Key takeaways:
Ozempic and other GLP-1s may have positive and negative effects on bone health. The risk of bone loss is greater as you lose more body weight, or if you lose weight very fast.
Lower bone density can also occur with other causes of weight loss — like low-calorie diets, weight-loss surgery, or illness.
A nutritious diet, weight-bearing and resistance exercises, and lower doses of GLP-1s can help offset the risk of bone loss.
Ozempic (semaglutide) — and other GLP-1 receptor agonists (GLP-1s) — are powerful and popular medications. Some people take them to manage Type 2 diabetes. For others, GLP-1s support weight management along with diet and exercise. Many people take GLP-1s like Ozempic for months or years. So you may have questions about their long-term effects on the body. Here we’ll take a look at the potential effects of Ozempic and other GLP-1s on your bones.
Does Ozempic cause bone loss?
In lab studies, medications like Ozempic actually improved bone-strengthening chemicals in the body. But studies in people taking GLP-1s show there may be some bone loss over time. Especially in bones and joints that bear weight, like the legs and hips. The risk of thinning bones increases if you lose a higher percentage of your body weight. Or if you lose it very fast.
But Ozempic also treats conditions that can affect bone loss. For example, diabetes can lead to inflammation that weakens muscles and bones. Managing blood sugar decreases that inflammation. One small study even showed a small increase in bone density for some people taking oral semaglutide for diabetes. So taking a GLP-1 for diabetes may be less of a risk than it is for people who use higher doses to lose weight.
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How does weight loss impact bone health?
When people lose weight on Ozempic, much of that is in the form of body fat. But up to 40% of the pounds shed with Ozempic may be lost muscle.
Decreased muscle mass is another way that GLP-1s could affect bone density. Muscles and bones work together. So when you lose muscle, you’re also at a higher risk of losing bone.
How fast you lose weight matters, too. Rapid weight loss increases the risk of bone loss. More specifically, this risk is higher in people who lose more than 14% of their body weight within a few months. This is true no matter what is causing the weight loss. People who lose a lot of weight through diet, weight-loss surgery, or illness also have a higher risk of thinning bones. But as more people use GLP-1 medications, they are more often the cause of rapid weight loss.
For people with increased weight, some weight loss is often good for bone health. Especially if you have a chronic condition like diabetes. But when you lose around 7% to 10% of your body weight, your risk for bone loss may go up.
The good news is that exercise can offset some of that risk. In some studies, people who lost weight with a low-calorie diet or GLP-1 had bone loss. But weight-bearing exercise and resistance training lowered that risk.
So, losing a lot of weight or losing it too fast could be hard on your muscles and bones. But adding movement and exercise to your routine could offset that risk.
Does Ozempic increase your risk of osteoporosis?
Osteoporosis isn’t a documented side effect of Ozempic. But there aren’t a lot of studies yet that look at bone loss over time. That will be changing soon.
One study — that has not yet been formally reviewed and published — attempts to answer this question. Researchers looked at people with diabetes and BMI over 30, and compared those taking a GLP-1 to those who were not. After 5 years, about 4% of people taking a GLP-1 developed osteoporosis. This risk was 30% higher than people not taking a GLP-1.
Even though the research is still evolving, it is important to be aware of this potential risk. Particularly for people who are already at higher risk for osteoporosis, like women after menopause. This doesn’t mean people at higher risk shouldn’t take medications like Ozempic. It may just mean they need more proactive screening, especially since early osteoporosis doesn’t have symptoms. People often don’t know they have it until they have pain or a fracture. So early changes to your bones could go unnoticed.
Muscle loss can also affect your strength and balance. So people who lose muscle on medications like Ozempic may be at higher risk of falls and fractures.
Can someone with osteoporosis take Ozempic?
If you have osteoporosis, a GLP-1 could still be the best diabetes treatment. For people with diabetes, GLP-1s may be neutral or even helpful when it comes to bone health. Talk with your healthcare team about which diabetes medications are safest for your bones.
If you’re taking a GLP-1 for weight loss, your bones could be at greater risk. Especially if you take a higher dose of medication, lose a large amount of weight, or lose it very quickly. So you may want to use a lower dose, or have extra checks on your bone health. Your healthcare team can help you with those decisions.
One small study looked at the effects of the GLP-1 liraglutide in older adults with low bone density. There was some bone loss after 1 year. But it was about the same as what happens with other methods of weight loss. Other studies found that GLP-1s don’t have much of an effect on bone. Especially when you add in weight-bearing exercises.
Can you prevent bone loss while taking Ozempic?
Whether you’re taking medication like Ozempic or not, you can help to protect your bones if you’re losing weight. Some ways to prevent bone loss include:
Only use medications like Ozempic under the guidance of a licensed healthcare professional.
Losing weight at a slower pace is safer for your bones and for your health in general.
Get plenty of lean protein, a variety of plant-based foods, and calcium.
Boost your vitamin D through sunlight, foods, or supplements.
Stay active. Especially with weight-bearing exercise like walking. And resistance training with weights, bands, or your own body weight.
Talk with your healthcare team about screening tests for bone density.
Consider supplements for bone health after talking with a healthcare professional.
The bottom line
GLP-1s like Ozempic are helpful for managing blood sugar in people with diabetes. And, when needed, for weight loss. But losing too much weight or losing it too fast can put your muscles and bones at risk. That could lead to falls and fractures. If you use a GLP-1, take the lowest effective dose for you, add an exercise routine, and eat nutritious foods. That can help to keep your bones as healthy as the rest of you.
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References
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