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This review explores the relationship between obesity, weight-loss modalities, and bone health. While obesity was historically viewed as bone-protective due to mechanical loading, recent evidence highlights qualitative bone deterioration and sitespecific fracture risks. Intentional weight loss through caloric restriction or bariatric surgery consistently accelerates bone turnover and reduces bone mineral density (BMD), with surgical interventions showing the most significant impact. Emerging data on GLP-1RAs suggest modest BMD declines, largely proportional to weight loss and likely driven by mechanical unloading. Conversely, preclinical studies indicate that GLP-1 signaling may exert direct osteoanabolic and anti-resorptive effects. To preserve skeletal integrity, obesity management must shift toward a holistic body composition framework. Integrating structured resistance exercise, optimizing nutrition (calcium, vitamin D, and protein), and implementing skeletal monitoring in high-risk individuals are essential. Future obesity care should prioritize the maintenance of bone quality and lean mass alongside fat reduction to ensure long-term skeletal resilience and prevent fragility fractures.<\/jats:p>","DOI":"10.3803\/enm.2026.2986","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T08:04:36Z","timestamp":1775635476000},"page":"210-221","update-policy":"https:\/\/doi.org\/10.3803\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond Weight Loss: Skeletal Considerations in Obesity Treatment"],"prefix":"10.3803","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3485-1879","authenticated-orcid":true,"given":"Myung Jin","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, 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