If you only read key findings, you’d think it was worse for those without diabetes. (Someone sent this to me yesterday and said glp1s cause bone loss!)
KEY FINDINGS:
Among adults without diabetes, osteoporosis risk was slightly higher for patients prescribed a GLP-1 than for patients prescribed other weight loss medications, compared to a baseline of stable-weight patients who were prescribed weight loss medications other than a GLP-1.
Later it says:
Among groups that lost more weight, osteoporosis risk rose for those with and without GLP-1s, but the increase in risk was consistently smaller among GLP-1 users. Weight gain was associated with increased osteoporosis risk among those not on a GLP-1, while weight gain was not associated with statistically significant change in osteoporosis risk for those on a GLP-1.
I would strongly consider eating natto, Japanese fermented soybean.Natto is loaded with vitamin k2, and “nattokinase” (which is a protein but not a kinase). These things are adept at “activating matrix GLA protein” -in short, natto helps keep calcium out of arteries and in bones. It is also a potent fibrinolytic: it helps prevent the kind of clotting in the heart attack process. DO NOT EAT NATTO WHILE ON Bisphosphonates, or WARFARIN-like drugs. I actually buy and eat natto from the Japanese grocery, but I also buy nattokinase and K2 in the form of ("mk7 or Menaquinone-7), for ex. Doctors’Best brand, which also includes vit. D. And do squats. Good luck.
It depends on which study you are reading from LOL
In a large analysis of more than 146,000 adults with obesity and type 2 diabetes, GLP-1 users were found to have a 29% higher relative risk of osteoporosis over five years compared to nonusers, according to reports.
Bisphosphonates affect your jaw that it becomes incredibly difficult/impossible to do dental work. So here’s hoping your teeth are well taken care of! This is why I won’t touch this drug class
What are you talking about? Isn’t that a rare side effect? That you should reduce risk for but not assume you’ll get?
If you learned about all the rare side effects from all of the supplements you were taking (they are not elucidated because they never were studied), you wouldn’t take either of those either.
The risk appears to be 0.2%. That should be weighed against fracture risk. Risk vs. reward, total mortality and net expected quality of life, as always.
Tooth extraction while on bisphosphonates (e.g., Fosamax, Zometa) carries a risk of Medication-Related Osteonecrosis of the Jaw (MRONJ), a rare condition causing poor healing and bone necrosis. While risk is low for oral, short-term users, it increases significantly with long-term or IV use.
I’m assuming that people here will be in that significant increased risk of long term usage where the chance goes up to 0.5-1.7%. Still low, but horrible if it happens.
Well this has been an informative thread. Appreciate the information and insights. Had been thinking about starting (re-starting) an alendronate but I think I won’t. The evidence seems to suggest that the risks of osteonecrosis are quite low if you are taking an oral alendronate (as opposed to an infusion) but knowing what we know about how drug works (kills or deactivates the osteoclasts) I just don’t think I want to do this. Also, n=1, a friend who has multiple myeloma was given zometa infusions as a counter to one of the chemo drugs she had to take. She developed osteonecrosis of the jaw. It was extremely painful and it was just about impossible for her to open her mouth and move her jaw, much less eat, and then it led to a major infection. So, I know that has entered into my very imperfect assessment about whether to take a fosamax-like drug.
The risk is higher when used with regards to cancer than osteoporosis according to Wikipedia.
In patients taking drugs for cancer, the likelihood of MRONJ development varies from 0 - 12%. This again, varies with the type of cancer, although prostate cancer and multiple myeloma are reported to be at a higher risk.[8]
In patients taking oral drugs for osteoporosis, the likelihood of MRONJ development varies from 0 - 0.2%.[7]
The trial I linked had 1 case for placebo 1 for zoledronic acid over 3 yrs in 3889 patients in total with 1 injection yearly. The question is how many years do one even take them…?
Something to consider in the risk/reward calculation. If you’re old, don’t fall down! But bisphosphonates can reduce the risk if you’re osteoporotic.
In the US, how many die from fall-related complications per year. I.e., elderly person falls, breaks hip, bedridden, physiological decline, death.
