Key takeaways:
Glucagon-like peptide-1 receptor agonists (GLP-1s) can increase the risk of bone loss in some people. This can happen for a few different reasons.
Weight loss decreases the normal stimulation of new bone growth. Exercise and resistance training can help offset some of that effect.
GLP-1s can also lead to nutrient deficiencies — of calcium, vitamin D, iron, and protein — that affect bone health. So it’s important to make sure you’re getting the nutrients you need, even with a lower appetite.
Save on related medications
There’s little doubt that glucagon-like peptide-1 receptor agonists (GLP-1s) have changed the world of weight management. But this has also shed light on some of the risks associated with weight loss — particularly when it comes to bone health. This topic has gotten a lot of attention lately. So, we’ll walk you through what we currently know about GLP-1s and bone loss.
Do GLP-1s cause bone loss?
The answer isn’t straightforward. And not all the research agrees.
Test tube and animal studies suggest that GLP-1s may improve bone health. GLP-1s reduce bone resorption (the breakdown of bone tissue) and stimulate the building of new bone, according to some research. This improves bone mineral density (BMD).
But studies in people don’t show the same results. In fact, GLP-1s may have the opposite effect in humans. Some studies have shown they increase bone resorption, and decrease BMD.
For example, one study of people with an increased risk of bone fracture found that taking a once-weekly semaglutide injection for 52 weeks reduced spine and hip BMD more than taking a placebo. It was unclear if the bone loss was due to weight loss or the GLP-1.
But it may depend on the study population. A systematic review and meta-analysis noted that GLP-1s reduced fracture risk in people with Type 2 diabetes. This is worth noting, considering that having Type 2 diabetes also makes you more likely to develop osteoporosis.
Another study compared people with and without Type 2 diabetes. It found that those without diabetes had greater losses in hip BMD from a GLP-1 than those with diabetes. And that’s even though both groups lost weight.
In short: We need more long-term studies before we can say for certain whether GLP-1s cause bone loss — and who is most at risk.
Why do GLP-1s cause bone loss?
Bone loss from GLP-1s is likely caused by weight loss, not the medication itself.
Studies show that intentional weight loss can lead to bone loss. This effect starts to become noticeable when people lose 7% to 10% of their body weight. As a reference, in early clinical trials of semaglutide, people lost an average of 14.9% of their weight over 68 weeks.
People who get bariatric surgery face the same problem. The increased risk of fractures becomes noticeable in the third year after surgery.
There are a few reasons why significant weight loss affects bone health. First, your bones need weight and pressure to stimulate new bone growth. Less body weight means less load on your bones, which signals them to slow down that process.
Rapid weight loss also causes you to lose more than just fat. About 25% of the weight you lose comes from muscle. And when you lose muscle, you lose more tiny proteins that tell your bones to stay strong.
Finally, since GLP-1s suppress appetite, they can make it challenging to meet all the nutrients your bones need. In particular, studies show that people on GLP-1s struggle to get adequate vitamin D, calcium, iron, and protein. These nutrients are essential for building bone.
Can you prevent bone-density loss on GLP-1s?
Exercise plays a key role in preventing bone loss on GLP-1s. One study found that people who combined GLP-1 with exercise lost the most weight (about 37 lbs) without losing bone density. On the other hand, those who took GLP-1s without doing exercise lost 30 lbs but saw measurable declines in hip and spine bone density.
Aerobic and resistance exercise both put mechanical stress on the bones. This stress tells your bones to build up tissue for future workouts.
Nutrition is also essential. Many people who take GLP-1s fall short on bone-health nutrients like vitamin D, calcium, iron, and protein. So, keep a close eye on how much you’re getting to prevent bone loss. Ask your prescriber if supplements are warranted.
What are the signs of low bone density?
You might have low bone density and not even realize it. Early osteoporosis — a consequence of low bone density — doesn’t come with physical symptoms. This means many people discover they have low bone density from a screening test at the doctor’s office.
Symptoms appear once osteoporosis progresses. These include:
Pain
Loss of height
Extreme rounding or hunching of the upper back and shoulders
Fractures
Who’s most at risk of experiencing bone loss from GLP-1s?
