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Dr. Spencer Nadolsky and Karl sit down with Dr. Susan Brian, a Yale-trained endocrinologist, certified menopause provider, and medical director of a clinic with seven endocrinologists who runs an active bone fragility fracture clinic, to answer the question that has been flooding social media since a viral abstract with two fake bones on a surgical table convinced people their skeletons are quietly dissolving.
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In this episode they cover why the preclinical and mechanistic data on GLP-1 medicines actually points toward bone benefit rather than harm by improving osteoblast activity and reducing osteoclast activity, why the meta-analyses from over two decades of GLP-1 use in type 2 diabetes show reduced fracture risk rather than increased risk, what the recent Israeli retrospective cohort study actually found and why an 11% increased fragility fracture signal in older adults on GLP-1 for diabetes versus other treatments deserves attention without panic, why almost every nutritional deficiency flagged in GLP-1 patients turns out to be vitamin D deficiency that likely predated the medicine, why the degree of weight loss matters far more than the medicine itself and how the one to two pounds per week threshold and the one percent of body weight per week guideline translate into real clinical practice, what the Hansen JAMA 2024 study showed about GLP-1 alone versus GLP-1 with resistance training and why that finding is the single most important takeaway for anyone on these medicines, why Spencer has idiopathic hypercalciuria and was spilling 650 milligrams of calcium per day in his urine before anyone caught it, how romosozumab works and why it is the most powerful bone building medicine available, why Dr. Brian orders baseline bone densities on patients well before the standard screening age and why insurance almost always covers it, and why comparing GLP-1 nutritional risk to bariatric surgery nutritional risk is not even close to an apples to apples comparison.
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