About 41,000 older adults (65+) died from falls in 2023. The CDC’s reported unintentional fall death rate for adults 65 and older was 69.9 per 100,000 in 2023, and press coverage of the same CDC report summarized that as “over 41,000” deaths. (cdc.gov)
That is the cleanest official number for deaths attributed to falls. It already includes a lot of what you are talking about: the fall, the injury, the hospitalization, the downstream decline, and then death being coded as fall-related. But it also misses some cases where the final death certificate gets coded under something else, so it is not a perfect capture of the whole cascade. That means the true “fell, declined, then died” burden is probably somewhat larger than the headline fall-death number. (cdc.gov)
For the specific hip-fracture pathway:
The CDC says there are about 300,000 hip-fracture-related hospitalizations each year due to older adult falls. (cdc.gov)
After a hip fracture, one-year mortality is commonly around 17% to 25% in older adults in modern studies/reviews. (pmc.ncbi.nlm.nih.gov)
That does not mean all of those deaths are directly caused by the fracture alone, because these patients are older and frailer to begin with. But clinically, the sequence you described is very real: fall → hip fracture → immobility/delirium/deconditioning/infection/loss of independence → death. (pmc.ncbi.nlm.nih.gov)
So the practical answer is:
Directly counted U.S. fall deaths in older adults: about 41,000/year
Hip fractures from falls: about 300,000 hospitalizations/year
One-year death rate after hip fracture: roughly 1 in 5, sometimes a bit lower or higher depending on age, sex, frailty, and comorbidities (cdc.gov)
Confidence: high for the ~41,000 U.S. fall-death figure; medium-high for using hip-fracture mortality to estimate the downstream “bedridden then decline” burden, because attribution gets messy.
It is relative to the 65+ population, not the whole U.S. population. The CDC brief is explicit: “the unintentional fall death rate for adults age 65 and older was 69.9 per 100,000 population,” and the table is for “adults age 65 and older” with 41,400 deaths. (cdc.gov)
Agreed, that 's why you need to carefully evaluate your own individual situation. Are there contraindications in you case? Interactions with other drugs, special considerations? If you are about to have dental procedures involving extractions, implantations or other bone involvement, even root canal - well, stop the bisphosphonates, or wait until after, with a good safety margin. Clearly. Spontaneous osteonecrosis with no precipitating factor (such as surgery) is very rare. So if there are no special contraindications, and you have severe osteoporosis, I personally (not a doctor, not medical advice) would keep in mind that the benefits outweigh the risks… and again,bisphosphonates lower all cause mortality. YMMV.
Agree with what others have said-- that it has to be a personalized decision based on your own particulars. The bone marker tests that I did years ago showed that my resorption levels were normal, not elevated, (despite having osteoporosis) so a bisphosphenate, which is basically an anti resorptive, would not be a good drug for me. If the bone markers had shown high resorption levels, I would most probably have taken the bisphosphenates. Perhaps I will get the bone markers repeated.
Arhu, I agree with you. Resistance training, vibrating platform, biking and walking, K2Mk7 and MK4, magnesium, D and raloxifene. Osteoporosis is kind of like Alzheimers – in that we have been treating manifestations of the primary problem (tau, Amyloid, and disrupted bone remodeling) instead of root causes. In the case of Alzheimers we are now recognizing that it is initiated by inflammation, and disrupted glucose regulation. I have not seen information anywhere about supposed root causes of osteoporosis but I suspect that there is an underlying metabolic/inflammatory and maybe hormonal constellation of factors that start the imbalances in the bone remodeling.
Deborah, if I can add a nano observation regards osteoporosis, try to add some form of impact signal to your physical routine. Many standard recommendations focus on low-impact weight-bearing activities and resistance/strength training, which are excellent and safe for most people with osteoporosis. However, if you can, impact provides a stronger stimulus for bone remodeling, especially in the hips, spine, and legs (a process called Wolff’s Law).
Best, xx
Hi Beth!
As far as I know, weighted ball exercises are occasionally mentioned in broader programs as part of UPPER-body/impact loading in case studies or protocols. However, they were not studied in isolation or compared head-to-head with LOWER-body impact activities for osteoporosis. Please, ask your PT for the comparative studies that he has based his recommendation… My understanding on this matter so far is that you need to generate ground reaction forces through your feet and legs hitting the ground to get the strongest bone-building stimulus at key sites like the hip and spine – but hey, your PT may know better: ask him for the comparative clinical studies done.
Your point about needing to “generate ground reaction forces through feet and legs…” This is why a vertical (must be vertical, not side-to-side) oscillation can be beneficial as a stimulus for bone remodeling and a way to reduce/prevent the development of disrupted bone remodeling (osteoporosis).
