How to Protect Your Bone Health During Weight Loss

Weight loss can improve your health in many ways. But it can also come with some drawbacks, like bone loss. Losing too much bone can make your bones weaker and raise your risk of fractures. 

The good news is that there are steps you can take to help protect your bones during weight loss. Here’s why bone loss can happen, how glucagon-like peptide-1 (GLP-1) medications may play a role, and what you can do to keep your bones healthy and strong. 

Is it normal to lose bone mass as you lose weight?

Yes, some bone loss is normal when you lose weight. Bone loss happens whether you lose weight through diet and exercise, medication, or weight loss surgery. 

But losing some bone density doesn’t mean you’ll definitely develop weak bones or have a fracture. Your risk becomes greater if you lose a lot of bone mass during weight loss. 

Some people are more likely to lose more bone during weight loss. Your risk may be higher if you:

• Are an older adult

• Have gone through menopause

• Already have osteopenia or osteoporosis

• Have had a fracture caused by weak bones

• Lose a large amount of weight

• Don’t get enough calcium, vitamin D, or protein

• Don’t get regular exercise

• Have another health condition that can weaken your bones

• Take a medication that can weaken your bones

This doesn’t mean that losing weight is bad for your bones. But it does mean that protecting your bones should become part of your weight loss and health plan. 

Why does bone mass decrease with weight loss?

Weight loss affects your bones in several ways at the same time:

• Your bones carry less weight. Your bones respond to the amount of weight and pressure placed on them. A higher body weight puts more pressure on weight-bearing bones, which signals your body to keep them strong. As you lose weight, your body may respond by building less bone and breaking down more bone. 

• You lose some muscle, too. Weight loss doesn’t only come from body fat. Some of the weight you lose comes from muscle and other tissue. Your muscles pull on your bones when you move, which helps keep bones strong. Losing muscle means your bones get less of this healthy pressure.

• Your hormone levels change. Fat tissue helps make and control several hormones that affect your bones. Losing body fat can change your hormone levels and may cause your body to break down more bone than it replaces.

• You may get fewer bone-building nutrients. Eating less food can make it harder to get enough calcium, vitamin D, and protein. Your body needs these nutrients to maintain strong bones and build new bone.

Together, these changes can cause your body to break down bone faster than it builds new bone. That’s why protecting muscle and getting enough exercise and nutrients can be an important part of protecting your bones.

Do weight loss medications cause bone loss?

Yes, some bone loss can happen when you lose weight with medications like semaglutide (Wegovy) or tirzepatide (Zepbound). Research suggests that people who lose more weight with these medications also tend to lose more bone. 

But the amount of bone loss is similar to what happens with nonsurgical weight loss. This suggests that weight loss, rather than the medication itself, is what’s causing bone loss. 

So far, there isn’t enough research to know whether one weight loss medication causes more bone loss than another. Researchers are also studying amylin combination weight loss medications. Amylin is a peptide that may slow bone breakdown and support new bone growth during weight loss. 

Can you prevent bone loss as you lose weight?

There aren’t specific guidelines for protecting bone health while losing weight with a GLP-1 medication. But experts agree that people taking GLP-1 medications should prioritize exercise and good nutrition. Some people may also need to have their bone health monitored. Talk with your healthcare team about a bone health plan while taking a GLP-1 medication, especially if you:

• Lose more than 10% of your body weight

• Are an older adult

• Have gone through menopause

• Already have osteopenia or osteoporosis

• Have a history of fractures

• Have a history of osteoporosis or osteopenia

Here are some steps you can take to protect your bone health during weight loss.

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Written by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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