
Study: Semaglutide, tirzepatide, and fractures in older adults with diabetes