Key Concerns for Older Adults Using GLP-1 Drugs:

Key Concerns for Older Adults Using GLP-1 Drugs:

     GLP-1 receptor agonists like Ozempic and Wegovy (and others!) have shown impressive benefits for weight loss and glycemic control. But, in some older adults there are legitimate concerns around muscle loss, strength decline, fall risk increases, as well as osteopenia/osteoporosis.

Loss of lean muscle mass (sarcopenia)

     GLP-1 drugs lead to weight loss, but studies have shown a significant proportion of that weight loss can be muscle! This is especially there is NOT accompanied by resistance exercises and adequate protein intake. Older adults are often already prone to age related sarcopenia, and further loss can lead to facility which can lead to loss of independence.

Strength and function

     Muscle loss leads to weakened grip strength, slower gait speed, and reduced ability to perform activities of daily living (ADL’s) such as getting out of a chair and going up/downstairs or curbs. These declines are often associated with higher fall risk and loss of independence.

Bone health

     Weight loss, particularly rapid or significant, can result in reduced bone mineral density. We know that lean        muscle mass helps maintain skeletal loading and its loss may accelerate the risk of osteopenia/osteoporosis and fracture risk. This risk is unfortunately pronounced in women.

Fall risk

      Studies link GLP-1 use in seniors with increased fall risk, potentially due to muscle weakness, dehydration, malnutrition, hypoglycemia, fatigue, as well as orthostatic hypotension. Not to mention that loss of muscle mass may influence negatively on bone health.

Recommendations for mitigating risk in older adults

Strength training and exercise        

            Prioritize resistance training: train 2-3x/week to maintain muscle mass, but of course including balance training, cardio-respitory exercises, and mobility training!

            Adequate protein intake: Seniors may need 1.0-1.2 kg/day of protein spread throughout the day/meals.

            Monitor bone density: Consider DEXA scans as well as talk with your doctor or dietician about calcium and vitamin D.

            Gradual weight loss and medical supervision: Avoid, if possible, aggressive weight loss goals. Preserving function matters more than just pounds lost. Of course, consult with your medical provider on the best course of action!

     In summary, GLP-1 drugs can be helpful in seniors with obesity and diabetes, but they should be used judiciously. The balance between metabolic health benefits and the risk of muscle and bone loss, including risk of increasing falls is especially critical to be aware of in this awesome population!