You’ve lost 30 pounds on Ozempic. Your knees feel better, your energy is back, and you’re finally returning to the pickleball court. Then, reaching for a shot, something in your shoulder gives way.

That scenario sits at the center of a new five-year study presented at the 2026 American Academy of Orthopaedic Surgeons (AAOS) meeting. People with obesity taking GLP-1 medications had roughly a 50% higher rate of major tendon tears, including the rotator cuff, the Achilles, and the quadriceps tendon just above the kneecap.

The headlines stop there. But that 50% figure may represent far fewer extra tears than you’d expect, and the most likely reason behind it is something you can actually influence. Here’s what the research found, what the numbers mean in real life, and what’s worth measuring if you’re on one of these medications.

Episode Video

What the GLP-1 Tendon Study Found

The research came from a team at the University of Texas Medical Branch and was later summarized by the authors in AAOS Now.

How the Study Was Designed

Researchers reviewed health records for more than 78,000 people with obesity who had a prescription for a GLP-1 medication. They compared this group to an equal number of people matched for age, sex, body weight, diabetes, and cholesterol who were not taking these medications. Both groups were followed for five years.

The Headline Results

Compared to the matched group, people on GLP-1 medications had higher rates of:

• Rotator cuff tears

• Achilles tendon tears

• Pectoralis (chest) tendon tears

• Quadriceps tendon tears

Depending on the tendon, the increased risk ranged from roughly 45% to 55%. In a separate analysis, the same team found a higher rate of osteoporosis among people with diabetes and obesity on these medications (4.1% compared to 3.2%).

Relative Risk vs. Absolute Risk: Why the Number Feels Bigger Than It Is

This is the part most coverage skips, and it matters most for your decisions.

Putting the Rotator Cuff Numbers in Perspective

Over five years, about 1.5% of people not taking a GLP-1 had a rotator cuff tear. In the GLP-1 group, that number was about 2.4%.

In real terms, out of 1,000 people, that’s roughly 15 tears in one group and 24 in the other. That’s a 55% relative increase, and it’s also about nine extra people out of 1,000. Both statements are true, neither should be ignored, and you deserve to hear both.

The Limits of a Records Study

This study showed an association, not proof of cause. A prescription in a medical chart doesn’t confirm someone actually took the medication, and the tears were identified through diagnosis codes rather than confirmed imaging. The authors acknowledged these limitations directly. This is not a reason to panic, but it is a reason to pay attention.

Why GLP-1 Medications Might Affect Your Tendons

No one has proven the mechanism yet, but a couple of explanations make biological sense.

Rapid Weight Loss Includes Muscle Loss

When you lose weight quickly, you don’t only lose fat. In the major trial that led to semaglutide’s approval for weight loss, participants who had body composition scans lost a meaningful amount of lean mass. Lean mass accounted for close to 40% of their total weight loss.

Muscles Are Your Tendons’ Shock Absorbers

A strong muscle absorbs load, controls movement, and protects the tendon attached to it. When muscle drops quickly, the tendon suddenly handles more of the work.

Now picture someone who feels lighter and more energetic and starts doing more (pickleball, golf, hiking, lifting weights). The scale went down, but the tendon’s capacity to handle load may not have kept pace.

Possible Direct Effects on Connective Tissue

GLP-1 receptors have been identified in tissues beyond the gut and pancreas, and researchers are exploring whether these medications act directly on connective tissue. That research is still early, so it’s too soon to draw conclusions.

This Is Not a Reason to Stop Your Medication

GLP-1 medications have done real good for many people, including those with serious heart and metabolic disease. Never stop or change a prescribed medication without talking to the doctor who prescribed it. The goal is to have the full picture so you can make informed decisions together.

Which of These Four Situations Describes You?

You’re on a GLP-1 and Actively Protecting Your Muscle
You’re doing resistance training, eating enough protein, and tracking body composition rather than just weight. You’re in the best position, because the medication is doing its job without costing you the structure that protects your joints.

You’re on a GLP-1 and Only Watching the Scale
The number is going down and you’re happy, but nobody is measuring what that number is made of. This is the most concerning group, because muscle losses stay invisible until something gives.

You’re Thinking About Starting a GLP-1
This is the ideal time to have this conversation. Getting a baseline body composition measurement and building strength before you begin puts you in a far better position than trying to catch up later.

You’re on a GLP-1 and Have New Joint Pain
New shoulder pain, heel pain, or pain above the kneecap is not something to push through. Tendons usually send warning signals before they tear, and an early evaluation (with imaging when appropriate) generally leaves you with more options than waiting for a rupture.

Measuring What Matters

If you fall into the second or fourth group, understanding how body composition is measured is a smart next step. Home body composition tracking and DEXA scans each have strengths and limitations worth knowing before you choose one.

Final Thoughts

A 50% higher relative risk is worth knowing, and so is the fact that it translates to about nine extra tears per 1,000 people over five years. The medication isn’t the whole story, because what happens to your muscle while you’re on it may be the part you can actually control. Protecting your strength could be one of the best investments you make in your joints. For the full discussion, including how to think about body composition tracking, watch or listen to this episode of Mobilize and Energize. Subscribe so you don’t miss future episodes on joint health, movement, and recovery.

Frequently Asked Questions

1. Do GLP-1 medications like Ozempic cause my tendons to tear?
   The study found an association between GLP-1 use and tendon tears, but it did not prove the medications cause them.

2. How much does my risk of a tendon tear actually increase on a GLP-1?
   For rotator cuff tears, the risk rose from about 15 to 24 per 1,000 people over five years, roughly nine extra tears.

3. Should I stop taking my GLP-1 medication because of this study?
   No, you should never stop or change a prescribed medication without first talking to the doctor who prescribed it.

4. How can I protect my tendons while I’m losing weight on a GLP-1?
   Resistance training, eating enough protein, and tracking your body composition rather than just your weight can help preserve the muscle that protects your tendons.

5. What should I do if I develop new shoulder, heel, or knee pain while on a GLP-1?
   See your doctor for an early evaluation, since tendons often send warning signals before they tear.

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