Overview
- An AAOS-presented observational study of about 146,000 adults with obesity and Type 2 diabetes found higher five-year rates of osteoporosis (4% vs a little over 3%), osteomalacia (about twice as often), and gout (7.4% vs 6.6%) among GLP-1 users.
- The AAOS analysis has not been peer-reviewed and lacked details on diet, exercise, supplement use, or the specific GLP-1 prescribed, limiting conclusions about causation.
- A separate Epic Cosmos analysis reported nuanced results: among patients with Type 2 diabetes who maintained stable weight, GLP-1 use correlated with an 8.7% lower osteoporosis risk, while weight loss increased risk in both users and nonusers.
- In adults without diabetes taking weight loss medications, the Epic analysis associated GLP-1 prescriptions with a 22% higher osteoporosis risk versus other weight loss drugs among those with stable weight, after adjusting for key confounders.
- The new signals echo prior fracture-risk findings and FDA labeling for semaglutide, and clinicians recommend nutrition support, adequate protein, vitamin D and calcium when indicated, resistance and weight-bearing exercise, and bone-health monitoring rather than broad changes to prescribing.