GLP-1 Gout and Bone Fracture Risks Highlighted in New Studies

Multiple recent studies have linked the popular drugs to losses in bone density, particularly for elderly patients.

Two new studies suggest medications like Ozempic and Mounjaro may pose risks to bone health in older adults, raising concerns about prescribing the drugs to elderly patients.

In one of the studies, researchers from Israel report that the widely used diabetes and weight loss medications may significantly increase the risk of fractures among patients with fragile bones, a condition that commonly develops with age. 

Published in the Journal of Clinical Endocrinology and Metabolism last month, it is the second study in recent months to warn about potential bone risks.

Ozempic and Mounjaro, as well as their weight loss versions, Wegovy and Zepbound, all belong to a class of medications known as glucagon-like peptide 1 (GLP-1) receptor agonists. The class, which also includes Trulicity, Saxenda, Rybelsus and others, has skyrocketed in popularity in recent years as the medications became linked with increased weight loss and beneficial metabolic effects.

However, the researchers noted the drugs are increasingly prescribed to elderly patients despite limited understanding of their potential effects on bone health. Raising similar concerns, researchers from Denmark published a study in 2024 looking at bone density in 195 participants given the GLP-1 drug Victoza. They linked GLP-1s to a decrease in bone mineral density (BMD), particularly around the hips and legs.

If confirmed, the findings could add to a growing list of GLP-1 side effects that were not originally disclosed on the drug labels. The manufacturers already face thousands of GLP-1 stomach paralysis lawsuits and GLP-1 vision loss lawsuits filed in courts nationwide, each alleging the drug makers failed to adequately test the medications and failed to provide proper warnings about the risks on the product labels.

In the new study on bone fracture risks, researchers analyzed a retrospective new user cohort of 46,177 patients age 65 and older who had been diagnosed with Type 2 diabetes. All participants began treatment with either GLP-1 medications, such as Ozempic or Mounjaro, or older diabetes drugs like Januvia and Byetta between 2018 and 2022.

Patients were followed for a median of 34.7 months. During that period, 4,086 participants, or about 8.8%, experienced fractures linked to bone fragility. The researchers found that elderly patients taking GLP-1 medications were about 11% more likely to suffer such fractures compared to those treated with other types of diabetes drugs.

Based on the findings, the researchers concluded that initiating GLP-1 therapy was associated with “a modestly increased risk of fragility fractures in older adults with type 2 diabetes.” They indicated the results may help physicians weigh potential skeletal risks against the drugs’ expected health benefits.

GLP-1 Osteoporosis and Gout Risks

The findings come as University of Pennsylvania researchers warned last week that GLP-1 side effects could also increase the risks of osteoporosis and gout.

Led by Dr. John Hornett, researchers initiated the study after he began noticing patients developing tendon injuries from minor injuries. The study’s findings were presented at the American Academy of Orthopaedic Surgeons’ annual meeting on March 2 and have not yet been published for peer review.

Dr. Hornett’s team looked at data on 146,000 adults with diagnoses of both obesity and Type 2 diabetes over the course of five years, comparing those who took GLP-1 medications with those who did not.

According to the findings, those taking GLP-1 drugs faced a 30% increased risk of osteoporosis. They also indicate that rates of gout were about 12% higher among those taking GLP-1 drugs as well.

The researchers did note that the current label for Ozempic (semaglutide) does include a warning of an increased risk of bone fractures in older adults and women.

GLP-1 Stomach Paralysis Lawsuits

Claims that GLP-1 drug makers allegedly failed to warn about the risk of gastroparesis, or stomach paralysis, sparked the first wave of litigation against the manufacturers of the popular diabetes and weight loss medications.

The lawsuits target Novo Nordisk, the maker of Ozempic and Wegovy, and Eli Lilly, which manufactures Mounjaro and Zepbound. Plaintiffs allege the companies did not adequately disclose the risk that the drugs could severely slow stomach emptying, leaving patients and doctors unaware of the potential complication.

The litigation accelerated after an October 2023 study linked GLP-1 drugs to a threefold increased risk of gastroparesis compared to users of non-injectable weight loss medications. Since then, more than 3,300 GLP-1 stomach paralysis lawsuits have been filed in federal courts nationwide.

Those claims have since been consolidated into a multidistrict litigation in the Eastern District of Pennsylvania, where U.S. District Judge Karen Marston is overseeing coordinated discovery and pretrial proceedings.

Judge Marston has indicated the court will work with the parties to select a small group of representative cases for bellwether trials, allowing both sides to gauge how juries may respond to evidence and testimony likely to recur across thousands of similar claims.

GLP-1 Vision Loss Lawsuits

In January, the same judge was also put in charge of a growing number of GLP-1 vision loss lawsuits, a smaller, but growing, litigation that began after a series of studies linked semaglutide-based drugs, like Ozempic, Wegovy and Rybelsus, to being associated with a condition known as non-arteritic anterior ischemic optic neuropathy (NAION).

The condition can cause rapid onset of blurred or reduced vision, including blindness. It occurs suddenly and the damage is often permanent. More than 50 GLP-1 vision loss lawsuits have already been filed by patients facing such injuries.

It is expected that Judge Marston will also plan a series of bellwether trials for these cases as well. However, this litigation is much earlier in the process than those involving stomach paralysis.

While the outcomes of these trials, for either condition, will not be binding on other claims, they will be closely watched to see what kinds of payouts juries award to plaintiffs, which are likely to have a significant impact on negotiations. However, if no settlement is reached following the bellwether trials, Judge Marston is likely to remand the cases back to their originating districts for individual trial dates.

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