This review examined mechanisms by which weight loss causes bone loss and identifies factors influencing skeletal responses to caloric restriction. Bone loss involves endocrine, metabolic, nutritional, mechanical, and microbiota-mediated mechanisms. Greater bone loss occurs in older and lean adults and after severe restriction (including with GLP-1 drugs or bariatric surgery), and can be attenuated by adequate nutrient intake, exercise, and possibly osteoporosis medications.
Why it is interesting: As GLP-1 drugs drive population-scale weight loss, bone health outcomes become a population-level concern; this review clarifies mechanisms and identifies countermeasures that may affect how these drugs affect skeletal health across age groups.