Part of The Future of MSK at Work: Clinical Insights Series
GLP-1 medications are changing the health and benefits conversation.
Originally developed to improve blood sugar control in type 2 diabetes, GLP-1 receptor agonists such as semaglutide, liraglutide and tirzepatide have become part of a much wider conversation around weight loss, metabolic health and long-term disease risk.
But for employers, there is another conversation emerging: what does rising GLP-1 use mean for musculoskeletal health?
Medical insurance claims linked to GLP-1 use are increasing, and these medications are now appearing in wellbeing, private medical insurance and absence management conversations in ways that were not on the agenda a few years ago. But the MSK dimension is still under-discussed.
That matters because MSK conditions are already a major source of absence, presenteeism and healthcare spend. If more employees are using GLP-1 medications, employers need to think beyond weight loss alone and consider muscle, bone, joint health and long-term function.
Weight loss is not the whole story
Weight loss can reduce mechanical load on joints, which may benefit some people with pain or mobility challenges. GLP-1s may also have anti-inflammatory effects, which could have implications for joint health.
But MSK health is not only about body weight.
It is also about strength, movement capacity, balance, confidence and function. If someone loses weight but also loses muscle mass, reduces activity or becomes less confident with movement, the overall health picture becomes more complex.
That is why the GLP-1 conversation needs to include MSK health from the start.
For benefits and wellbeing teams, the question is not whether GLP-1s are “good” or “bad”. It is how to make sure employees are supported in a way that protects function, not just weight-related outcomes.
Bone health needs nuance
The evidence on GLP-1s and bone health is still developing.
A 2025 meta-analysis of 25 randomised controlled trials in people with type 2 diabetes found no significant increase in fracture risk with GLP-1 receptor agonists, alongside small improvements in bone mineral density at the hip and lower spine. Earlier evidence has also suggested a broadly neutral effect on bone density and fracture risk.
But not all findings point in the same direction. A 2024 phase 2 randomised trial in adults with increased fracture risk, mostly postmenopausal women, found that once-weekly semaglutide over 52 weeks was associated with higher markers of bone breakdown and lower bone density at the lower spine and hip versus placebo. The authors suggested that accompanying weight loss may be a key driver.
The implication is not that GLP-1s are bad for bones. It is that populations matter.
For older employees, postmenopausal women and those with existing fracture risk, the MSK conversation needs to be more careful and more personalised.
Muscle health matters
A common concern around GLP-1s is muscle loss.
The nuance is important. A 2024 review concluded that changes in skeletal muscle with GLP-1-based therapies appear largely proportional to the amount of weight lost. In other words, lean mass reduction is expected with significant weight loss by any route.
But functionally, the key question is not simply how much muscle someone has. It is how much strength, power and physical capacity they preserve.
This matters most for employees who are older, more sedentary, already in pain or less confident with movement. GLP-1-driven weight loss without parallel strength or activity support is very different from GLP-1-driven weight loss in someone who is already active and supported.
Joint health may be the most promising area
The most encouraging evidence appears to sit in joint health, particularly osteoarthritis.
A 2025 review found observational evidence linking GLP-1 receptor agonist use with lower progression to hip and knee replacement surgery in people with pre-existing osteoarthritis, slower cartilage loss in some MRI studies, and possible anti-inflammatory effects inside the joint.
But caution is important. Much of the evidence is observational, meaning it is difficult to separate the effects of the medication from the effects of weight loss and improved metabolic health.
So, while joint health is a space to watch, GLP-1s should not be seen as a standalone MSK solution.
Why lifestyle support belongs alongside the drug
Across bone, muscle and joint health, the message is consistent: GLP-1s are not a substitute for physical activity, resistance training, recovery and sleep.
The employees most likely to be affected by muscle or bone-related risks are often those who lose significant weight without parallel strength or activity support. Longer term, employees who stop the medication will also need sustainable behaviours to help maintain weight, muscle mass and function.
For employers, this is the practical takeaway: if GLP-1 use is growing in your workforce, your MSK strategy becomes more important, not less.
What this means for MSK support: VIDA Personal Pathways
At Vitrue, our view is that MSK support needs to reflect the whole person.
Two employees using GLP-1 medication may have very different needs. One may need support maintaining strength. Another may need help building movement confidence. Another may already have joint pain, low activity levels, life-stage factors or existing MSK risk.
VIDA Personal Pathways is designed to move beyond generic advice by using a richer picture of each person’s MSK health. It brings together assessment data, pain history, workplace factors and clinical reasoning to shape more relevant support.
In the GLP-1 era, that kind of personalisation matters.
Because the goal is not just to help people lose weight. It is to help them stay strong, active and able to function well over time.
References
- Tan Y, Liu S, Tang Q. Effect of GLP-1 receptor agonists on bone mineral density, bone metabolism markers, and fracture risk in type 2 diabetes: a systematic review and meta-analysis. Acta Diabetologica. 2025.
- Hansen MS, Wölfel EM, Jeromdesella S, et al. Once-weekly semaglutide versus placebo in adults with increased fracture risk: a randomised, double-blinded, two-centre, phase 2 trial. EClinicalMedicine. 2024.
- Cheng L, Hu Y, Li YY, et al. The impact of GLP1 agonists on bone metabolism: a systematic review. Medicina. 2022.
- Neeland IJ, Linge J, Birkenfeld AL. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes, Obesity and Metabolism. 2024.
- Gatto A, Liu K, Milan N, Wong S. The effects of GLP-1 agonists on musculoskeletal health and orthopedic care. Current Reviews in Musculoskeletal Medicine. 2025.
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