Complex clinical encounter series: Glucagon-like peptide-1 receptor agonists-induced weight loss: are we paying attention to bone health?

A 65-yr-old White woman with obesity class II, hypertension, hyperlipidemia, obstructive sleep apnea, osteoarthritis, and pre-diabetes was started on s.c. semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), for weight loss. Her DXA BMD, 3 mo prior to the initiation of semaglutide, showed osteopenia. She did not have personal or family history of fractures. She had gone into menopause at the age of 52 with no other risk factors for osteoporosis. She maintains an adequate intake of calcium and cholecalciferol, and she is active but does not exercise regularly. After 1 yr on semaglutide, she lost ~15% of her weight with improvement of blood pressure, lipid profile, and sleeping pattern. She reports 2 recent falls. The initial recommendation was to repeat DXA in 2-3 yr. However, recent evidence suggests that in elderly patients experiencing ~9% weight loss with semaglutide, monitoring bone remodeling markers and BMD after 1 yr of treatment is justified. Counseling on adequate protein intake and strengthening exercise to preserve muscle mass should also be provided.