What an orthopedic surgeon wants every patient to understand about GLP-1 medications, muscle loss, bone health, and joint protection
By Brian Nwannunu, MD, MS
If you’re taking Ozempic, Wegovy, Mounjaro, or another GLP-1 medication, you’re part of one of the fastest-growing health trends of the decade. GLP-1 medications have evolved from diabetes treatments into one of the most significant medical developments of our time. Millions of Americans are now taking them to lose weight, and for many, the results have been remarkable. Patients are experiencing significant weight loss, improved blood sugar control, and meaningful cardiovascular benefits.
But what happens to your bones, muscles, and joints while that weight comes off?
That’s the question many patients aren’t asking, and as an orthopedic surgeon, I believe they should.
I think GLP-1 drugs are excellent medications for the right patient, but the full picture is more complex than many people realize. Some of the risks may affect the very patients who are least equipped to handle them. Here’s what I wish every GLP-1 patient knew.
Your Knees Love It.
Let’s start with the good news. Excess body weight is extremely hard on the joints, especially the knees. The numbers are striking. For every additional pound of body weight, the knee joint experiences roughly four pounds of force during walking.
That means if you’re carrying an extra 25 pounds, your knees may be absorbing the equivalent of 100 extra pounds of force with every step. When patients lose 20, 30, or more pounds on a GLP-1 medication, the relief can be dramatic.
Weight loss has long been a cornerstone of non-surgical treatment for knee osteoarthritis. For the right patients, GLP-1 medications may become one of the most effective tools we’ve ever had to help achieve that goal. In some cases, reducing stress on the joints can significantly improve quality of life and even delay the need for major procedures such as knee replacement surgery.
Your Muscles Might Not.
Weight loss medications don’t just reduce fat. They can also contribute to the loss of lean muscle mass, and that’s something I encourage patients to take seriously.
Weight loss is rarely limited to body fat alone. When muscle mass declines, it can affect both joint stability and bone health. In some individuals, that may increase the risk of injuries or even fragility fractures.
The reason is simple: muscle and bone health are closely connected. People with greater muscle mass generally have stronger, denser bones. The reverse is also true. Significant muscle loss can place added stress on the skeletal system in ways that may not become apparent for years.
Not Everyone Pays the Same Price.
Not everyone taking a GLP-1 medication faces the same orthopedic risks. Postmenopausal women and older adults already have a higher risk of developing osteoporosis. When the potential muscle-depleting effects of a GLP-1 medication are added to that existing vulnerability, the combined effect can become concerning.
For patients in these groups, adequate protein intake and regular resistance training are essential strategies for preserving both muscle and bone health.
Questions Still Being Asked
As GLP-1 prescriptions have surged into the tens of millions, researchers have begun studying the medications’ long-term effects.
In March 2026, The Washington Post reported on emerging research suggesting possible associations between long-term GLP-1 use and increased risks of osteoporosis, gout, and osteomalacia, a condition that causes bones to soften.
As more patients use these medications over longer periods of time, we will inevitably learn more about both their benefits and their risks. That makes ongoing monitoring especially important. Physicians should be counseling patients about potential adverse effects and regularly reassessing whether continued treatment remains appropriate if complications begin to develop.
Don’t Skip This Part.
When patients taking Ozempic, Wegovy, or similar medications come into my office, I typically focus on two questions:
• How much weight are you losing each week?
• How many grams of protein are you consuming each day?
Protein intake matters because preserving muscle mass is one of the most important ways to protect both bones and joints during weight loss.
I also strongly encourage resistance training. Research shows that resistance exercise stimulates a process known as mechanotransduction, in which cells convert physical stress into chemical signals that promote bone remodeling and strengthening.
In plain English, lifting weights tells your bones to become stronger. That doesn’t mean patients should immediately begin intense workout programs. I generally caution against extremely heavy lifting or high-impact activities that may increase injury risk, particularly during periods of rapid weight loss.
Let’s Not Overdo It.
Many ask if they should get a bone density scan. That’s a great question, but this is where I push back against the instinct to over-medicalize. I do not believe everyone taking a GLP-1 medication needs to rush out and get a bone density scan or start taking calcium and vitamin D supplements without a specific medical reason. Those decisions should be made in consultation with a physician.
Taking supplements that aren’t needed usually accomplishes very little. In many cases, the body simply eliminates the excess. Instead, I recommend making sure your physician includes routine laboratory monitoring as part of your treatment plan. If vitamin deficiencies are identified, they can be addressed appropriately and effectively.
A Promising Possibility.
There is also emerging data suggesting that patients taking GLP-1 medications may experience lower infection rates following joint replacement surgery. The theory is reasonable, even if the evidence isn’t fully there yet.
Research has consistently shown that severe obesity and poorly controlled diabetes increase the risk of prosthetic joint infections. Because GLP-1 medications often improve both weight and blood sugar control, they may help reduce some of those risks. However, larger studies are still needed before we can draw firm conclusions.
The Real Risk Ahead.
What I’m hoping to see in five to ten years of follow-up data, is genuinely optimistic. I hope we will see patients enjoying longer-lasting joint health, delaying the need for major orthopedic procedures, and experiencing fewer complications when surgery becomes necessary.
At the same time, I have one significant concern.
I am worried that many patients will adopt a “one size fits all” philosophy to the medications and will inadvertently cause other harm unknowingly.
GLP-1 drugs are excellent medications for the right patient when they are used thoughtfully and monitored carefully. I encourage anyone taking or considering a GLP-1 medication to revisit their goals, progress, and potential side effects regularly with their health care provider. These medications work best when they are part of a larger, actively managed health strategy.
Success Requires a Strategy.
Make sure your physician is checking your labs regularly. Pay attention to your protein intake. Incorporate resistance training into your routine. And if you’re a postmenopausal woman or older adult, have a direct conversation with your provider about protecting your bone health. Most importantly, don’t view these medications as a set-it-and-forget-it solution. They require active management, ongoing monitoring, and a partnership between patient and physician every step of the way.
