In recent years, there has been a rise in popularity in glucagon-like-peptide-1 medications, commonly referred to as GLP1s and more likely to be known under their brand names such as Ozempic, Wegovy or Mounjaro. These medications are commonly used to treat type 2 diabetes and certain brands are approved in Australia to be used for chronic weight management. With a number of patients coming through our doors taking these medications, it prompted us to have a look at their impact on bone health.

Diabetes impact on bone health

According to Healthy Bones Australia, people with type 1 diabetes are at a higher risk of having low bone mass, as the condition can impact them at at time when they are building the majority of their skeletal mass, in childhood and adolescence. While type 2 diabetes is different, and may not have a direct impact on bone density, those with type 2 diabetes have a higher lifetime risk of developing a fracture. The reasons appear to be multi-factorial, some relating to the impact higher blood sugar can have on bone density and architecture, and others relating to complications that can arise as a result of the condition that may result in increased risk of falls later in life. 

GLP1-s and bone health

According to a review by Zhao et al. in 2017, GLP1 medications may be beneficial to bones, if we consider them in isolation to any weight loss. That is, the drugs themselves may actually have a bone preserving effect, though research is currently inconclusive.

The main outcome of taking these medications is significant weight loss, and it is actually this that is most likely to have a detrimental effect on muscle and bone health. Studies looking at the impact of these drugs show that in the studies spanning 68-72 weeks, participants lost up to 10% of their muscle mass, which is the equivalent to the muscle mass lost across 20 years of ageing (Mechanick et al., 2025). Another study found that between 25-39% of all weight loss while taking these medications is from muscle mass (Prado et al., 2024).

With such rapid loses of muscle, and even just considering the significant loss of size that accompanies significant loss of body mass, it is necessary to consider the bones. Our bones remain dense directly in correlation to how much force is put through them. That is, how much our muscles are contracting and pulling on the bones. With less muscle mass, and less body mass, there is less loading on the bones, and as such losses in bone density can accompany losses in body weight, particularly when occurring in such high amounts and at such high speeds (Jensen et al., 2024). 

How to reduce muscle and bone loss

There are a couple of really important considerations from an allied health standpoint when taking these medications and that is to consult with a dietician alongside taking these medications to avoid completely depriving the body of the nutrients required to continue to function in a healthy manner. The other is to commence resistance based exercise program to maintain muscle and bone mass and to mitigate loss of these tissues as much as possible. Some early research has indicated that exercise can mitigate bone density losses associated with these medications (Jensen et al., 2024).  

Many GPs are sending their patients for DEXA scans prior to starting these medications as well as referring to physio/exercise physiology and dietetics to facilitate appropriate support throughout the process. This may be particularly important in the context of diabetes or other co-morbidities that might already impact bone health.

Take aways:

• GLP1s like Ozempic and Wegovy are being prescribed for diabetes management and in some cases for chronic weight management
• A side effect of these medications is often significant weight loss
• Significant weight loss is likely to include muscle mass
• Loss of muscle mass results in loss of bone & can be dangerous to your health in the long term
• You can mitigate these effects with appropriate dietary measures as well as by doing resistance training 
• Getting regular DEXA scans while on these medications likely to help in monitoring their effect on these aspects

We offer 1:1 consultations and small group classes to help you with an exercise program to help support you when taking these medications. Click here to get started with any of our physios. 

References:

1. Healthy bones Australia, https://healthybonesaustralia.org.au/resource-hub/fact-sheets/diabetes-bone-health/. 
2. Zhao C, Liang J, Yang Y, Yu M, Qu X. The Impact of Glucagon-Like Peptide-1 on Bone Metabolism and Its Possible Mechanisms. Front Endocrinol (Lausanne). 2017 May 3;8:98. doi: 10.3389/fendo.2017.00098. PMID: 28515711; PMCID: PMC5413504.
3. Mechanick JI, Butsch WS, Christensen SM, Hamdy O, Li Z, Prado CM, Heymsfield SB. Strategies for minimizing muscle loss during use of incretin-mimetic drugs for treatment of obesity. Obes Rev. 2025 Jan;26(1):e13841. doi: 10.1111/obr.13841. Epub 2024 Sep 19. PMID: 39295512; PMCID: PMC11611443.
4. Prado, Carla M et al. (2024), Muscle matters: the effects of medically induced weight loss on skeletal muscle, The Lancet Diabetes & Endocrinology, Volume 12, Issue 11, 785 - 787
5. Jensen SBK, Sørensen V, Sandsdal RM, Lehmann EW, Lundgren JR, Juhl CR, Janus C, Ternhamar T, Stallknecht BM, Holst JJ, Jørgensen NR, Jensen JB, Madsbad S, Torekov SS. Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Jun 3;7(6):e2416775. doi: 10.1001/jamanetworkopen.2024.16775. PMID: 38916894; PMCID: PMC11200146.