Exercise, GLP-1 RA Aid Weight Loss and Bone Retention

TOPLINE:

People with obesity who exercise while taking glucagon-like peptide 1 receptor agonists (GLP-1 RAs; liraglutide) showed increased weight loss and preserved bone health, according to a study published in JAMA Network.

METHODOLOGY:

• Patients were placed on an initial diet that consisted of no more than 800 calories per day for 8 weeks. Those who lost at least 5% of their starting weight were then placed into a 1-year program.
• Participants included 195 adults aged between 18 and 65 years with obesity and no diabetes, 64% of whom were women.
• They were split into four groups of interventions: Exercise only (48 patients), liraglutide only (49 patients), a combination of both (49 participants), and placebo (49 participants), for a 1-year period.
• Patients received liraglutide or volume-matched placebo as daily injections starting at 0.6 mg/d with a weekly increase until 3 mg/d was reached; exercise entailed 30-minute sessions for 4 days a week.
• Researchers studied bone health at each patient’s hip, spine, and forearm after they lost weight, by measuring bone mineral density (BMD).

TAKEAWAY:

• The overall average change in weight loss over the course of 52 weeks was 7.03 kg in the placebo group, 11.19 kg in the exercise group, 13.74 kg in the liraglutide group, and 16.88 kg in the combination group.
• After the initial low-calorie diet-induced weight loss, the placebo group regained weight, the exercise and liraglutide groups maintained weight loss, and the combination group lost additional weight.
• BMD did not change in the combination group in comparison to the placebo group at the hip (mean change, −0.006 g/cm²; 95% CI, −0.017 to 0.004 g/cm²; P = .24) or spine (−0.010 g/cm²; 95% CI, −0.025 to 0.005 g/cm²; P = .20).
• BMD of the spine in the liraglutide group decreased in comparison to the exercise group (mean change, −0.016 g/cm²; 95% CI, −0.032 to −0.001 g/cm²; P = .04) and the placebo group, in addition to decreases in the hip.

IN PRACTICE:

“Our results show that the combination of exercise and GLP-1 RA was the most effective weight loss strategy while preserving bone health,” study authors wrote.

SOURCE:

The study was led by Simon Birk Kjær Jensen, PhD, of the Department of Biomedical Sciences and Faculty of Health and Medical Sciences at the University of Copenhagen in Copenhagen, Denmark, and published on June 25 in JAMA Network Open.

LIMITATIONS:

The study only included adults aged between 18 and 65 years without other chronic diseases and may not apply to patients who are older or have diabetes. The study sample was diverse but was conducted in Denmark, with a population of generally similar ancestry.

DISCLOSURES:

Madsbad reported serving on advisory boards for AstraZeneca, Boehringer Ingelheim, Bayer, and Amgen, among others. Other authors reported various financial interests, including grants, personal fees, and salaries, including from Amgen, Novo Nordisk, and Abbott Lab, among others.