By HANA KAHLEOVA
Tuesday is World Osteoporosis Day, and one quantity deserves extra consideration than it will get: one in two women over 50 will break a bone due to osteoporosis. Bone loss quickens as estrogen falls throughout menopause. But within the rush to deal with midlife weight achieve with the most recent medicine, bones hardly ever come up.
I consider a affected person who sat down and named the drug earlier than she mentioned the rest. She was in her early 50s, and she or he wished a GLP-1, the weekly injection everybody appears to be on now. She had gained weight round her center that nothing would contact, and she or he had not slept by the night time in months. Two or thrice an evening she awakened soaked, kicked off the covers and lay awake. Two of her associates had began the drug that spring. She anticipated a prescription, not a dialog.
She is a composite of ladies I’ve handled, however her request is widespread. About one in five adults ages 50 to 64 have taken a GLP-1 drug, the very best share of any age group. Many are ladies in search of reduction from the load achieve and damaged sleep of the menopause transition.
They’ve good motive to need one thing that works. For generations, ladies’s menopause signs had been minimized or left for them to endure. A drug that lastly does one thing can really feel like overdue respect. In a 15-minute go to, additionally it is the quickest factor a physician can provide. That isn’t an unreasonable selection. The query is whether or not it ought to be the primary one.
What modified my reply for this affected person was a line already in her chart. A bone density scan the yr earlier than had proven osteopenia, the thinning that comes earlier than osteoporosis. It had earned a word to keep watch over it after which dropped out of the dialog, as these findings so typically do.
Right here is why it mattered. The burden folks lose on GLP-1 medicine shouldn’t be all fats. Throughout medical trials of those drugs, roughly a quarter of the weight lost was lean mass. In one retrospective study of sufferers taking semaglutide or tirzepatide, bone density on the hip fell by almost 3% over about three years. For a lady already dropping bone as estrogen declines, speedy weight reduction lands on high of an current deficit. And about half of patients stop semaglutide within a year, typically regaining weight, so some pay that price with out protecting the profit.
So I requested her a easy query: Of every part bothering you, what’s the worst half? It was not the load. It was the nights. She had stopped making morning plans as a result of she by no means knew what sort of night time she would have.
That reply gave me one thing higher to supply. In a randomized trial my colleagues and I revealed within the journal Menopause, 84 postmenopausal ladies with frequent scorching flashes both switched to a low-fat, plant-based weight-reduction plan with half a cup of cooked soybeans a day or made no adjustments. After 12 weeks, moderate-to-severe scorching flashes fell 88% within the weight-reduction plan group, in contrast with 34% within the management group. Half the ladies who modified their weight-reduction plan had no moderate-to-severe scorching flashes left in any respect. Many additionally misplaced weight with out counting energy.
I informed her all of it, together with the caveat that outcomes fluctuate and the one method to know is to strive. I advised 10 weeks, with the GLP-1 nonetheless on the desk if nothing modified. She was skeptical. She had tried consuming higher earlier than. I defined that this was not obscure recommendation. It was a selected swap: much less meat and dairy, extra beans and lentils, and a every day serving of soybeans, tofu or soy milk, backed by a trial that measured precisely the symptom she wished fastened.
She got here again at 10 weeks. The night time sweats had not vanished, however that they had gone from most nights to about twice per week, and so they had been delicate sufficient that she normally fell again asleep inside minutes. She had misplaced just a little weight. She had began making weekend plans once more.
GLP-1 medicine are an actual advance, and I prescribe them. For a lot of ladies, they’re the appropriate selection. However our well being care system is constructed to make the prescription the default. Brief visits reward it. Insurers pay for it extra readily than for the time it takes to discover different choices. Bone density outcomes get filed and forgotten. None of that serves ladies in midlife nicely.
Ladies can push again. Earlier than beginning any weight-loss drug, ask what your final bone density scan confirmed, or whether or not you want one. Ask what else may deal with the symptom that bothers you most. Docs can begin by asking what is definitely driving the go to. And insurers ought to cowl vitamin counseling and follow-up as readily as they cowl the drug, so the selection is actual.
Now, when a affected person asks me for a GLP-1, I ask first what’s protecting her up at night time. Ladies in midlife have waited lengthy sufficient to be requested.
Hana Kahleova, MD, PhD, is a doctor board-certified in inside medication, endocrinology and life-style medication, and director of medical analysis on the Physicians Committee for Responsible Medicine, a nonprofit that advocates plant-based vitamin and funded the new flash trial described right here. The affected person described is a composite drawn from her medical expertise.
