Do GLP-1 drugs like Ozempic or Wegovy affect bone density?
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as Ozempic (semaglutide) and Wegovy (semaglutide), are widely used for treating type 2 diabetes and weight loss. Recent studies highlight potential risks to bone mineral density (BMD) and fracture risk, particularly in specific patient populations. Incorporating a regular exercise routine can help mitigate potential bone loss from GLP-1 drugs due to rapid weight loss.
How Do GLP-1 Drugs Affect Bone Density?
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including Ozempic, Wegovy, and Mounjaro, interact with the body's bone metabolism in complex ways. These medications act on receptors in both osteoblasts (which build bone) and osteoclasts (which break bone down), potentially tipping the balance between bone formation and resorption.
GLP-1 drugs influence bone metabolism through receptors in bone-forming osteoblasts and bone-resorbing osteoclasts:
- Increase bone formation by stimulating osteoblast activity.
- Reduce bone breakdown by inhibiting osteoclast development.
These drugs also affect bone health indirectly:
- Better blood sugar control reduces fracture risk in diabetes patients.
- Rapid weight loss may cause hormonal changes that accelerate bone loss.
- Reduced appetite in adolescents may impact bone development due to lower nutrient intake.
Research is ongoing to study the effects of GLP-1 drugs on bone development in adolescents. There is concern about whether patients in this age group taking GLP-1 drugs might not get enough nutrition due to a decreased appetite, which could impact bone health.
What Does Research Say About GLP-1 Drugs and Bone Health?
Recent large studies provide reassurance about fracture risk and bone mineral density with GLP-1 receptor agonists in people with type 2 diabetes; meta-analyses have shown a neutral or lower risk of fracture compared to other diabetes therapies.
- 2018 Meta-Analysis (49,000 Participants): Found GLP-1 drugs were associated with a lower fracture risk compared to placebo or other diabetes medications, with exenatide showing the lowest risk.
- 2024 JAMA Study (195 Adults with Obesity, 52 Weeks): Exercise + GLP-1 therapy helped maintain bone density at the hip, spine, and forearm vs. GLP-1 therapy alone (liraglutide) led to reduced bone mineral density at the hip and spine.
- 2022 Systematic Review: Reported no significant effect of GLP-1 drugs on bone density or fracture risk in type 2 diabetes patients (limited by small sample sizes).
- 2025 Retrospective Cohort Study: Included 1,845 patients with Type 2 diabetes and found that GLP-1 receptor agonists were linked to lower risks of osteoporosis compared to patients who did not use GLP-1 drugs.
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How to Support Bone Health with GLP-1 Therapy
For people using GLP-1 drugs such as Ozempic, Wegovy, or Mounjaro—especially those at risk for osteoporosis—there are evidence-based steps to preserve bone density:
- Prioritize weight loss at a safe pace to avoid excessive bone turnover.
- Include regular resistance and weight-bearing exercise (after consulting your healthcare provider), which studies show helps maintain bone mineral density during GLP-1 drug treatment.
- Maintain adequate intake of calcium, vitamin D, and protein to support bone remodeling, and monitor blood levels as directed by a healthcare provider.
- Discuss periodic bone density testing (DEXA scans) with clinicians, particularly for older adults, postmenopausal women, or those with a history of osteoporosis.
- Seek early evaluation if symptoms such as bone pain, fragility fractures, or unexplained musculoskeletal complaints arise.
Summary
GLP-1 drugs appear to have a neutral to minimal impact on bone health. However, rapid weight loss can contribute to bone loss. Incorporating regular exercise may help preserve bone density during treatment. If you have concerns about bone health while taking GLP-1 medications, consult your healthcare provider.
References
- Chen, M., Lyu, Y., Zhao, J., Han, X., Huang, T., Yang, T., & Zhou, Y. (2025). Use of GLP-1 receptor agonist and risk of osteoporosis among patients with type 2 diabetes: a real-world study. Frontiers in endocrinology, 16, 1586589. https://doi.org/10.3389/fendo.2025.1586589
- Daniilopoulou, I., et. al. 2022. The Impact of GLP1 Agonists on Bone Metabolism: A Systematic Review. In: Medicina. DOI: https://doi.org/10.3390/medicina58020224
- Hansen, M. S., Wölfel, E. M., Jeromdesella, S., Møller, J. K., Ejersted, C., Jørgensen, N. R., Eastell, R., Hansen, S. G., & Frost, M. (2024). Once-weekly semaglutide versus placebo in adults with increased fracture risk: a randomised, double-blinded, two-centre, phase 2 trial. EClinicalMedicine, 72, 102624. https://doi.org/10.1016/j.eclinm.2024.102624
- Iepsen, E. W., et. al. 2015. GLP-1 Receptor Agonist Treatment Increases Bone Formation and Prevents Bone Loss in Weight-Reduced Obese Women, The Journal of Clinical Endocrinology & Metabolism, Volume 100, Issue 8, 1 August 2015, Pages 2909–2917, https://doi.org/10.1210/jc.2015-1176
- 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. In: JAMA. DOI: https://doi.org/10.1001/jamanetworkopen.2024.16775
- UCI Health. 2024. GLP-1 weight loss drugs can affect bone development in adolescents. Accessed 02/24/2025 at https://www.ucihealth.org/news/2024/12/ozempic-bone-health
- Xie, B., et. al. 2021. The Impact of Glucagon-Like Peptide 1 Receptor Agonists on Bone Metabolism and Its Possible Mechanisms in Osteoporosis Treatment. In: Frontiers. DOI: https://doi.org/10.3389/fphar.2021.697442
- Zhang, Y. S., et. al. 2018. Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials. In: Osteoporosis International. DOI: https://doi.org/10.1007/s00198-018-4649-8
- Zhao, C., Liang, J., Yang, Y., Yu, M., & Qu, X. (2017). The Impact of Glucagon-Like Peptide-1 on Bone Metabolism and Its Possible Mechanisms. Frontiers in endocrinology, 8, 98. https://doi.org/10.3389/fendo.2017.00098
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