GLP-1 medications such as Ozempic and Wegovy have transformed treatment for type 2 diabetes and obesity — but new research suggests doctors may need to pay closer attention to bone health, especially in older patients taking the drugs.
Older adults with type 2 diabetes who started GLP-1s had an 11% higher risk of fragility fractures compared to those taking other diabetes medications, a study published in February in the Journal of Clinical Endocrinology & Metabolism found.
Dr. Michal Kasher Meron, an endocrinologist at Meir Medical Center in Israel and lead author of the study, said the relative increase may sound small, but it carries weight for an at-risk population.
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"Both older age and type 2 diabetes are independent risk factors for fragility fractures," Kasher Meron told Fox News Digital. "This is a population that deserves special attention."
Fragility fractures are breaks from minor falls or routine activity, often linked to osteoporosis, and can lead to hospitalization, loss of independence and even increased mortality in older adults, Kasher Meron noted.
The study followed more than 46,000 adults 65 and older for nearly three years. After adjustments, GLP-1 users had a modest but statistically significant increase in fracture risk.
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Previous research in younger patients using older GLP-1s did not show increased fracture risk, but newer, more potent versions are now widely prescribed to older adults, Kasher Meron noted.
"In older adults treated with contemporary medications, the fracture risk picture looks different and warrants close attention," she said.
The study, however, was observational, meaning it shows an association but not causation. Researchers were unable to determine whether the risk was driven by weight loss, changes in diet, muscle loss, or a direct effect on bone.
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Nonetheless, Kasher Meron says, "Bone health should be assessed before starting these medications in older patients — not as an afterthought."
The findings come as separate research presented at the American Academy of Orthopaedic Surgeons' annual meeting this month raised additional bone health concerns.
In a large analysis of more than 146,000 adults with obesity and type 2 diabetes, GLP-1 users were found to have a 29% higher relative risk of osteoporosis over five years compared to nonusers, according to reports.
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Rates of gout were also slightly higher, affecting 7.4% of GLP-1 users compared to 6.6% of nonusers — about a 12% relative increase.
Osteomalacia, a softening of the bones, was rare but occurred about twice as often in GLP-1 users, according to the study, which has not yet been peer-reviewed. It was also observational, showing only an association. Fox News Digital has reached out to the researcher for comment.
Several mechanisms could be at play, experts say. GLP-1 medications suppress appetite and can lead to rapid weight loss. Significant weight loss is known to reduce bone density, partly because less mechanical load is placed on the skeleton.
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"It’s the same idea as when we always hear about astronauts going up into space, and they’re in a gravity-zero environment for too long," lead author Dr. John Horneff, an associate professor of orthopedic surgery at the University of Pennsylvania, told NBC News. "There’s nothing forcing their bones to kind of hold their weight anymore. And a lot of those astronauts come back with low bone density."
Additionally, eating fewer calories may also mean lower intake of calcium, vitamin D and protein — nutrients critical for bone strength.
Rapid weight loss can also temporarily increase uric acid levels, a byproduct of tissue breakdown, which may explain the uptick in gout cases.
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Despite the findings, experts say the results should not discourage appropriate use of GLP-1 medications, which have proven benefits for blood sugar control, weight loss and cardiovascular risk reduction.
In addition to bone density screening, experts say patients should ensure adequate nutrition and resistance training to help preserve muscle and bone during weight loss.
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A spokesperson for Novo Nordisk, which manufactures GLP-1 medications, said the company prioritizes patient safety, works closely with the U.S. Food and Drug Administration (FDA) and welcomes independent research into its products.
The known risks and benefits of the drugs are reflected in the current FDA-approved labeling, Liz Skrbkova, head of U.S. media relations for Novo Nordisk, told Fox News Digital. She emphasized that semaglutide has demonstrated 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.
Fox News Digital's Melissa Rudy contributed reporting.
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