GLP-1 medication — together with Ozempic and Wegovy — could also be tied to a barely greater threat of osteoporosis and gout, in accordance with analysis introduced Monday on the American Academy of Orthopaedic Surgeons’ annual assembly.
Dr. John Horneff, an affiliate professor of orthopedic surgical procedure on the College of Pennsylvania and the lead creator of the examine, mentioned he started trying into the difficulty after some sufferers appeared to develop critical tendon tears after comparatively minor accidents. That led them to look at whether or not GLP-1s may have an effect on bone and different connective tissue extra broadly.
“Persons are taking these medicines, and clearly there’s an amazing quantity of upside,” Horneff mentioned. “However with that, they begin to lower their consumption of meals and vitamins.”
Osteoporosis is a illness that weakens the bones and makes them likelier to interrupt or fracture, usually from minor falls. It’s a standard concern for a lot of older adults and for individuals who lose a big quantity of weight over a brief time frame. Gout, in the meantime, is a painful type of arthritis that may happen when the physique has an excessive amount of uric acid, which may come from a eating regimen excessive in purple meat and alcohol — in addition to fast weight reduction.
Within the new examine, which has not but been printed in a peer-reviewed journal, researchers analyzed 5 years of medical information from greater than 146,000 adults with a prognosis of each weight problems and Sort 2 diabetes.
The examine in contrast sufferers taking GLP-1 medication to sufferers not taking them.
The information didn’t embrace detailed details about which GLP-1 drug every affected person was taking, although medicines documented included semaglutide, bought as Ozempic and Wegovy, and liraglutide, bought as Victoza and Saxenda.
About 4% of GLP-1 customers developed osteoporosis, in contrast with a little bit over 3% of nonusers — an elevated threat of about 30%. A associated situation, osteomalacia, which includes the softening of the bones, was uncommon but in addition occurred about twice as usually amongst individuals on GLP-1s.
Charges of gout have been additionally barely greater — 7.4% for GLP-1 customers versus 6.6% for nonusers — an elevated threat about 12%.
“It’s not enormous,” Horneff mentioned. “However inside that information that was put in there, you even noticed practically a doubling of the chance of getting some type of bone mineral density concern at 5 years.”
“Weight reduction does trigger bone loss,” Dr. Clifford Rosen, a professor of drugs at Tufts College who has been finding out the potential influence of GLP-1s on bone well being. He wasn’t concerned with the brand new analysis.
“The query we’ve been finding out is whether or not it is a regular compensation of the skeleton, it’s simply reshaping itself, or whether or not that is really a threat for dropping bone that’s extra fast than what can be anticipated,” Rosen mentioned.
As a result of the brand new analysis was observational, it could actually’t show the medicines induced both situation. Horneff mentioned the group didn’t learn about sufferers’ eating regimen or train habits, or whether or not they have been taking vitamin D dietary supplements or different vitamins vital for bone well being. However the outcomes echo different analysis, together with a examine printed in February within the Journal of Scientific Endocrinology & Metabolism that linked GLP-1 medication to a better threat of osteoporosis-related fractures in older adults with Sort 2 diabetes.
The Meals and Drug Administration notes in its label for semaglutide that it’d enhance the chance of bone fractures in older adults and ladies, Rosen mentioned.
Dr. Susan Spratt, an endocrinologist and the senior medical director for the Inhabitants Well being Administration Workplace at Duke Well being in North Carolina, questioned whether or not the elevated threat was because of the fast weight reduction or another mechanism of the drug.
She mentioned some research have prompt musculoskeletal advantages with GLP-1 medication and that she usually sees enhancements in joint ache amongst sufferers who reduce weight on the medicines. However she emphasised that joint well being and bone density should not the identical.
Horneff mentioned extra analysis is required to grasp why GLP-1 medication may have an effect on bone well being.
One concept, he mentioned, is that as a result of the medicines suppress urge for food, some sufferers might not get sufficient key vitamins, resembling vitamin D and calcium, that are vital for sustaining bone well being.
One other risk is that the fast weight reduction itself modifications how the physique builds and breaks down bone.
“It’s the identical thought like once we all the time hear about astronauts going up into house they usually’re in a gravity-zero atmosphere for too lengthy,” Horneff mentioned. “There’s nothing forcing their bones to type of maintain their weight anymore. And lots of these astronauts come again with low bone density. So the thought is, these sufferers, their skeleton was used to type of sustaining one body, after which impulsively, that’s being decreased.”
For gout, Horneff mentioned, fast weight reduction can result in a brief spike in uric acid, rising the chance of gout.
Dr. Christopher McGowan, a gastroenterologist who runs a weight reduction clinic in Cary, North Carolina, mentioned that even when GLP-1 medication do enhance the chance, it doesn’t imply sufferers are powerless. Different information, he mentioned, counsel that when GLP-1s are mixed with structured train, bone density loss is basically mitigated.
“That tells us way of life elements play a serious function,” he mentioned.
The analysis, McGowan mentioned, shouldn’t alter the prescribing of GLP-1 medicines. He mentioned it’s a reminder that weight problems remedy additionally requires steering on protein consumption, train and bone well being monitoring.
“The takeaway isn’t worry. It’s refinement,” he mentioned.
