GLP-1s and bone density: What the new research means for you

In this article:

• What research found
• Who\'s most at risk
• Do you need a DEXA scan?
• How to protect your bone density
• FAQs

In this article

• What research found
• Who\'s most at risk
• Do you need a DEXA scan?
• How to protect your bone density
• FAQs

Glucagon-like peptide-1 (GLP-1) receptor agonists, commonly known as GLP-1s, include medications such as Ozempic (semaglutide), Wegovy (semaglutide), Saxenda (liraglutide), and Trulicity (dulaglutide). These medications offer many health benefits, but you may have questions about their drawbacks, such as their potential effect on bone health. Some research has linked GLP-1 use to a higher risk of osteopenia or osteoporosis, although a direct cause-and-effect relationship has not been established. Here’s what the recent research says about  GLP-1s, fracture risk, and bone density, as well as steps you can take to help protect your bones while taking a GLP-1..

What the new research actually found

Research presented at the 2026 annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that among people with Type 2 diabetes or obesity, those who were taking a GLP-1 agonist had a 29% higher risk of developing osteoporosis than those who were not taking one after five years. It also found a 150% increase in osteomalacia, a disease that causes the bones to soften and weaken, in the same population.

Now, does this mean that GLP-1 receptor agonists directly raise osteoporosis risk? Not necessarily. For starters, this was a retrospective study, not a clinical trial, which means that it used existing data and medical records to learn what factors may be associated with a specific disease or condition. “These findings may suggest an association, meaning they identify correlations between two variables (in this case, GLP-1 use and bone-related outcomes may be related), but cannot be used to establish causation (where GLP-1 use would be the confirmed reason for the observed bone outcomes),” explains Anastasiya Shor, PharmD, the Director of the Drug Information Center at Touro College of Pharmacy in New York.

Is it the drug, or the weight loss?

“There is currently insufficient evidence to support a direct effect of GLP-1 medications on bone density,” says Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California. “Instead, several secondary factors contribute to bone loss,” he adds.

According to Dr. Ali, these include:

• Significant weight loss or loss of muscle mass, which can cause hormonal and metabolic changes that affect bone health
• Reduction in exercise or activity due to fatigue (a known GLP-1 side effect), which decreases the mechanical load on the bones and contributes to low bone density
• Appetite suppression leading to a lack of essential vitamins and minerals that maintain bones, such as calcium, vitamin D, and protein
• Underlying health conditions or age, which can cause bone loss 

In other words, changes in bone density are likely due to other health or lifestyle changes rather than a side effect of these diabetes and obesity drugs.

Who’s most at risk

The groups of people most at risk of osteoporosis are the same whether there is a GLP-1 agonist in the mix or not. Per Dr. Shor and Dr. Ali, these include:

• Perimenopausal and postmenopausal women with low estrogen
• Adults older than 60 years of age
• People with a sedentary lifestyle
• People with preexisting bone conditions or prior fractures
• People with a family history of osteoporosis
• People with a low BMI (body mass index) who are underweight
• People with poor nutrition or who consume alcohol in excess
• People who smoke

However, certain GLP-1 receptor agonist side effects can contribute to these factors, such as becoming underweight due to appetite loss or becoming sedentary due to fatigue or nausea from the medication.

Should you get a bone density (DEXA) scan?

If you’re generally healthy and don’t fall into a high risk group, you likely don’t need to get a DEXA scan to measure your bone density before you start taking a GLP-1, Dr. Ali says. However, “If a patient has multiple risk factors for osteoporosis, obtaining a baseline DEXA scan before starting a GLP-1 treatment can help guide clinical management,” he adds. From there, your healthcare provider may advise getting a new scan every one to two years.

Depending on where you live and the type of facility you visit, a DEXA scan can cost anywhere from $40 to $250 out of pocket. “Insurance coverage varies widely,” Dr. Ali says. “However, if there is a documented medical necessity for a DEXA scan, it is generally covered.”

How to protect your bone density while on a GLP-1

“I advise all my patients undergoing weight loss, whether through medication, counseling, or surgery, that the goal is to eliminate fat while preserving muscle and bone,” Dr. Ali says. Fortunately, there are simple, concrete steps you can take to make sure you don’t lose bone density while taking GLP-1 drugs. Here are the most important ways to promote bone strength.

Doing resistance and weight-bearing exercise

The combination of resistance training and aerobic exercise is the most effective for combatting loss of bone density in postmenopausal women, according to a review published in Scientific Reports. “Weight-bearing or impact exercises include running, dancing, lifting weights, or playing sports,” Dr. Shor says. “Older adults can also be encouraged to engage in balance-building exercises like Tai Chi to reduce the likelihood of falls, which can lead to fractures.” Resistance exercises include squats, deadlifts, and push-ups.

Eating enough protein

Dr. Ali explains that getting enough protein is key for supporting bone formation and maintaining bone mass. Another study in Scientific Reports found a positive association between protein intake and bone mineral density (BMD), with BMD improving as protein intake increased. According to the American Heart Association, the recommended daily intake of protein for adults is 0.8 grams per kilogram of bodyweight.

Getting adequate calcium and vitamin D

“Patients taking a GLP-1 may have a decreased appetite and consume less food, leading to potentially low levels of calcium and vitamin D,” Dr. Shor says. These two micronutrients are essential for healthy bones. First, she suggests trying to eat a variety of foods that contain calcium and vitamin D, such as dairy products, leafy greens, almonds, oranges, fish, eggs, and mushrooms. Then, if you suspect you’re still not getting enough, talk to your healthcare provider about supplementation. “I recommend that all my patients take multivitamins alongside additional calcium and vitamin D supplements,” Dr. Ali says.

If you’re worried about your budget, SingleCare has coupons for supplements.

Frequently asked questions

What is a good T-score for bone density?

A T-score of -1 or higher means your bones are healthy, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Does everyone lose bone density on a GLP-1?

No. If you’re taking the right steps to keep your bones healthy and don’t have any other issues affecting your bone health, you may not lose bone density while taking a GLP-1.

How long do you have to be on a GLP-1 before bone density changes show up?

GLP-1s do not appear to directly affect bone density. However, after you start losing weight, bone density may start to change if you don’t make the appropriate diet and lifestyle changes, such as following a protein-rich diet and strength training.

Can you take calcium and vitamin D supplements while on a GLP-1?

Yes, and it’s often recommended.

Does stopping a GLP-1 reverse bone density loss?

Not necessarily, since it does not appear to be the GLP-1 itself that directly causes changes in bone density.

The bottom line

“Changes in bone density do not appear to be a direct effect of the medication itself, but rather a consequence of weight loss, hormonal shifts, and nutritional changes,” Dr. Ali says. That means that if you make the right diet and lifestyle changes while on a GLP-1, an increased osteoporosis risk is not a foregone conclusion. Be sure to talk to your healthcare provider as you’re getting started about any concerns you have. They can discuss the best solutions for you.