AT THE European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) symposium, experts explored the effects of GLP-1 receptor agonists on bone, joints, and muscle. Originally developed for Type 2 diabetes, these therapies are now widely used for obesity, raising questions about their broader impact on the musculoskeletal system.
Gülistan Bahat from Istanbul University noted that rapid weight reduction may lead to loss of bone mineral density and skeletal muscle mass, especially in older adults. However, GLP-1 receptors are expressed in bone, muscle, and joint tissues, with data suggesting anti-inflammatory and tissue-modulating effects independent of weight loss.
Nicholas Harvey from the University of Southampton discussed bone health. While obesity has been viewed as protective against fractures, diabetes complicates the picture. Type 2 diabetes is associated with a 30-40% increased fracture risk. Human evidence on GLP-1 drugs and bone remains inconclusive, with some studies showing preserved bone mineral content during weight loss, while others show reductions in hip and spine BMD. Harvey stressed that resistance exercise is critical.
Ali Mobasheri from the University of Oulu argued that osteoarthritis is a metabolically driven disease. The STEP 9 trial demonstrated that semaglutide reduced pain and improved physical function in patients with obesity-related osteoarthritis over 68 weeks, while also reducing reliance on analgesics.
Gustavo Duque from McGill University addressed concerns about lean mass loss. Preclinical data show beneficial muscular effects, and reductions in lean mass have not translated into impaired muscle function in short-term human studies. However, weight regain after stopping treatment may disproportionately accumulate as fat, including intramuscular fat.
Across all presentations, experts agreed that exercise, particularly resistance training, remains essential alongside GLP-1 therapy to preserve musculoskeletal health.