A bone-crushing side effect?
The benefits of GLP-1 drugs like Ozempic are myriad, from weight loss to improved cardiovascular health to potentially preventing dementia, lowering the risk of depression and reducing the intensity of migraines.
However, new research suggests these wildly popular meds could raise your risk of developing a different serious condition.
In the new study, researchers found that 4% of GLP-1 users with obesity and Type 2 diabetes developed osteoporosis, compared with a little over 3% among nonusers — an increased risk of about 30%.
Osteoporosis is defined by a loss of bone mineral density and bone mass, a weakening that makes people with the condition more vulnerable to fracture. An estimated 10.2 million people in the US age 50 and older have it, and about 43.3 million more people have low bone mass, which puts them at high risk for osteoporosis.
Researchers also found that osteomalacia, a related condition in which bones soften, occurred twice as often among GLP-1 users.
“It’s not huge,” said lead study author Dr. John Horneff, an associate professor of orthopedic surgery at the University of Pennsylvania, “But within that data that was put in there, you even saw nearly a doubling of the risk of having some sort of bone mineral density issue at five years.”
This latest round of research is observational and did not factor in diet, exercise or vitamin supplementation.
However, the results are consistent with research published last month that found an association between GLP-1 drugs and a higher risk of osteoporosis-related fractures in older adults with Type 2 diabetes.
The Food and Drug Administration currently lists “increased risk of bone fracture in older adults and women” on its label for semaglutide.
Why is this happening?
Women in perimenopause and menopause are particularly at risk due to naturally falling levels of estrogen, a key hormone in the bone remodeling process. When levels fluctuate during perimenopause and then plummet after menopause, bone loss accelerates.
Osteoporosis is also common among those who experience rapid weight loss.
Horneff says that with a suppressed appetite, patients don’t get essential, bone-protective nutrients like vitamin D and calcium from their diets.
“People are taking these medications, and obviously there’s a tremendous amount of upside,” he said. “But with that, they start to decrease their intake of food and nutrients.”
He also suggests that rapid weight loss could affect how the body builds and loses bone, comparing patients who lose a lot of weight in a short amount of time to astronauts in a zero-gravity environment.
“There’s nothing forcing their bones to hold their weight anymore. A lot of astronauts come back with low bone density. The thought is, these patients, their skeleton was used to maintaining one frame, and then all of a sudden, that’s being decreased.”
The question of whether the increased risk of osteoporosis is due to weight loss or another mechanism of the drug remains unanswered.
Experts assert that exercise — specifically, weight-bearing exercise — can help maintain bone mass and slow bone loss. The force exerted on bones during strength training stimulates bone-forming cells to build more bone, making bones denser and stronger.
Watch out for gout
The study also found that the risk for gout, a type of inflammatory arthritis triggered by a buildup of uric acid in the body, was also 12% higher among GLP-1 users. Rapid weight loss can temporarily raise uric acid levels, which can to explain this increased risk.
Experts emphasize that the results of this study shouldn’t discourage the prescription of GLP-1 drugs, but rather should encourage providers to offer patients guidance on protein intake, nutrition, physical activity and monitoring of bone health.
