Ozempic and Wegovy May Raise Osteoporosis and Gout Risk, New Research Warns

New research presented Monday at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting found that patients taking GLP-1 drugs like Ozempic and Wegovy had higher rates of osteoporosis and gout compared to patients not taking them.

The study — led by Dr. John Horneff, an associate professor of orthopedic surgery at the University of Pennsylvania — analyzed five years of medical records from more than 146,000 adults diagnosed with both obesity and type 2 diabetes.

About 4% of GLP-1 users developed osteoporosis in the study period. Gout rates were also elevated in the GLP-1 group.

But before adjusting your medication: the findings are preliminary, the likely mechanism is nutritional rather than pharmacological, and the study hasn't yet been published in a peer-reviewed journal.

Why This Probably Isn't About the Drug Itself

Dr. Horneff described how his interest in this question started: patients on GLP-1s were showing up with serious tendon tears after relatively minor injuries. That prompted him to look at whether the drugs might affect bone and connective tissue more broadly.

His explanation for the findings is telling: “People are taking these medications, and obviously there's a tremendous amount of upside. But with that, they start to decrease their intake of food and nutrients.”

That's the key phrase. GLP-1 drugs work by suppressing appetite — significantly. Patients eat substantially less. If that reduced food intake isn't carefully managed, it can mean inadequate protein, calcium, and vitamin D — all of which are critical for bone health.

Osteoporosis from rapid weight loss is a known phenomenon. Bariatric surgery patients have faced this for years, and the management approach is well-established: monitor bone density, supplement appropriately, and prioritize protein intake throughout treatment.

The Gout Connection

The gout finding is similarly explainable through mechanism rather than direct drug toxicity. Rapid weight loss — from any cause — temporarily increases uric acid levels as the body metabolizes fat cells. Elevated uric acid is the direct cause of gout attacks.

This means the gout risk is likely highest during the active weight-loss phase, particularly in patients who were already at elevated baseline uric acid levels (common in obesity and type 2 diabetes).

What the Study Can and Cannot Tell Us

Limitations worth noting before drawing firm conclusions:

• Not peer-reviewed yet. These are conference presentation findings. The full methodology and statistical analysis haven't been independently evaluated.
• No causal proof. An association between GLP-1 use and osteoporosis/gout doesn't mean the drugs cause these outcomes directly. Confounding factors — including pre-existing nutritional deficiencies, the severity of obesity, baseline uric acid levels — aren't fully controlled in the current analysis.
• Population overlap. Patients with obesity and type 2 diabetes (the study population) already have elevated baseline rates of both osteoporosis and gout compared to the general population. The study compared GLP-1 users to non-users within this population, but the two groups may differ in important ways.
• Medication wasn't specified. The records didn't detail which GLP-1 each patient was taking. Semaglutide, tirzepatide, and liraglutide weren't separated — so we can't say whether the risk differs by drug.

What Patients on GLP-1s Should Do

This research doesn't suggest you should stop taking semaglutide or tirzepatide. The cardiovascular and metabolic benefits of these medications are well-established and significant. But it does reinforce the importance of managing nutrition throughout treatment.

Specific things to discuss with your provider:

• Bone density baseline. If you're at elevated risk for osteoporosis (postmenopausal women, older men, anyone with prior fractures), consider a baseline DEXA scan before starting a GLP-1 and monitor annually.
• Calcium and vitamin D. Supplementation is often recommended for patients on GLP-1s, especially those eating significantly less. Standard recommendations: 1,000–1,200 mg calcium daily and 1,000–2,000 IU vitamin D.
• Protein intake. The research on protein and muscle/bone preservation during GLP-1-induced weight loss is clear: adequate protein (0.8–1.2g per pound of body weight) helps protect lean mass and bone density.
• Uric acid monitoring. If you have a history of gout or are in a high-risk group (high-purine diet, prior gout attacks), ask your provider about baseline uric acid and monitoring during the active weight-loss phase.

Context: The Bigger Picture

Every effective treatment has trade-offs. Statins have a small increased risk of diabetes. Aspirin carries bleeding risk. The question is always whether the benefit outweighs the harm at a population level and for your individual situation.

For GLP-1 drugs, the evidence for cardiovascular risk reduction, glycemic control, and sustained weight loss is substantial. The osteoporosis and gout signals from this study are real and worth monitoring, but they're manageable — and almost certainly secondary to nutritional changes rather than direct drug toxicity.

The takeaway isn't “don't take GLP-1s.” It's “take them with appropriate nutritional support and monitoring.”

This article is for informational purposes only. Consult your healthcare provider before making any changes to your medication. Last updated: March 2026.