Eight percent of US adults older than 65 years have taken a GLP-1 agonist either to lose weight or to treat comorbidities like diabetes and cardiovascular disease. Older adults are drawn to the medications because of the many antiaging benefits — some medical experts have even called them a veritable “fountain of youth.”
But both patients and physicians should also be aware of some of the drawbacks and potential side effects for which older adults are particularly susceptible like a dangerous reduction in muscle mass, bone loss, low blood pressure, and dehydration.
Understanding this age group’s particular vulnerabilities can help physicians know what to look out for while also staving off some potential side effects before they become an issue.
Benefits in Older Adults
Researchers point to a wide breadth of research showing the proven cardiovascular and renal benefits for older adults taking GLP-1s.
A May 2024 study published in the American Journal of Preventative Cardiology followed a large group of over 83,000 people and found that cardiovascular and renal outcomes were significantly better in the group who took GLP-1s, including improved blood flow, reduced risk for stroke, improved kidney function, and improved overall mortality.
“Older adults are generally at a higher risk of cardiovascular disease and poor renal outcomes so this is a group that can see a lot of benefits,” said Ziyad Al-Aly, a physician and clinical epidemiologist at Washington University School of Medicine in St. Louis, who has extensively studied GLP-1 medications.
Other research has shown that GLP-1s can reduce the risk for hospitalization for heart failure, which is also of particular importance to older adults. A study released last month in the Journal of Cardiac Failure found that taking GLP-1s mildly reduced ejection fraction, when the heart muscle pumps but doesn’t relax and refill as it should, leading to symptoms of heart failure. The disease directly causes 8.5% of heart disease deaths in the US annually.
Early data has also shown that these medications are helpful for staving off neurodegenerative diseases like Alzheimer’s disease and dementia which affect nearly 10% of patients older than 65 years. As the data becomes clearer, this is another place where older adults especially could see significant benefits.
Muscle and Bone Health
It’s clear that these medications are beneficial to older adults, but there’s also some concern around side effects that could be more harmful to this age group. A study published in November 2024 in The Lancet Diabetes and Endocrinology found that there was a substantial increase in loss of muscle mass in older patients who had taken GLP-1s.
It’s already harder to maintain muscle mass as you age and in fact, after age 30 muscle mass begins to decrease from 3% to -8% naturally each decade. To make matters worse, once patients lose muscle in this age group, it’s difficult to regain it because of the reduced muscular fiber and protein synthesis that comes with age.
“If you take a GLP-1, no matter how old you are, you’re going to lose a fair amount of weight and part of that weight loss is going to be muscle,” said Steven B. Heymsfield, an author of The Lancet study and professor of Metabolism & Body Composition Laboratory at Louisiana State University, Baton Rouge, Louisiana. This could accelerate a patient’s entry into the sarcopenia range, defined as a loss of 5%-13% muscle mass in individuals between 60 and 70 years old, he added.
While you might not worry about someone in their 30s losing muscle mass, for those older than 65 years, it can mean that they become frail and in danger of falling and breaking a bone, said Al-Aly.
Heymsfield said part of combatting muscle loss is ensuring that you’re getting enough protein in your diet and are also being intentional about what you eat. Older adults require between 90 g and 120 g of protein daily, depending on their body weight in conjunction with daily weight or resistance training exercises.
Additionally, when people lose weight, they also lose bone mass and bone density because the bones don’t have to work as hard to hold up the body’s frame.
“Bone density is a function of how much the bone carries and while it’s a bit paradoxical, people with obesity actually have a stronger bone mass,” said Al-Aly.
Bones are living tissues that are constantly remodeling, which is why really thin people can have issues with frailty and osteoporosis, when bones become weaker and are more prone to breaks and fractures.
In order to combat this bone loss, patients need to ensure that they’re getting enough protein as well as calcium and vitamin D to help with bone growth. Adults older than 70 years should be getting at least 1200 mg of calcium and 800 IU of vitamin D daily.
Blood Pressure and Kidney Function
Another concern in taking GLP-1 medications is low blood pressure, also called hypotension. This can happen when someone taking a GLP-1 loses weight, which reduces strain on the heart and lowers their blood pressure as a result.
Often patients who are still on blood pressure medications may start to experience low blood pressure, which can be so severe that it leads to fainting in some patients. In this case, physicians need to check vitals regularly to ensure that their blood pressure medications are titrated to the correct dosage or stopped completely.
Finally, GLP-1 medications can also cause dehydration, which can be problematic for older patients, said Carolynn Francavilla, MD, a nationally recognized obesity physician who owns and operates Green Mountain Partners for Health and Colorado Weight Care, both in Denver. Much of the fluid that we take in comes from the foods we eat like a salad or a big juicy peach and when appetite is suppressed, so too is the amount of fluids that a patient is consuming.
“Older people tend to have more renal disfunction or kidney disease, which means that they could be more susceptible to the risks of dehydration,” said Francavilla.
But Francavilla adds that this is easy to remedy by making sure that patients are drinking enough fluids each day and for those at higher risk, ensuring their doctor is monitoring their kidney function at least a few times annually. If doctors are aware of these potential concerns, they can be safely dealt with in patients.
“All of these medications are going to come with risks and benefits, that’s why discussing them with your doctor at any age is so important,” said Francavilla.
https://www.medscape.com/viewarticle/everything-patients-need-know-about-aging-glp-1s-2025a1000n72
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