The Five-Year Incidence of Progression to Osteoarthritis and Total Joint Arthroplasty in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists

Jun 10, 2024The Journal of arthroplasty

Five-Year Risk of Osteoarthritis and Joint Replacement in Patients Taking Glucagon-Like Peptide 1 Receptor Agonists

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Abstract

Among obese and non-obese diabetic patients, GLP-1 receptor agonist users had a greater risk of progressing to hip and knee osteoarthritis over five years.

Obese diabetic patients using GLP-1 receptor agonists experienced a 63% increased risk of hip osteoarthritis and a 52% increased risk of knee osteoarthritis.
Non-obese diabetic patients using GLP-1 receptor agonists had a 78% increased risk of hip osteoarthritis and a 58% increased risk of knee osteoarthritis.
Higher rates of major joint injections were observed in diabetic patients using GLP-1 receptor agonists, but rates of total hip and knee arthroplasties were similar between users and non-users.
No significant differences in five-year outcomes were found in obese, nondiabetic patients when comparing those prescribed GLP-1 receptor agonists to those not exposed.

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BACKGROUND: Research has suggested that glucagon-like peptide-1 receptor agonists (GLP-1-RAs) may have therapeutic effects on osteoarthritis of the hip and knee, in addition to managing diabetes and obesity. However, there is a lack of understanding regarding the association between GLP-1-RA use and the diagnosis of osteoarthritis (OA) of the hip and knee.

METHODS: A collaborative network analytics platform was queried for obese diabetic (n = 1,094,198), obese nondiabetic (n = 916,235), and nonobese diabetic (n = 157,305) patients who had an index visit between 2015 and 2017. Patients who had pre-existing hip and/or knee OA were excluded. A 1:1 propensity score matching was used to balance GLP-1-RA use in stratified cohorts for age, sex, race, body mass index, and hemoglobin A1c. The primary outcomes were rates of progression to hip OA, knee OA, major joint injections, total hip arthroplasty, and total knee arthroplasty. Cox proportional hazards models determined hazard ratios (HRs) between cohorts prescribed and not prescribed GLP-1-RAs.

RESULTS: All patients had a five-year follow-up. Rates of progression to hip and knee OA were higher among the GLP-1-RA users in both obese diabetic (hip HR: 1.63, 95% confidence interval [CI]: 1.46 to 1.82; knee HR: 1.52, CI: 1.41 to 1.64) and nonobese diabetic (hip HR: 1.78, CI: 1.50 to 2.10; knee HR: 1.58, CI: 1.39 to 1.80) cohorts. These diabetic cohorts received higher rates of major joint injections, though there was no difference in rates of total hip arthroplasty or total knee arthroplasty. No differences in five-year outcomes were seen when comparing obese, nondiabetic patients who were prescribed GLP-1-RAs with obese, nondiabetic patients not exposed to GLP-1-RAs.

CONCLUSIONS: This five-year analysis found a greater risk of progression to hip and knee OA among obese and non-obese diabetic GLP-1-RA users. Further studies should explore GLP-1-RA effects upon glucose management, weight loss, and lower extremity arthritis development.

LEVEL OF EVIDENCE: III, retrospective cohort study.

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The Five-Year Incidence of Progression to Osteoarthritis and Total Joint Arthroplasty in Patients Prescribed Glucagon-Like Peptide 1 Receptor Agonists

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