Complex clinical encounter series: Glucagon-like peptide-1 receptor agonists-induced weight loss: are we paying attention to bone health?

A 65-year-old woman lost about 15% of her weight after 1 year on semaglutide, but there are concerns regarding her bone health and falls during treatment.

Summary and findings

This case report discusses a 65-year-old woman with obesity class II who was treated with subcutaneous semaglutide for weight loss. After 1 year, she lost approximately 15% of her weight, with noted improvements in blood pressure and lipid profile. The report highlights concerns regarding bone health following weight loss in elderly patients.

Abstract

A sixty-five-year-old white woman with obesity class II, hypertension, hyperlipidemia, obstructive sleep apnea, osteoarthritis, and pre-diabetes was started on subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), for weight loss. Her DXA BMD 3 months prior to the initiation of semaglutide showed osteopenia. She did not have personal or family history of fractures. She had gone into menopause at the age of 52 with no other risk factors for osteoporosis. She maintains an adequate intake of calcium and cholecalciferol and she is active but does not exercise regularly. After 1 year on semaglutide, she lost ~15 % of her weight with improvement of blood pressure, lipid profile, and sleeping pattern. She reports two recent falls. The initial recommendation was to repeat DXA in two-three years. However, recent evidence suggests that in elderly patients experiencing ~ 9% weight loss with semaglutide, monitoring bone remodeling markers and BMD after 1 year of treatment is justified. Counseling on adequate protein intake and strengthening exercise to preserve muscle mass should also be provided.

Key findings

• Not reported in abstract.

Limitations

• Not reported in abstract.

Elsewhere in the Semaglutide corpus