Osteoporosis, gout could be the latest GLP-1 side effects

According to data from KFF, around one in five U.S. adults have used GLP-1 drugs, with rates expected to grow over time, especially as costs decrease. Aside from weight loss and diabetes, research suggests that GLP-1s could have positive impacts on heart health, kidney disease, fertility, arthritis, and even addiction.

However, the medications also have significant side effects, including unintended muscle mass loss, nutritional deficiencies, a potential for increased risk of miscarriage or birth defects, and severe mental health issues like depression and suicidal thoughts. Some of the more severe side effects of GLP-1s are gastroparesis or stomach paralysis, intestinal blockage, inflammation of the pancreas, and gallbladder damage.

In a new study, which has not yet been peer reviewed, researchers found that GLP-1 medications may also increase the risk of osteoporosis and gout. Osteoporosis is a disease that causes the loss of bone mineral density and bone mass, which makes people more vulnerable to fractures. Gout is a type of inflammatory arthritis that is caused by a buildup of uric acid, which can occur with rapid weight loss.

For the study, researchers analyzed five years of medical records from over 146,000 patients who were obese and had type 2 diabetes and compared those who were taking GLP-1 medications to those who weren't.

Overall, researchers found that roughly 4% of patients taking GLP-1s developed osteoporosis compared to a little over 3% of those not taking GLP-1s. This represented a 30% increased risk of osteoporosis among patients taking GLP-1s. Patients taking GLP-1s also developed osteomalacia — a related condition where bones soften — twice as often as those not on the medications.

GLP-1 users also had slightly higher rates of gout compared to non-users (7.4% versus 6.6%, respectively). The increased risk of gout among patients taking GLP-1s was 12%.

Currently, it's not clear how or why GLP-1s drugs affect people's bone health, but one potential theory is that some patients on GLP-1s may not be getting enough key nutrients, such as vitamin D and calcium, due to their appetites being suppressed. Rapid weight loss on GLP-1s could also change the way the body builds and breaks down bones.

How to stay healthy while on GLP-1s

According to Christopher McGowan, a gastroenterologist who runs a weight-loss clinic in North Carolina, the research reaffirms the need for careful guidance on protein intake, exercise, and bone health for patients taking GLP-1s to ensure they're still getting proper nutrition while on the medications.

"The takeaway isn't fear," McGowan said. "It's refinement."

Separately, Ilana Muhlstein, a registered dietitian nutritionist based in Los Angeles, recommends patients regularly meet with their doctors to check their progress and assess their health. "If you're on these medications, you should be seeing your doctor at least once a year and getting labs drawn to check your vitamin and mineral levels, not just your weight," she said.

Some other ways people can stay healthy and protect their bones while on GLP-1s include:

• Exercising regularly: Weight-bearing exercises like walking, yoga, and lifting weights are great for your bone health.
• Eating healthy foods: It's important to get enough calcium, magnesium, vitamin D, protein, and other nutrients. You can also talk to your healthcare provider about supplements if you think you're not getting enough of a certain nutrient.
• Consulting with a healthcare provider as needed: If you're worried about how GLP-1s will impact your bone density or other parts of your health, you can talk to your healthcare provider about potential screenings or what you can do to reduce your risk of certain conditions.