When it comes to treating obesity, type 2 diabetes, and other chronic health conditions, GLP-1 agonist drugs—such as Ozempic, Zepbound, and Wegovy—have been a game changer for literally millions of Americans.
But as with any medication, these drugs can deliver unwelcome side effects. And a recent study that just garnered a bunch of attention raised the possibility of new ones.
The research, which was presented at the 2026 American Academy of Orthopaedic Surgeons annual meeting in March and has not yet been peer-reviewed, found a link between GLP-1 use and increased risk of bone issues, including osteoporosis (weak, brittle bones) and osteomalacia (soft bones). The study also found a link between GLP-1 use and heightened risk of gout, a type of arthritis that causes pain and swelling in the joints.
The lead study author said he became interested in whether GLP-1s might affect bone and other connective tissue after some of his patients “developed serious tendon tears following relatively minor injuries,” according to NBC News. After analyzing five years of medical records from nearly 147,000 adults with type 2 diabetes and obesity, the study authors concluded that GLP-1 use was associated with a “significantly increased” risk of osteoporosis, osteomalacia, and gout.
Of course, this news is likely unsettling for anyone on these medications. But should we be legit worried about these findings? And how exactly could GLP-1s harm bone health in the first place? We tapped two experts for answers, along with practical tips for protecting bone health while taking GLP-1s.
How concerning are these findings?
First, some relieving news: As of now, there is “no sound scientific evidence” that suggests GLP-1s directly increase the risk of osteoporosis or osteomalacia, Marci Laudenslager, MD, an obesity medicine physician with The Johns Hopkins Healthful Eating, Activity & Weight Program, tells SELF. (Same goes for gout, she adds.)
Dr. Laudenslager, who was not involved in the study, points out that it was observational in nature, meaning it looked at correlation…not causation. “While well-conducted observational studies can reveal a potential relationship between a medication and a clinical outcome, they cannot determine whether a medication directly causes that clinical outcome,” she explains.
Another limitation of the study is that it relied on medical records alone, which means it assumed that all patients who were prescribed GLP-1s, as noted in their medical records, were actually taking the drug. In reality, many patients who are prescribed GLP-1s are unable to take them because of cost or medication shortages, Dr. Laudenslager says. Moreover, people who do start taking don’t always continue due to insurance, cost, or problems tolerating the drug, she adds.
Beyond that, the study didn’t take into account factors that commonly impact bone health, like exercise habits, nutritional habits, and other lifestyle factors, Kelyssa Hall, an exercise physiologist and certified strength and conditioning specialist at Hospital for Special Surgery, tells SELF. “These factors can play a huge role in bone health with or without the addition of GLP-1s.” The study also didn’t account for certain endocrine conditions, cancers, alcohol use, family history, and steroid use–all of which can also play a role in bone health, Dr. Laudenslager adds. And the study didn’t note which specific GLP-1 drug people used and the dosage, she adds.
Lastly, the study findings have not yet been peer reviewed–a step that Dr. Laudenslager describes it as “essential” in the scientific process. As Hall puts it: The study “highlights the need for more research on these topics.”
Is there any link between GLP-1 use and worsened bone health?
Okay, so that particular study has its limitations. But other research supports the notion that these drugs may be linked with declining bone health. So…is there actual cause for concern?
According to Dr. Laudenslager and Hall, taking GLP1-s can indeed decrease bone density for some people. But that’s likely due to the volume and rate at which people lose weight while on these drugs—and not anything specific to the medication itself, Dr. Laudenslager says.
“When you take GLP-1s, there can be rapid weight loss which means there is less load being carried around on the skeleton,” Hall says. “Bone formation or strengthening is improved with load to the skeletal system,” she explains, “so losing weight decreases the regular load on the bones overall.”
Over time, this decrease in loading can translate to a decrease in bone density, Dr. Laudenslager says. But, again, this isn’t unique to GLP-1s: “Significant weight loss through any mechanism—lifestyle change, medications, or surgery—can impact metabolism as a whole and bone metabolism, in particular,” she says. Basically, whenever you lose a bunch of weight—regardless of how you lost those pounds—there’s always a risk of bone loss.
