Bone Abstracts

Background: GLP-1 and dual GIP/GLP-1 receptor agonists are increasingly being used, but rapid weight loss may adversely affect bone and muscle health. Following NICE TA1026 and incorporation of tirzepatide into the 2026/27 GP Quality and Outcomes Framework, NHS provision is expanding from a predominantly self-funding population to more diverse groups with higher baseline fracture risk. As a specialist metabolic bone service, we anticipate that the rapid expansion of pharmacological weight loss will translate into clinical questions about long-term skeletal health. Little is known about patient awareness or acceptability of bone-protective interventions to inform these conversations and future trial design.

Methods: We conducted an online survey as a patient and public involvement activity to inform the design of a future trial of bone-protective strategies during pharmacological weight loss. Adults currently taking or about to start weight-loss medication were recruited through social media, primary care, pharmacies and supermarkets. The survey assessed awareness of bone and muscle loss, concerns, outcome priorities, and acceptability of investigations and treatment including intravenous zoledronate. Quantitative data were summarised descriptively and free-text responses analysed thematically.

Results: Thirty adults participated (87% female; 87% tirzepatide; 100% self-funded; 100% White ethnicity). Key findings are summarised in Table 1. Qualitative themes emphasised desire for clearer information, trust in clinicians, and concern about long-term consequences.

Conclusions: The majority of patients on pharmacological weight-loss therapy are unaware of potential effects on bone and muscle health, and most have never discussed bone protection with a clinician. Despite this information gap, acceptability of bone-protective strategies including zoledronate is high, supporting the feasibility of trials in this area and highlighting the importance of patient-centred outcome selection. As NHS provision expands to more diverse populations with higher baseline fracture risk, embedding bone health into counselling, monitoring and intervention design should be a priority.