The Impact of Contemporary Glucagon-like Peptide-1 Receptor Agonists on the Onset, Severity, and Conversion to Arthroplasty in Hip and Knee Osteoarthritis

📖 Top 20% JournalJan 15, 2025Orthopaedic journal of sports medicine

How Modern Diabetes Drugs Affect the Start, Severity, and Hip or Knee Replacement in Osteoarthritis

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Abstract

GLP-1 receptor agonist use is associated with a reduced risk of total hip and knee arthroplasties in patients with preexisting osteoarthritis.

In patients with preexisting osteoarthritis, GLP-1 receptor agonist use correlated with lower rates of conversion to total hip arthroplasty (1.1% vs 2.2%) and total knee arthroplasty (1.4% vs 2.1%).
In those without preexisting osteoarthritis, GLP-1 receptor agonist use was linked to an increased incidence of hip osteoarthritis (0.9% vs 0.7%) and knee osteoarthritis (2.1% vs 1.9%).
Patients without prior osteoarthritis prescribed GLP-1 receptor agonists experienced a slightly greater decrease in body mass index compared to those not prescribed the medication (-1.00 vs -0.90).
No difference in body mass index change was noted in patients with a prior diagnosis of hip or knee osteoarthritis, regardless of GLP-1 receptor agonist use.
Further investigation is warranted to clarify the relationship between GLP-1 receptor agonist use and the increased incidence of osteoarthritis and conversion to total knee arthroplasty in patients without prior osteoarthritis.

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BACKGROUND: The growing popularity of (GLP-1-RAs) for weight loss could significantly impact joint preservation and arthroplasty. While this will in part be driven by the association between obesity, osteoarthritis (OA), and (TJA), recent evidence also indicates that GLP-1-RAs may have direct joint-protective, anti-inflammatory effects.

PURPOSE: To evaluate the association between GLP-1-RA use and the onset and progression of hip and knee OA in an obese population.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: A national health network was queried for patients with an index visit between June 1, 2021, and January 1, 2023, and a body mass index (BMI) ≥30. Patients were stratified into groups without (n = 1,092,225) and with(n = 237,043) preexisting hip and/or knee OA. One-to-one propensity score matching was used to balance GLP-1-RA use based on age, sex, race, BMI, and comorbid type 2 diabetes mellitus. Primary outcomes were incidence of hip OA, knee OA, major joint injections, total hip arthroplasty (THA), and total knee arthroplasty (TKA) within 1 year. Cox proportional hazards models were used to estimate hazard ratios (HRs) between cohorts prescribed and not prescribed GLP-1-RAs.

RESULTS: In patients with preexisting OA, GLP-1-RA use correlated with reduced odds of conversion to THA (1.1% vs 2.2%; HR, 0.6; 95% CI, 0.5 to 0.8) and TKA (1.4% vs 2.1%; HR, 0.8; 95% CI, 0.6 to 0.9) within 1 year. In patients without preexisting OA, GLP-1-RA use was associated with an increased incidence of hip OA (0.9% vs 0.7%; HR, 1.4; 95% CI, 1.2 to 1.6), knee OA (2.1% vs 1.9%; HR, 1.3; 95% CI, 1.2 to 3.1), major joint injections (2.2% vs 1.8%; HR, 1.4; 95% CI, 1.3 to 1.5), and TKA (0.09% vs 0.04%; HR, 2.6; 95% CI, 1.6 to 4.3). Comparing cohorts without prior OA, patients who were prescribed a GLP-1-RA demonstrated slightly greater decreases in BMI (-1.00; 95% CI, -1.06 to -0.96) at 1-year after the index visit compared with patients not prescribed a GLP-1-RA (-0.90; 95% CI, -0.94 to -0.84). However, in patients with a prior diagnosis of hip or knee OA, there was no difference noted in BMI change.

CONCLUSION: GLP-1-RAs may provide direct disease-modifying behaviors in patients with preexisting OA diagnosis, per a reduced risk of conversion to TJA not attributable to weight loss. Further investigation is also needed to elucidate the association between GLP-1-RA use and the increased incidence of OA diagnosis and conversion to TKA in patients with no preexisting OA diagnosis.

Key numbers

1.1% vs 2.2%

Decrease in Odds

Comparison of conversion rates to in patients with preexisting prescribed vs. those not prescribed.

0.9% vs 0.7%

Increase in Hip Incidence

Incidence of hip in patients without prior prescribed vs. those not prescribed.

0.09% vs 0.04%

Increase in Odds

Comparison of incidence in -free patients prescribed vs. those not prescribed.

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Abstract

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