The Role of GLP-1 Medications in Musculoskeletal Health: Benefits, Concerns, and a Holistic Approach

ByTae Won Kim, MD
Division Head, Orthopaedic Oncology Center
Cooper University Health Care

GLP-1 receptor agonists like semaglutide and liraglutide have gained attention for their ability to promote significant weight loss—often exceeding 15% in a year. While primarily used for diabetes management and now increasingly prescribed for weight loss, their impact on musculoskeletal (MSK) health is an emerging area of interest.

How GLP-1s Affect MSK Health

Weight Loss and Joint Health

Excess body weight places additional stress on weight-bearing joints, increasing the risk of conditions like osteoarthritis. Studies have shown that weight loss reduces knee joint load, leading to improved pain and function (Aaboe et al., 2011; Christensen et al., 2015). The STEP 3 Trial (Wadden et al., 2021) further demonstrated that semaglutide, when combined with behavioral therapy, led to a 10.7% weight reduction—suggesting potential benefits for joint health.

Inflammation and Pain Relief

Obesity has long been associated with musculoskeletal pain, including lower back pain. While once thought to be solely due to biomechanical stress, research suggests that chronic systemic inflammation plays a key role (Seaman, 2013). GLP-1s may offer anti-inflammatory benefits, though further research is needed to validate these effects.

Muscle Loss Concerns

Despite their benefits, GLP-1s have raised concerns about muscle loss (sarcopenia). Some studies suggest that up to 50% of weight lost through GLP-1 therapy may come from muscle and other vital tissues (Sargeant, 2019). This is especially concerning for older adults, as muscle loss can lead to increased fall risk and fractures (Wagar, 2010). Since 95% of hip fractures result from falls, maintaining muscle mass is crucial for long-term health.

Challenges and Limitations of GLP-1 Therapy

• Compliance Issues: Studies suggest that adherence to GLP-1 therapy drops below 30% within a year due to gastrointestinal side effects (Myshko).
• Weight Regain: Patients often regain most of the lost weight after stopping GLP-1s (Wilding et al.).
• Off-Label Use: While effective for weight loss, these drugs are not FDA-approved for this purpose, leading to concerns about their long-term use.
• High Costs: Without robust cost-effectiveness data, the economic feasibility of GLP-1s for MSK health remains uncertain. Weight loss alone does not necessarily reduce the need for MSK treatments like physical therapy, injections, or joint replacement surgeries.

A Holistic Approach to MSK Health and Cost Containment

While GLP-1s may contribute to improved MSK health, they should be one component of a broader strategy that includes:

• Targeted Ergonomic Interventions: Preventing repetitive strain injuries through better workplace setups.
• Physical Therapy & Strength Training: Essential for preserving muscle mass, especially when using GLP-1s.
• Behavioral Therapy & Lifestyle Changes: Long-term weight management requires sustainable habits beyond medication.
• Comprehensive Wellness Programs: Addressing diet, movement, and mental health together enhances overall well-being.

SimpleTherapy’s Approach to Supporting GLP-1 Users

At SimpleTherapy, we recognize the potential benefits of GLP-1 therapy but also the risks associated with muscle loss. Our physical therapists work closely with patients to integrate resistance training into their care plans, ensuring they maintain muscle strength while managing weight loss.

Kelly McLaughlin, DPT, ATC, Cert MDT, our MSK Program Director, explains:

"When designing care plans for patients on GLP-1s, we prioritize resistance training—incorporating exercises like squats, lunges, and resistance bands to build strength, boost metabolism, and reduce fall risk."

Final Thoughts: Balancing Innovation with Caution

While GLP-1s present an exciting option for weight management, they are not a standalone solution for MSK health. Their long-term effects remain unclear, and a multifaceted approach—combining medication with exercise, therapy, and lifestyle changes—is necessary for sustainable results.

At SimpleTherapy, we’re committed to helping individuals navigate these challenges with evidence-based, personalized care. If you’re using GLP-1s and want to ensure you’re maintaining muscle strength and joint health, our team is here to support you.

Sources

J Aaboe 1, H Bliddal, S P Messier, T Alkjær, M Henriksen, 2013. Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis

Thomas A. Wadden, PhD1; Timothy S. Bailey, MD2; Liana K. Billings, MD, MMSc3; et al, 2021. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity. 

Sargeant, 2019: Sargeant JA, Henson J, King JA, Yates T, Khunti K, Davies MJ. A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinol Metab (Seoul). 2019;34(3):247-262.

Wagar, 2010: Scott V, Wagar L, Elliott S. In Victoria Scott Consulting ed. , ed. Falls and related injuries among older Canadians: fall‐related hospitalizations & intervention initiatives. Prepared on behalf of the Public Health Agency of Canada. Victoria, BC, Canada: Division of Aging and Seniors.

Myshko, 2023. Real World Study Shows Low Patient Adherence for Weight Loss Drugs, Formulary Watch.

Seaman, D.R. 2013. Body Mass and Musculoskeletal Pain. Is There a Connection? Chiropractic and Manual Therapies, 21, 15.