GLP-1 receptor agonists, like Ozempic and Wegovy have revolutionised weight loss and type 2 diabetes management by mimicking the natural hormone GLP-1 to regulate blood sugar and suppress appetite.

These are marketed under trade names Semaglutide (Ozempic, Wegovy, & Rybelsus), Liraglutide (Victoza, Saxenda), Dulaglutide (Trulicity), Exenatide (Byetta, Bydureon), Tirzepatide (Mounjaro) Albiglutide (Tanzeum) and Lixisenatide (Adlyxin & Lyxumia)

While there are benefits to these drugs, recent studies have highlighted potential impacts on bone health, particularly bone density. This article explores how these medications work, their potential risks to bone health, and precautions for individuals managing obesity, type 2 diabetes, and osteoporosis.

How GLP-1 Receptor Agonists Work 

GLP-1 receptor agonists mimic a hormone that is naturally produced in the gut called glucagon-like peptide-1 (GLP-1). They work by:

• Stimulating insulin secretion to regulate blood sugar.
• Suppressing glucagon, which reduces sugar production in the liver.
• Slowing gastric emptying, leading to prolonged feelings of fullness.
• Acting on the brain’s appetite centres to reduce hunger and calorie intake.
• Suppressing reward pathways by modulating dopamine activity in the brain’s reward centres, reducing the desire for high-calorie foods and overeating, and may modulate other addictive behaviours.

These combined effects promote significant weight loss, making GLP-1 receptor agonists a game-changer for managing obesity and type 2 diabetes for some people.

How GLP-1 Reduces Appetite

1. Activation of GLP-1 Receptors:

• After food intake, GLP-1 is secreted by intestinal cells and binds to GLP-1 receptors in the body.
• These receptors are present in the hypothalamus, a key brain region for regulating hunger and satiety.

2. Neural Signalling:

• GLP-1 communicates with the brain via the vagus nerve, transmitting signals from the gut to the hypothalamus.
• This activates specific neurons in the hypothalamus, such as pro-opiomelanocortin (POMC) neurons, which promote feelings of fullness.

3. Suppression of Reward Pathways:

• GLP-1 modulates dopamine activity in the brain’s reward centres, reducing the desire for high-calorie foods and overeating.

Potential Impacts on Bone Health 

While effective for weight loss, GLP-1 receptor agonists may influence bone density, particularly during rapid weight loss:

1. Bone Density Reduction: Studies suggest that significant weight loss can lead to decreased bone mineral density (BMD), increasing the risk of fractures. GLP-1 receptor agonists may exacerbate this by altering the balance between bone formation and resorption.

2. Slower Nutrient Absorption: These drugs slow gastric emptying, which could affect the absorption of essential bone-supporting nutrients like calcium and vitamin D, though evidence on this is still emerging. A reduced appetite may also reduce macro and micro-nutrient availability necessary for bone and muscle maintenance and repair.

Precautions for Individuals with Obesity, Type 2 Diabetes, and Osteoporosis 

If you are managing these conditions and considering or already using GLP-1 receptor agonists, the following steps can help minimise risks to bone health:

1. Monitor Bone Health: Regular bone density scans (DEXA,  EchoLight, or HRpQCT)  are essential, especially for individuals with a history of osteoporosis or fracture risk.

2. Optimise Nutrient Intake: Ensure adequate levels of macro and micro-nutrients through diet or supplements to support bone and muscle health. Test for deficiency and supplement where necessary after consulting a health professional with specific expertise in bone health.

3. Incorporate Heavy Weight-Bearing Exercises: Engage in suitable activities that trigger osteogenesis like OsteoStrong^® which safely mimics heavy weightlifting in a slow, controlled, and measurable way to stimulate bone formation and maintain muscle mass, to counterbalance the potential bone density loss associated with weight loss. Although exercises like walking, jogging, cycling, swimming, yoga and Pilates, are excellent for mobility and metabolic health, they do not trigger bone growth because the stimulus is insufficient to trigger osteogenesis

4. Consult Healthcare Providers: Regular check-ins with healthcare professionals can ensure that your treatment plan addresses all aspects of your health, including bone health. They may recommend additional therapies or lifestyle adjustments. Test don’t guess, and supplement for deficiency as required.  You can’t manage what you don’t measure, so testing and monitoring your health is a crucial step during any weight loss program with bone health in mind.

5. Explore Medication Alternatives or Natural Solutions: If you are at significant risk of osteoporosis, consult your doctor to determine whether GLP-1 receptor agonists are the most suitable option. For those seeking a natural alternative to traditional bone medications, the OsteoStrong^® program offers a scientifically proven approach to improve bone strength and density. This program is effective for most individuals, regardless of age or activity level, and can be integrated alongside GLP-1 treatments for a holistic approach to health.

Summary

GLP-1 receptor agonists may offer transformative benefits for managing obesity and type 2 diabetes, but they also highlight the importance of a holistic approach to health. Bone health should not be overlooked, particularly for individuals at risk of osteoporosis. By monitoring bone density, maintaining nutrient levels, and incorporating a suitable program like OsteoStrong^®, you can maximise the benefits of GLP-1 medications while safeguarding your bones.

For those managing obesity, type 2 diabetes, or osteoporosis, collaboration with medical and healthcare professionals is key to achieving long-term health and wellness. Let’s embrace these medical advancements responsibly, ensuring a balanced approach to treatment and prevention.