Recent studies indicate that GLP-1 drugs, including Ozempic and Wegovy, may increase fracture risk and osteoporosis in older adults with Type 2 diabetes, prompting calls for closer monitoring of bone health.
A new study suggests that GLP-1 medications, such as Ozempic and Wegovy, may elevate the risk of fractures by 11% in adults aged 65 and older who have Type 2 diabetes, compared to those using other diabetes treatments.
These GLP-1 drugs have revolutionized the management of Type 2 diabetes and obesity, but recent findings indicate that healthcare providers should be more vigilant regarding bone health in older patients prescribed these medications. A study published in February in the Journal of Clinical Endocrinology & Metabolism revealed that older adults with Type 2 diabetes who began using GLP-1 medications experienced a statistically significant increase in the risk of fragility fractures.
Dr. Michal Kasher Meron, an endocrinologist at Meir Medical Center in Israel and the study’s lead author, emphasized that while an 11% increase may seem modest, it is significant for a vulnerable population. “Both older age and Type 2 diabetes are independent risk factors for fragility fractures,” she stated. “This is a population that deserves special attention.”
Fragility fractures are typically caused by minor falls or routine activities and are often associated with osteoporosis. Such fractures can lead to hospitalization, loss of independence, and even increased mortality among older adults, according to Dr. Kasher Meron.
The study monitored over 46,000 adults aged 65 and older for nearly three years. After making necessary adjustments, researchers found that those using GLP-1 medications had a modest but statistically significant increase in fracture risk.
Previous studies involving younger patients using older GLP-1 medications did not indicate an increased fracture risk. However, the newer and more potent versions are now commonly prescribed to older adults, which alters the risk landscape. “In older adults treated with contemporary medications, the fracture risk picture looks different and warrants close attention,” Dr. Kasher Meron noted.
It is important to highlight that the study was observational, indicating an association rather than causation. Researchers could not ascertain whether the increased risk was due to weight loss, dietary changes, muscle loss, or a direct effect on bone health.
Despite these findings, Dr. Kasher Meron advocates for assessing bone health before initiating GLP-1 medications in older patients rather than treating it as an afterthought. The study’s results coincide with additional research presented at the American Academy of Orthopaedic Surgeons’ annual meeting, which raised further concerns regarding bone health.
In an analysis of over 146,000 adults with obesity and Type 2 diabetes, those using GLP-1 medications were found to have a 29% higher relative risk of developing osteoporosis over five years compared to nonusers. Additionally, rates of gout were slightly elevated, affecting 7.4% of GLP-1 users versus 6.6% of nonusers, representing a 12% relative increase. Osteomalacia, a condition characterized by softening of the bones, was rare but occurred approximately twice as often in GLP-1 users, according to the study, which has not yet undergone peer review.
Experts suggest several mechanisms may contribute to these findings. GLP-1 medications suppress appetite and can lead to rapid weight loss, which is known to reduce bone density. This reduction occurs partly because less mechanical load is placed on the skeleton. Dr. John Horneff, an associate professor of orthopedic surgery at the University of Pennsylvania, likened this phenomenon to astronauts experiencing low bone density after extended periods in a zero-gravity environment.
Moreover, a decrease in caloric intake may result in lower consumption of calcium, vitamin D, and protein—nutrients essential for maintaining bone strength. Rapid weight loss can also temporarily elevate uric acid levels, a byproduct of tissue breakdown, potentially explaining the rise in gout cases.
Despite these concerns, experts caution against discouraging the appropriate use of GLP-1 medications, which have demonstrated significant benefits for blood sugar control, weight loss, and cardiovascular risk reduction. In addition to bone density screenings, experts recommend that patients ensure adequate nutrition and engage in resistance training to help preserve muscle and bone during weight loss.
A spokesperson for Novo Nordisk, the manufacturer of GLP-1 medications, stated that the company prioritizes patient safety and collaborates closely with the U.S. Food and Drug Administration (FDA). Liz Skrbkova, head of U.S. media relations for Novo Nordisk, emphasized that the known risks and benefits of these drugs are reflected in the current FDA-approved labeling. She noted that semaglutide, one of the GLP-1 medications, has shown cardiovascular, kidney, and liver benefits when used under medical supervision.
“Osteoporosis is a complex condition that develops over many years as a result of interdependent risk factors,” Skrbkova added.
These findings underscore the need for healthcare providers to closely monitor bone health in older adults prescribed GLP-1 medications, ensuring that the benefits of these treatments are balanced with potential risks.
According to Fox News Digital, the implications of these studies are significant for the management of diabetes and obesity in older populations.