In short, while it’s true that some people taking GLP-1s have had changes to their bone health, these changes seem to “be driven primarily by magnitude of weight loss rather than a direct, negative consequence of the medications themselves,” Dr. Laudenslager says. That said, the use of GLP-1s and bone health “is an active area of study,” she adds. More research is needed to fully understand the impact of GLP-1s on bone density.
How to protect your bone health when taking a GLP-1
Lean into strength training.
Resistance training is important for pretty much everyone—and that includes folks on GLP-1s. One of its many benefits is that it’s been shown to improve bone density, Hall says. That means it can be a helpful strategy to bolster bone health when you’re on a GLP-1. Plus, strength training can help guard against muscle loss that can happen when you’re losing weight. “Retaining muscle mass is important for strength and stability,” she says. And it can also help support your overall metabolism, she adds, which can help your body sustain weight loss results for the long haul.
If you’re new to strength training, Dr. Laudenslager recommends gradually building up to a routine of two to three sessions a week, with at least a day off in between each workout to allow your muscles the time they need to recover. Before getting started though, make sure to check with your doctor or other medical provider so they can advise what type of workouts are safe and recommended for you.
Make sure you’re eating enough overall.
A common side effect of GLP-1s is appetite suppression, which can sometimes lead people to follow a really low calorie diet. Calorie restriction can suppress bone growth and increase the risk of fractures, according to research, which is one of the reasons you want to make sure you’re still eating enough to support your overall health while on a GLP-1. “Hunger is an essential hormonal cue we all need in order to sustain health,” Dr. Laudenslager says. The ideal amount of calories is highly individualized, but if you’re unsure that you’re getting what you need, bring it up with your doctor or another qualified expert, such as a registered dietitian.
Don’t skimp on protein.
Protein is often touted for its muscle-building benefits, but it’s also vital for bone health, as it helps to build bone mass. The recommended dietary allowance for adults is 0.8 grams of protein per kilograms of bodyweight a day—a general guideline that Dr. Laudenslager also suggests for people taking GLP-1s. She suggests a slightly higher intake for people at greater risk of bone health issues (such as older adults and postmenopausal women) and lesser amounts in people with kidney disease. Just make sure that as you prioritize protein, you don’t skimp on important components of a well-rounded diet, including fiber, water, healthy fats, and essential vitamins, minerals, and nutrients, she adds.
Strive for gradual weight loss.
Rapid weight loss can be harmful for bone health, so to mitigate this risk, strive for a more gradual reduction in pounds. The recommended rate of weight loss depends on your starting weight, but as a general guideline, Dr. Laudenslager recommends losing 5% to 10% of your total weight over the course of about six months. This translates to an average of about 0.5 to 2 pounds lost a week. So if you notice that taking a GLP-1 is causing you to lose weight at a faster pace, bring it up with your doctor. They may want to adjust your medication dosing to help slow your weight loss rate into a more ideal, gradual range.
Bring up any concerns with your doctor.
Bone loss isn’t an overnight thing. In fact, clinically significant bone loss typically happens over the course of years, Dr. Laudenslager says. “This means there are a wealth of opportunities throughout a person’s weight loss journey to prevent and treat bone loss early on if it’s detected through surveillance.” So if you have any bone health concerns, mention them to your doctor (though hopefully your provider is proactively thinking about this too).
On that note, Dr. Laudenslager strongly encourages people interested in obesity treatment to seek care from a board-certified obesity medicine physician. She recommends the American Board of Obesity Medicine and the Obesity Action Coalition websites as resources for finding a board-certified provider.
A final note
GLP-1s can be a true game-changer for people struggling with chronic health conditions. Unfortunately, there’s still a lot of societal stigma and misunderstanding surrounding obesity, including the misconception that “anti-obesity medications are dangerous and should be avoided,” Dr. Laudenslager says. In truth, though? “The medication side effects are quite manageable when prescribed by providers who are well-versed in current practice guidelines,” she says.
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