Does Ozempic Cause Bone Loss? What the Research Shows So Far

Written by Dr. Sheri Tomas. Updated November 4, 2026.

The Ozempic prescribing label does not list bone loss, low bone density or fractures as a side effect, but the research so far is not fully reassuring either. Small trials of semaglutide, the active ingredient in Ozempic, found slight drops in bone mineral density (BMD, a measure of how much mineral is packed into bone) at the hip and spine, and those drops appear to track the amount of weight lost rather than a direct effect of the drug. Studies of actual fractures point in both directions: in people with type 2 diabetes, GLP-1 drugs were linked to fewer fractures, while in older adults and people without diabetes some observational data suggest more. The label for Wegovy, a higher dose of the same molecule, notes that in its large heart outcomes trial, people aged 75 and older reported more hip and pelvic fractures than those on placebo. Below, density and fracture studies are covered separately, as of November 2026.

No. The current Ozempic prescribing information (revised May 2026) does not mention fractures, bone density or osteoporosis in its warnings, its list of adverse reactions or its clinical study results. The word 'bone' appears only in sections describing animal studies. Ozempic is approved for type 2 diabetes, as described in Ozempic for diabetes.

The Wegovy label is different. Wegovy contains the same molecule at a higher weekly dose (2.4 mg) and is approved for weight management. Its label states that in the SELECT cardiovascular outcomes trial, which enrolled more than 17,600 adults, 'patients aged 75 years and older reported more fractures of the hip and pelvis on WEGOVY than on placebo.' The differences between the two products are covered in Ozempic vs Wegovy, and how the brand names relate to the generic drug is explained in Ozempic vs semaglutide.

The most detailed semaglutide bone study is a 2024 Danish trial by Hansen and colleagues. It gave 64 adults at increased fracture risk (most were postmenopausal women, average age 63, with low bone density or a recent fracture) either semaglutide 1.0 mg weekly or placebo for 52 weeks. Bone density did fall slightly more with semaglutide: by 0.018 g/cm² at the lumbar spine and 0.020 g/cm² at the total hip compared with placebo, with no difference at the femoral neck (the top of the thigh bone). The semaglutide group lost 6.8 kg more, and the authors attributed the bone changes to that weight loss.

A 2025 pilot trial in 20 adults aged 65 and older (average age about 73) found no difference in whole-body bone density after 20 weeks between semaglutide plus lifestyle advice and lifestyle advice alone, though the semaglutide group lost more weight (5.3% against 0.89%).

A 2026 retrospective study by Liu and colleagues compared 255 people taking semaglutide or tirzepatide with 255 matched people not taking them; most were women around 64 years old, followed for a median of 17 months. Hip bone density fell by a similar amount in both groups overall. In people without diabetes, however, users lost somewhat more total hip density than controls (1% against 0.6%). The large STEP 1 weight-loss trial ran a body scan substudy in 140 participants, but we could not find a published bone density result from it.

Most of the evidence points to weight loss as the main driver. Bone adapts to the load it carries, so it tends to lose some density when weight falls. A 2015 review of 41 studies found that diet-induced weight loss lowered total hip bone density by about 0.010 to 0.015 g/cm² over 6 to 24 months, with no significant change at the spine. That is in the same range as the hip change in the Hansen semaglutide trial.

The Look AHEAD lifestyle study found greater hip loss in men, but not women, at year 8 and beyond. A 2026 trial in adults aged 65 to 85 (UPLIFT) found that the more weight people lost, the more hip density they lost, and eating more protein (1.2 g/kg a day) did not significantly protect bone density on its own. A 2025 joint nutrition advisory from four obesity and lifestyle medicine societies states that weight loss of 14% or more achieved rapidly, over three to four months, 'is associated with significant bone loss.' Because Ozempic can produce substantial weight loss, as described in Ozempic for weight loss, the same principle applies.

