More Than Just Weight Loss—Working Out on GLP-1s Linked to Surprising Benefit However, the study also found that exercising while taking liraglutide and other GLP-s may help prevent bone loss
A recent study suggests that people taking the GLP-1 liraglutide experienced more bone loss than people who exercised during the same time period
- A new study suggests that people who take the GLP-1 receptor agonist liraglutide may lose bone due to rapid weight loss.
- However, the research found that exercising helped preserve bone loss.
- Experts said that the findings may apply to other GLP-1s, such as semaglutide, the active ingredient in Ozempic.
A rapid drop in weight can result in a loss of bone density, but a new study suggests that exercising may counteract that side effect for people taking weight management drugs.
The research, published in the journal JAMA Network Open, focused on the GLP-1 receptor agonistliraglutide, used for weight loss and to treat type 2 diabetes. Researchers discovered that people who took the drug but didn’t exercise regularly lost bone mineral density. At the same time, those on the medication who did routine physical activity had no bone loss despite losing more weight.
While this study focused solely on liraglutide, senior author Signe Sørensen Torekov, PhD, said she “would presume” that exercise would also stave off bone density loss in people taking other GLP-1s, such as semaglutide, the active ingredient in the popular weight loss drugs Ozempic and Wegovy. “It is the same mode of action…but it needs to be investigated,” said Torekov, a professor of clinical translational metabolism at the University of Copenhagen Department of Biomedical Sciences.
Prior to this study, combining these medications with exercise had "not been investigated in the context of bone health," she said.
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Measuring Weight and Bone Loss
For the study, the researchers performed a “secondary analysis” of a randomized clinical trial conducted from August 2016 to November 2019 at the University of Copenhagen and Hvidovre Hospital in Denmark. The trial included 195 participants aged 18 to 65 with obesity but not diabetes. Their average age was 42.84, and about two-thirds were women.
The participants consumed about 800 calories daily for eight weeks and were then randomly split into four groups. For nearly four years, one group took 3 milligrams (mg) of liraglutide daily, another took a placebo, the third performed moderate-to-vigorous intensity exercise, and the last group took the drug and also exercised.
The exercise consisted of group sessions involving 30-minute interval-based indoor cycling and 15-minute circuit training workouts, which included both aerobic exercise and resistance training (with weights and without).
“The most frequently performed individual exercises were cycling, running, brisk walking, and individual circuit training,” Torekov said. “Participants wore heart rate monitors during all exercise sessions to monitor adherence.”
The researchers found that those taking liraglutide had more bone loss than those in the exercise group, despite similar weight loss. Participants in the combination exercise-GLP-1 group experienced the most weight loss, but their bone mineral density levels remained similar to those not taking the medication. Furthermore, people on liraglutide lost similar amounts of weight as the combination group but lost more bone mineral density in their hips and spine compared to those who engaged solely in exercise.
Whether weight management drugs lead to a reduction in bone density hasn’t been clear cut due to limitations in the research, such as “no BMD assessments, short duration of intervention, or the use of other diabetic drugs that may have affected fracture risk,” Torekov explained.
Vijaya Surampudi, MD, MS, an associate professor of medicine at the David Geffen School of Medicine at UCLA and a quality improvement officer for UCLA Health, told Health that the study is “unique” because it includes people with obesity but not diabetes, which makes it clearer that any bone loss may be due to the medication rather than the disease.
Furthermore, “This study provides us more information on whether the decrease in bone mineral density with weight loss can be reduced with lifestyle measures,” she added.
Exercising for a ‘Better’ Outcome
While the study suggests that exercise can boost the bone health of people on GLP-1s, a few factors should be considered.
For one, the study focused on people younger than 65 and those without chronic health issues, like diabetes, so the results may not apply to these groups.
It also tested only one GLP-1, liraglutide. Experts said the results would likely apply to other GLP-1s, as Torekov suggested, but King’s College associate professor Jane Howard, MB BChir, PhD, said it’s possible that exercise’s protective effects may not be as pronounced for people using these other drugs.
“Yes, it likely will extrapolate to other” GLP-1 receptor agonists, Howard said. “However, the weight loss for semaglutide is significantly greater, meaning the likely loss of lean muscle mass and subsequent physical stress in bone density may be greater, potentially outweighing any direct beneficial effects on bone.”
That said, researchers said it makes sense that exercise would help preserve bone health for people taking GLP-1s. Exercise builds and preserves muscle mass, “which affects the biomechanical stress and force on bones during movement,” Howard said.
She recommends engaging in “weight-bearing exercises” such as walking, jogging, and resistance training to preserve muscle mass and bone. While an activity like swimming, for example, is good for cardiovascular health, it’s less helpful for protecting bone density because it’s not a weight-bearing exercise, she explained.
Surampudi said that losing weight and protecting bone density and overall health is multifaceted.
“The big takeaway from this study is diet and exercise are fundamental to healthy living and improving metabolic health,” Surampudi said. “Whether the endpoint is weight loss or metabolic health, all studies continue to demonstrate that weight loss interventions with medications or surgery have better outcomes when diet and exercise are incorporated.”
This story originally appeared on: Health News - Author:Brian Mastroianni
