Ozempic can cause loss of muscle mass – 07/25/2023 – Equilibrium

There are few constants in the world of weight loss, but one concept holds: no matter how you lose weight — through restrictive eating, bariatric surgery or the new class of injectable drugs like Ozempic and Wegovy — you’ll likely lose muscle, too.

That’s a particular concern for older adults, say experts in obesity medicine. The more muscle someone over 65 loses, the greater the risk of becoming frail or suffering a fracture or fall (which can be fatal depending on age). It is crucial for seniors to maintain muscle mass so they can remain agile and independent.

Muscle mass naturally decreases with age. A 70-year-old man, for example, is likely to have less muscle and more fat than a 30-year-old with the same BMI (body mass index), says Scott Hagan, an assistant professor of medicine at the University of Washington who has studied obesity.

When people lose large amounts of weight in a short period of time, as when taking a drug like Ozempic, the loss of muscle mass can be drastic, with dire health consequences.

We know very little about how older adults, in particular, fare with these drugs, says Janice Jin Hwang, chief of the division of endocrinology and metabolism at the University of North Carolina School of Medicine. Clinical trials of semaglutide, the active ingredient in Ozempic and Wegovy, typically involve people in their 40s and 50s.

“I’ve struggled with this when counseling patients,” says Hagan, adding that he has concerns about prescribing this type of medication “to a 75-year-old just because their BMI is 40.”

Risks include stomach and bone problems

In clinical trials of semaglutide, people aged 65 and over were more likely to experience gastrointestinal side effects, such as nausea and vomiting, than younger people. They were also more likely to stop taking medications because of general adverse reactions.

Fatigue is a common side effect of these drugs, and it can be even worse in older adults. It could be the result of not eating enough while on the drugs, but when too much weight is lost, blood pressure can also drop, says Hagan, which can leave patients groggy and tired.

High blood pressure is common in older adults, but they are also susceptible to orthostatic hypotension, a sudden drop in blood pressure when standing up from a sitting or lying position. The weight loss that accompanies these medications can exacerbate low blood pressure and exacerbate symptoms such as feeling faint or dizzy.

Those who already have or are predisposed to osteoporosis — which affects nearly 20 percent of women age 50 and older in the United States — need to be careful with these drugs, Hagan points out, because rapid weight loss can make your bones less dense.

Our bones are almost constantly changing, he says, and losing weight reduces the mechanical force we put on them, which can lead to bone loss in some people. Weight loss can also impair calcium intake and absorption, he says.

Reduced muscle mass means that older adults can also lose strength and endurance, says Andrew Kraftson, an associate clinical professor at Michigan Medicine. This can make carrying groceries or climbing stairs more difficult, for example.

“The image of frailty would be someone with osteoporosis, subject to falls, with fractures, unable to practice many common activities”, he says. “We’re trying not to do that.”

How to protect yourself from muscle loss

For those taking these medications, but especially the elderly, it is critical to engage in regular strength exercise, such as lifting weights, and consume enough protein to protect against muscle shrinkage.

Hagan generally recommends that patients taking medications like Wegovy or Ozempic consume at least 100g of protein a day — which can be challenging, he says, because the medications suppress appetite.

Doctors can also prescribe lower doses of the drug for people over 60, says Kraftson, to minimize side effects and delay weight loss.

“People should refocus their expectations and not try to get to the body weight they were at 18,” says Kraftson.

Every week, though, patients tell him they want just that — “regardless of age,” he says.

Translated by Luiz Roberto M. Gonçalves