Bone loss is more common in:
Older adults
Postmenopausal women
Those taking certain medications, like cancer medications or glucocorticoid steroids
People with a low weight or slender build
Families with a history of osteoporosis
GLP-1s can amplify the risk of bone loss in these populations.
Still, bone loss from GLP-1s can happen to anyone.
Frequently asked questions
You can’t fully reverse bone-density loss. However, you can slow down its progression and regain some bone density. Key strategies include exercising regularly, eating a balanced diet, and taking calcium or vitamin D supplements if your levels are low.
Bone loss, whether it’s from GLP-1s or other causes, can develop into osteoporosis. Osteoporosis makes your bones more prone to fracture, especially from a fall. Breaking a bone, particularly in the spine or hip, can be a big deal — especially for older adults. It can lead to disability and even increase the risk of death within the first year.
Treating bone-density loss involves stopping or slowing that loss and preventing fractures. Depending on the severity of the bone loss, lifestyle changes may suffice. Eat a balanced diet that includes plenty of calcium, vitamin D, protein, and calories. Limit alcohol and avoid or stop smoking. And engage in consistent exercise and strength training. If your bone loss is more advanced, your healthcare team may prescribe medications.
You can’t fully reverse bone-density loss. However, you can slow down its progression and regain some bone density. Key strategies include exercising regularly, eating a balanced diet, and taking calcium or vitamin D supplements if your levels are low.
Bone loss, whether it’s from GLP-1s or other causes, can develop into osteoporosis. Osteoporosis makes your bones more prone to fracture, especially from a fall. Breaking a bone, particularly in the spine or hip, can be a big deal — especially for older adults. It can lead to disability and even increase the risk of death within the first year.
Treating bone-density loss involves stopping or slowing that loss and preventing fractures. Depending on the severity of the bone loss, lifestyle changes may suffice. Eat a balanced diet that includes plenty of calcium, vitamin D, protein, and calories. Limit alcohol and avoid or stop smoking. And engage in consistent exercise and strength training. If your bone loss is more advanced, your healthcare team may prescribe medications.
The bottom line
Glucagon-like peptide-1 receptor agonists (GLP-1s) can lead to an increased risk of bone loss. It’s unlikely that the medications themselves cause bone loss — rather, it’s caused by rapid weight loss. You may reduce your odds of bone loss by exercising regularly and eating a diet rich in calcium, vitamin D, iron, and protein. It’s important to be proactive about your bone health. Especially because there are no early signs of osteoporosis, and the process cannot be reversed.
Why trust our experts?
References
Al Refaie, A., et al. (2025). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) for the treatment of type 2 diabetes mellitus: friends or foes to bone health? A narrative review of clinical studies. Endocrine.
Anyiam, O., et al. (2024). A systematic review and meta-analysis of the effect of caloric restriction on skeletal muscle mass individuals with, and without, Type 2 diabetes. Nutrients.
Hansen, M. S., et al. (2024). Once-weekly semaglutide versus placebo in adults with increased fracture risk: a randomised, double-blinded, two-centre, phase 2 trial. eClinicalMedicine.
Jensen, S. B. K., et al. (2024). Bone health after exercise alone, GLP-1 receptor agonist treatment, or combination treatment: A secondary analysis of a randomized clinical trial. JAMA Network Open.
Karam, L., et al. (2025). Effects of glucagon-like peptide-1 receptor agonists on bone health in people living with obesity. Osteoporosis International.
LeBoff, M. S., et al. (2022). The clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International.
Liu, Y., et al. (2026). Skeletal effect of semaglutide and tirzepatide in patients with increased risk of fractures. The Journal of Clinical Endocrinology & Metabolism.
Morin, S. N., et al. (2025). Osteoporosis: A review. JAMA.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022). Osteoporosis. National Institutes of Health.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2022). Osteoporosis: Diagnosis, treatment, and steps to take. National Institutes of Health.
Urbina, J., et al. (2026). Micronutrient and nutritional deficiencies associated with GLP-1 receptor agonist therapy: A narrative review. Clinical Obesity.
Wilding, J. P. H., et al. (2021). Once-weekly semaglutide in adults with overweight or obesity. The New England Journal of Medicine.
Zhang, Y., et al. (2025). Association of glucagon-like peptide-1 receptor agonists use with fracture risk in type 2 diabetes: A meta-analysis of randomized controlled trials. Bone.
