GLP-1 agonists like Ozempic, Wegovy, and Mounjaro have been taking the health and fitness industry by storm. They have become incredibly popular for weight loss and blood sugar control, particularly among women in midlife. While these medications are effective, they come with an often-overlooked risk: muscle and bone loss.
We put so much emphasis on weight and fat loss they muscle, and bone are often forgotten.
For women over 40, preserving muscle mass and bone density is essential for long-term health, strength, and independence. But rapid weight loss—especially without proper nutrition and resistance training—can accelerate sarcopenia (muscle loss) and osteoporosis (bone weakening).
If you’re using or considering a GLP-1 medication, it’s crucial to understand these risks and take steps to prevent them. In this post, we’ll explore how GLP-1 agonists impact muscle and bone health, why women in perimenopause and postmenopause are particularly vulnerable, and what you can do to protect your strength and longevity.
How GLP-1 Agonists Work
In case you have been living under a rock the past few years and are unaware of how GLP-1 agonists work, it got you. To quickly summarize, GLP-1 agonists mimic a hormone in our body that helps regulate blood sugar, slow digestion, and reduce our appetite. This can lead to significant weight loss, which is one reason they’re often prescribed to people with obesity or type 2 diabetes.
While weight loss can be beneficial, it often comes at the expense of lean body mass (muscle), especially if proper resistance training and protein intake aren’t prioritized. The concern isn’t just about looking toned—it’s about preventing frailty, maintaining metabolic health, and reducing injury risk as we age.
GLP-1 Medications and Muscle Loss (Sarcopenia)
Sarcopenia is the gradual loss of muscle mass and strength that occurs with age, and it’s a significant concern for women over 40. Muscle is essential not just for movement but for:
- Metabolic health – More muscle helps regulate blood sugar and maintain a healthy weight.
- Joint and bone support – Strong muscles protect against falls and fractures.
- Independence in aging – Loss of muscle can lead to reduced mobility and frailty later in life.
How GLP-1 Medications Contribute to Muscle Loss
When weight loss happens too quickly, the body doesn’t just burn fat—it also breaks down muscle. Since GLP-1 agonists suppress appetite, many women using them under-eat protein, which is critical for maintaining lean muscle.
This is where I have an issue with GPL-1 agonists. A lot of medical providers prescribing these medications are not warning their female patients about bone and muscle loss which is a great disservice. Any provider prescribing these medications needs to inform their patients and encourage them to meet their protein needs and strength train to prevent muscle and bone loss.
Some research suggests that up to 35% of the weight lost on GLP-1 medications may come from muscle, especially in those who aren’t resistance training. This is crazy! This means that while the scale is going down, the loss of strength, energy, and functional movement could be happening at the same time.
📌 Related Read: Why Women Over 40 Need to Strength Train
GLP-1 Agonists and Bone Health (Osteoporosis Risk)
Weight loss and reduced muscle mass don’t just affect strength—they also impact bone density. Women are already at higher risk for osteoporosis, especially after menopause when estrogen levels drop. Since estrogen plays a key role in bone maintenance, losing additional weight without proper bone-loading exercise can accelerate bone loss.
Studies suggest that rapid weight loss, especially when combined with low calcium and vitamin D intake, can increase fracture risk. Some evidence even suggests that GLP-1 medications may directly affect bone metabolism, making bones more fragile over time.
📌 Related Read: Lifting Heavier, Not Longer: How to Strength Train Efficiently After 40
How to Prevent Muscle and Bone Loss While Using GLP-1 Medications
If you’re on or considering a GLP-1 agonist, don’t panic—there are proactive steps you can take to protect your muscle and bone health while still benefiting from the medication.
1. Prioritize Strength Training 💪
The most effective way to maintain muscle and strengthen bones is through resistance training. Women over 40 should lift weights at least 3-4 times per week, focusing on compound movements like:
✔️ Squats and lunges (for legs, glutes, and bone density)
✔️ Deadlifts (for total-body strength and spine health)
✔️ Push-ups, bench presses, and overhead presses (for upper body strength)
✔️ Rows and pull-ups (to support posture and back health)
📌 Need a plan? Download my free 7-day strength training guide!
2. Eat Enough Protein
One of the biggest mistakes women make on GLP-1 medications is not consuming enough protein. Since these medications naturally reduce hunger, it’s easy to unintentionally under-eat.
A good rule of thumb: Aim for at least 1.0 grams of protein per pound of body weight to support muscle retention.
📌 Related Read: How to Calculate Protein for Women 40+
3. Support Bone Health with the Right Nutrients
Strong bones require more than just calcium. We need to prioritize:
- Calcium (fortified plant milks, leafy greens, almonds)
- Vitamin D (crucial for calcium absorption—consider a supplement)
- Magnesium (found in nuts, seeds, and legumes)
- Vitamin K2 (helps direct calcium into bones—found in fermented foods)
📌 Related Read: How to Reverse Bone Loss Without Medication
4. Incorporate Impact Activities
Strength training is the best way to maintain muscle and bone, but adding weight-bearing activities like hiking, plyometrics, rucking, and yoga can help, as well. I like to do a few plyometric exercises as part of my warmup before I strength train. So, things like box jumps, jumping jacks, and medicine ball slams are all good exercises.
5. Monitor Your Progress and Get Regular Check-Ups
- Track your strength gains.
- Consider a DEXA scan to monitor muscle and bone density. You used to need a doctor’s order, but there are companies that test muscle and bone mass for about $99 without a referral from your provider.
- Check vitamin D and calcium levels with your doctor.
Final Thoughts: It’s Not Just About Weight Loss—It’s About Strength & Longevity
I think that GLPs are great. Especially for those who have tried conventional weight loss measures and not been successful and/or have chronic medical conditions like diabetes. GLP-1 agonists can be powerful tools for weight loss and metabolic health, but they must be used strategically and alongside a high protein diet and strength training program.
For women over 40, the goal isn’t just to lose weight—it’s to build strength, preserve bone density, and maintain long-term health. By lifting heavy, eating enough protein, and supporting bone health, you can use GLP-1 medications without sacrificing your muscle and bones.
👉 Want expert guidance on strength training and nutrition for midlife women?
✅ Download my free 7-day strength training guide here for a step-by-step plan to build muscle.
✅ Looking for a personalized program? My 1:1 coaching program helps women over 40 build strength, prevent bone loss, and improve longevity. Learn more and apply here.
