The new Medicare GLP-1 Bridge program expands access to weight loss drugs for older adults, but experts warn that rapid weight loss may accelerate bone loss and fracture risk. Kristen Beavers of Wake Forest University highlights the need for screening and lifestyle interventions to protect skeletal…
The new Medicare GLP-1 Bridge program is designed to provide broader and more affordable access to weight loss medications, addressing the growing obesity crisis in the United States. However, there is a significant concern regarding bone health that accompanies this expanded access.
Kristen Beavers, a Wake Forest University expert on aging, obesity and bone health, explained that the rapid and substantial weight loss resulting from GLP-1 use can amplify the loss of bone and muscle that naturally occurs when older adults lose weight. Losing too much bone mass increases the risk for fractures, disability and loss of independence, she said.
Beavers emphasized that this is not a niche problem. Nearly 40% of older adults in the U.S. currently live with obesity, which translates to roughly 23 million people. As GLP-1 medications make substantial weight loss accessible to a growing share of that population, the number of older adults facing this bone loss tradeoff is expected to climb.
Beavers drew a comparison to bariatric surgery, noting that when the degree of weight loss is similar, such as around 25%, the magnitude of bone loss is also likely to be increased. She finds this concerning for older adults in particular, because they are already at greater risk for fracture.
She advises physicians to screen for bone strength in this at-risk population before prescribing a GLP-1 medication. Beavers has devoted her career to studying how older adults can lose weight without sacrificing bone and muscle mass. She has received more than $12 million in National Institutes of Health funding to investigate this issue.
Beavers clarified that older adults do not necessarily have to choose between weight loss and bone health, but the tradeoffs must be carefully managed. Losing weight has been shown to improve mobility, reduce joint stress, control blood sugar, and reduce the risk of cardiovascular disease, among other benefits.
However, because weight loss in this age group always includes some loss of muscle and bone, it also increases the risk of fractures and the accompanying health and lifestyle problems. Beavers described it as a deliberate balance: obtaining the cardiometabolic benefits of weight loss without quietly creating a new problem of skeletal fragility in a population least able to recover from fractures.
In one study examining a weekly dose of the GLP-1 drug semaglutide, which is sold as Ozempic or Wegovy, people lost about 10% of body weight and 2.5% of bone. In comparison, people who lose the same amount of weight through lifestyle changes such as calorie restriction and exercise lose 12% of bone.
Beavers noted that this is just one study, but it aligns with what is already known about weight loss contributing to bone loss regardless of how that weight loss is achieved. She pointed out that this dynamic is now playing out on a much larger scale.
"Take this and apply it to this next generation of GLP-1 medicines, which are capable of producing a degree of weight loss once only achievable with bariatric surgery, in a population that is already losing bone due to age," Beavers said. "And I think there is a clinical risk here that needs to be managed."
Beavers referred to Wegovy's own prescribing information as real-world evidence of that risk. Drawing on data from the SELECT cardiovascular outcomes trial, the label reports more hip and pelvis fractures in women taking the drug compared to placebo, with rates of 1% versus 0.2%. The difference was even starker in patients aged 75 and older, where fracture rates were 2.4% versus 0.6%.
A joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society suggests that GLP-1 treatment should be accompanied by care addressing diet, exercise and lifestyle. The advisory notes that many patients on GLP-1s receive little to no nutrition or lifestyle counseling, creating a significant gap in care.
Beavers has studied multiple modes for safer weight loss in older adults. Her research includes resistance training, wearing a weighted vest, and using osteoporosis drugs such as bisphosphonates like Fosamax.
Based on her research, she recommends that older adults living with obesity who are considering starting a GLP-1 for weight loss should undergo bone health screening, incorporate resistance exercise, ensure adequate protein and calcium intake, and work with a healthcare team that includes a registered dietitian or exercise specialist.
Beavers is a research professor in the Department of Health and Exercise Science at Wake Forest University. She also serves as a professor of Internal Medicine in the Section on Gerontology and Geriatric Medicine and as associate director of the Sticht Center for Healthy Aging and Alzheimer's Prevention at Wake Forest University School of Medicine.
She recently received a five-year NIH grant totaling more than $800,000 to enhance research and educational capacity in emerging areas relevant to aging, obesity, and body composition at Wake Forest. This grant includes studying the risk-benefit profile of GLP-1 use in older adults.
Beavers can provide expert insight on how greater access to weight loss drugs through the Medicare GLP-1 Bridge program raises concerns about bone loss in older adults. To arrange an interview, email email protected .
Wake Forest University's motto, Pro Humanitate, reflects a commitment to academic excellence and to using ideas, knowledge and talents on behalf of humanity. The university's Winston-Salem, N.C., campus is home to nearly 9,000 students, with more studying at Wake Forest locations in Charlotte, N.C., Washington, D.C., and around the world. In addition to the undergraduate College, the university encompasses the Graduate School of Arts and Sciences, as well as Schools of Business, Law, Medicine, Divinity and Professional Studies. Founded in 1834, Wake Forest embraces a university-wide approach to developing leaders of character and integrity. Learn more at www.wfu.edu.
Peptides referenced: Semaglutide, GLP-1.
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