Millions of Americans using GLP-1 drugs such as Ozempic, Zepbound, and Wegovy for obesity or type 2 diabetes may encounter unexpected risks to bone health.
Study links GLP-1 use to bone problems and gout
A study presented at the 2026 American Academy of Orthopaedic Surgeons annual meeting identified a connection between these medications and higher risks of osteoporosis, osteomalacia, and gout. The analysis examined five years of medical records from nearly 147,000 adults with type 2 diabetes and obesity but has not undergone peer review.
The lead researcher became interested in the topic after several patients experienced serious tendon tears from minor injuries. Findings indicated that GLP-1 use correlated with a “significantly increased” risk of these conditions.
Experts note that the results do not establish causation. The observational design only revealed an association, not proof that the drugs directly caused the issues.
Marci Laudenslager, an obesity medicine physician at Johns Hopkins, pointed out key limitations. The study depended on medical records that assumed patients consistently took their prescribed GLP-1s, which often isn’t the case due to cost, shortages, or side effects. It also overlooked lifestyle factors like exercise, nutrition, or other conditions affecting bone health.
The absence of peer review further limits confidence in the conclusions. Kelyssa Hall, an exercise physiologist at Hospital for Special Surgery, stated that more research is necessary.
Weight loss—not the drugs—may explain the risks
Though the study raised concerns, other evidence suggests the link between GLP-1s and bone loss could result from rapid weight reduction rather than the medications themselves.
Hall explained that GLP-1s can lead to quick weight loss, reducing the load on the skeleton. Bones strengthen under stress, so losing weight rapidly decreases that stimulus, potentially lowering bone density over time.
This effect isn’t limited to GLP-1s. Significant weight loss from any method—diet, surgery, or other drugs—can affect bone metabolism. Laudenslager added that the changes appear tied to the amount of weight lost, not a direct effect of the medications.
Research on the relationship between GLP-1s and bone health continues. For now, experts agree that the benefits of these drugs usually outweigh the risks for those who need them.
Patients on GLP-1s might notice their bones feeling different after weight loss, but the drugs aren’t solely responsible. The body adapts to changes in load, and without proper countermeasures, bone density can decline regardless of how the weight was lost.
How to protect bone health while on GLP-1s
Experts suggest several ways to reduce potential bone risks during treatment.
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Strength training plays a key role. Resistance exercises improve bone density and help prevent muscle loss, a common issue during rapid weight reduction. Hall recommends two to three sessions weekly, with rest days in between. Beginners should start slowly and consult a doctor before beginning a new routine.
Nutrition matters. GLP-1s often suppress appetite, leading some to consume too few calories. Severe restriction can harm bones, so maintaining adequate intake is essential. Protein supports bone mass, with a general guideline of 0.8 grams per kilogram of body weight daily, though some may require more.
Aim for steady weight loss. Losing 0.5 to 2 pounds per week is safer for bones than rapid shedding. If weight loss speeds up, doctors may adjust the dosage to slow the process.
Regular check-ups with a healthcare provider can detect early signs of bone loss. Laudenslager noted that clinically significant bone loss typically develops over years, allowing time for intervention.
For those considering GLP-1s, she advises seeking care from a board-certified obesity medicine physician. Directories from the American Board of Obesity Medicine and Obesity Action Coalition help locate qualified providers.
These medications remain valuable for managing chronic conditions, despite lingering stigma. Laudenslager emphasized that side effects are manageable when prescribed by knowledgeable professionals.
