Introduction Weight loss reduces obesity-related comorbidities.1 However, concomitant bone loss typically occurs with weight loss, seen as decreased bone mineral density (BMD) and increased bone turnover.2 Low BMD is associated with increased risk of fractures,3 and mortality rates increase following any fractures, particularly hip and vertebral fractures, but also other major fractures.4 Weight loss–induced bone loss is a particular concern in older adults.5 However, bone loss following weight loss has been shown not only in older adults,6-9 but also after gastric bypass,10 and after long-term calorie restriction in younger adults with11,12 and without obesity.13 Thus, weight loss–induced bone loss likely carries a risk across the lifespan, and identifying treatments that induce clinically relevant weight loss while minimizing bone loss is essential in long-term obesity management. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are used in obesity management because they induce weight loss via appetite inhibition.14-16 Physical activity is recommended for healthy weight loss, but most evidence is from prospective cohort studies.17 Exercise decreases fat mass and preserves or increases lean mass.18 In a recent trial,19 1 year of treatment with the GLP-1RA liraglutide (3.0 mg) or exercise as separate treatments maintained diet-induced weight loss and improved body composition.