As glucagon-like peptide-1 receptor agonists (GLP-1 RAs) — such as semaglutide (Ozempic, Wegovy) — gain traction for treating diabetes and promoting weight loss, a new concern is emerging: Are older adults at risk of losing too much muscle? An editorial in Annals of Internal Medicine warns that these popular drugs may exacerbate sarcopenia — the age-related loss of muscle mass and strength — in seniors.
Between 2018 and 2022, the use of GLP-1 RAs skyrocketed from just a few thousand to tens of thousands of users nationwide, with older or high-risk patients among them. While these medications are widely praised for lowering blood sugar and shedding pounds, the rapid reductions in body weight — sometimes exceeding 20% — have prompted questions about what type of weight is being lost.
With thoughtful planning and tailored support, it may be possible to harness the benefits of these drugs without sacrificing strength, mobility, or quality of life. Future study and tailored care may allow patients to reap metabolic gains without sacrificing strength and mobility.
GLP-1 RAs curb appetite and reduce caloric intake, leading to fat loss — but also loss of lean mass, including muscle. This can be especially harmful for older adults, who are already prone to muscle loss. Up to half of adults over age 80 experience sarcopenia, which increases the risk of falls, fractures, and disability. If medication-induced muscle loss adds to this, functional strength and mobility may suffer.
The editorial, entitled “Skeletal Muscle Mass Loss and Glucagon-Like Peptide-1 Receptor Agonists: Are Older Patients at Risk?,” authored by Anjali P. Kakkar and colleagues, emphasizes that adults over 65 are particularly vulnerable. Natural aging reduces skeletal muscle mass by 12% – 16%, leaving little margin before critical thresholds are crossed. Muscle loss from GLP-1 drugs could push some patients over the edge into frailty.
Studies show mixed data on how much muscle is lost. A 2024 review in Diabetes, Obesity & Metabolism found that 15% – 60% of weight lost on GLP-1 RAs may come from lean mass, depending on the patient and drug. While some muscle loss may be offset by reductions in fat within the muscle and improved muscle quality, older patients may not benefit in the same way, especially if the loss impairs mobility or strength.
Clinicians should watch for warning signs. The editorial notes that if patients don’t show expected improvements in function during treatment, skeletal muscle mass (SMM) loss should be evaluated. Gold-standard assessments like MRI and CT are effective but costly and not always practical. More accessible tools like DEXA scans and bioimpedance analysis exist, though they vary in quality.
To counteract muscle loss, the authors recommend pairing GLP-1 use with resistance training and a high-protein diet. While no drugs are currently approved to prevent muscle loss, companies like Eli Lilly and Scholar Rock are developing therapies that combine fat loss with muscle preservation, such as myostatin inhibitors and enobosarm.
Ultimately, the editorial calls for more personalized care: assessing baseline muscle mass, physical function, and nutrition before prescribing GLP-1 RAs to older patients. With thoughtful planning and tailored support, it may be possible to harness the benefits of these drugs without sacrificing strength, mobility, or quality of life. Future study and tailored care may allow patients to reap metabolic gains without sacrificing strength and mobility.
Loading ...