The drug may also have effects of its own. In the Hansen trial a blood marker of bone breakdown rose with semaglutide, while in an older liraglutide study a marker of bone formation rose by 16%. But the human trials so far are small and cannot cleanly separate a drug effect from a weight effect.

Fractures matter more than density. Here the evidence splits by population, and almost all of it is observational: it can show links, not prove cause.

In short, diabetes cohorts mostly show fewer fractures, while studies in older adults and people without diabetes show the opposite. Two results are conference abstracts not yet fully peer reviewed.

The studies compare different people against different drugs. In the diabetes cohorts, GLP-1 users were compared with people taking other diabetes medicines, so the result reflects how GLP-1 drugs stack up against those alternatives rather than against no treatment. Researchers have not settled why the benefit seems confined to diabetes. In the Hamad study, the lower fracture risk appeared only in people with type 2 diabetes.

People without diabetes who take GLP-1 drugs are usually doing so for weight loss and tend to lose more weight, which loads the skeleton less. The Liu study found extra hip density loss only in its non-diabetic group, and the Constantine study found higher fracture rates in non-diabetic users. These signals need confirmation in randomized trials.

The groups with the most reason for caution are those who already have weaker bones. The Wegovy label's fracture note concerns adults aged 75 and older; the Constantine study found the largest relative increase in people aged 78 to 88; and the Kasher Meron abstract found a modest increase in adults over 65 with diabetes. Postmenopausal women lose bone naturally as estrogen falls, and they made up 86% of the Hansen trial.

Losing muscle along with fat matters too, because weaker muscles raise the risk of falls. Changes in appearance that come with rapid weight and muscle loss are covered in Ozempic hands, feet and neck and Ozempic face.

The best evidence comes from liraglutide, an older drug in the same class. In the S-LiTE trial (2024), 195 adults first lost weight on a diet, then spent a year on liraglutide, exercise, both, or placebo. People who combined liraglutide with exercise did not lose significantly more hip or spine density than the placebo group. People on liraglutide alone lost more than those who only exercised. A smaller 2015 trial found that liraglutide after diet weight loss helped preserve bone mineral content compared with no drug. We found no completed trial of semaglutide plus exercise with bone results as of November 2026.

The 2025 joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society (Mozaffarian and colleagues) gives the clearest guidance. It notes the standard protein recommendation of 0.8 g per kilogram of body weight a day and proposes 1.2 to 1.6 g/kg a day during active weight loss. For a 90 kg (about 200 lb) adult, that is roughly 108 to 144 grams of protein a day. It recommends strength training at least three times a week plus 150 minutes of moderate aerobic activity weekly.

For calcium and vitamin D, the advisory suggests considering supplements when intake is at risk of falling short, but it does not give specific amounts for GLP-1 users, and we did not find society guidance that does. Ask your doctor or a dietitian what amount suits you, especially if you eat much less on the medication.

A DXA scan is a low-dose X-ray that measures bone density, usually at the hip and spine. According to the 2025 joint advisory, a DXA scan 'could be considered yearly or every 2 years' for people on GLP-1 therapy, particularly those at risk of bone loss. Whether you need one depends on your age, fracture history and expected weight loss.

For a wider look at weighing the drug's risks and benefits, see is Ozempic safe?. If you are planning to come off the drug, what happens when you stop taking Ozempic covers weight regain and other changes; we found no studies on whether bone lost during treatment recovers afterward.

Ozempic's label lists no bone side effects, and the bone density losses seen in small semaglutide studies are modest and largely explained by weight loss. Fracture data are mixed: reassuring in people with type 2 diabetes, less so in older adults and people without diabetes, and the Wegovy label notes more hip and pelvic fractures in people 75 and older. If you have weak bones or are older, talk with your doctor about a DXA scan, aim for enough protein and keep up strength training while you lose weight.

This article summarizes published research for general information and is not medical advice. Two fracture results cited are conference abstracts not yet fully peer reviewed, and most fracture data are observational.