A growing number of doctors are sounding the alarm over a potential side effect of popular weight-loss injections, particularly for the elderly and frail. These medications, known as GLP-1 agonists, have been widely used to help people shed pounds. However, research has shown that up to 40% of the weight loss associated with these jabs comes from muscle and bone mass. This raises concerns about the risk of osteoporosis and fractures for individuals taking these medications.
Risks for Vulnerable Populations
Women who have gone through menopause are already more prone to bone loss due to hormonal changes during this stage of life. The added risk associated with GLP-1 agonists could exacerbate this problem.
Dr. Roshini Rajapaksa, a gastroenterologist at NYU Langone Health in New York City, is among those raising concerns about the potential risks associated with these medications. She emphasizes the importance of focusing not just on weight loss but also on overall health:
"We need to make sure we’re not just focusing on weight loss but also on overall health," Dr. Rajapaksa said in an interview.
Guidelines from the American Society for Metabolic and Bariatric Surgery
The American Society for Metabolic and Bariatric Surgery (ASMBS) has also weighed in on the issue. They state that while GLP-1 agonists can be beneficial for certain patients who are obese or overweight and have other health conditions such as diabetes or high blood pressure, they should only be used under close supervision by a healthcare provider experienced in their use. According to ASMBS guidelines:
- Patients should undergo regular monitoring before starting treatment and every six months thereafter to assess their response to medication.
- The patient’s body composition should also be assessed periodically using dual-energy X-ray absorptiometry (DXA) scans or other methods.
However, there is uncertainty regarding the frequency of DXA scans:
"It’s unclear how often DXA scans would need to occur," said an endocrinologist at Massachusetts General Hospital who was not involved in developing ASMBS guidelines.
She noted that there is ongoing research into whether regular DXA scans could help identify individuals at higher risk for bone loss due to GLP-1 agonist therapy.
Research Findings
Researchers from Boston University School of Medicine conducted a study involving participants aged between 18 years old who were randomly assigned to receive either semaglutide (Wegovy), a type of GLP-1 receptor antagonist medication approved to treat obesity, or placebo injections weekly over a period of approximately months. The researchers found significant differences between groups regarding changes in body composition:
- Participants receiving semaglutide lost significantly more fat mass compared to those receiving placebo.
- Both groups lost similar amounts of lean body mass (muscle), but semaglutide recipients lost less total lean body mass than those receiving placebo.
This suggests it may take a longer time to lose the same amount of muscle when taking drugs like Wegovy compared to what happens naturally without them. According to the Mayo Clinic:
"When you lose weight quickly, it’s likely losing water rather than fat. You might notice your clothes fitting differently within a few days after starting a diet. But if you’re losing inches around your waistline, hips, thighs, arms, legs, etc., then you know you’re burning fat."
Alternative Treatments
It’s worth noting that some studies suggest alternative treatments may offer better results without increasing the risk of osteoporosis or fractures. For example, a study published last year found greater reductions in visceral adipose tissue (belly fat) among participants treated with tirzepatide (Mounjaro), another type of GLP-1 receptor antagonist medication approved to treat obesity, compared to those treated with Wegovy.
According to the Mayo Clinic, tirzepatide works similarly to semaglutide but targets two types of receptors instead of one. It helps reduce hunger, suppress appetite, and increase feelings of fullness, all of which contribute to helping people lose weight.
However, it is important to note that:
"Tirzepatide may not be available in all countries or regions," according to the Mayo Clinic.
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