Diabetes/metabolism research and reviewsJun 6, 2025

Risk of Osteoarthritis and Joint Replacement in Type 2 Diabetes Patients Using SGLT2 Inhibitors Compared to GLP-1 Receptor Agonists

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jan 20, 2026

Abstract

SGLT2 inhibitors are associated with lower risks of new-onset osteoarthritis and joint replacement surgery compared to GLP-1 receptor agonists.

The study involved 37,676 matched patients in each treatment group after initial identification of 51,177 SGLT2 inhibitor users and 52,977 GLP-1 receptor agonist users.
The average age of participants was 59.5 years, with approximately 45% being women.
SGLT2 inhibitors were linked to a hazard ratio of 0.951 for new-onset osteoarthritis, suggesting a potential reduction in risk.
The risk of joint replacement surgery in the SGLT2 inhibitor group was significantly lower, with a hazard ratio of 0.703.
These findings suggest that SGLT2 inhibitors may offer advantages over GLP-1 receptor agonists regarding joint health in patients with type 2 diabetes.

Simplified

AIMS: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) may have the potential to lower the risk of osteoarthritis through an anti-inflammatory mechanism. This study compared the risks of new-onset osteoarthritis and joint replacement surgery between new users of SGLT2is and new users of glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

MATERIALS AND METHODS: We conducted a propensity score-matched cohort retrospective study by using data obtained from the TriNetX platform. The Global Collaborative Network of TriNetX includes approximately 131 million patients from 109 health care organisations. First, new users of SGLT2is and GLP-1 RAs among patients with type 2 diabetes mellitus were identified. Two homogeneous groups were established through propensity score matching. The study outcomes were the risks of new-onset osteoarthritis and joint replacement surgery of the hip or knee. Hazard ratios (HRs) along with 95% CIs were calculated using the TriNetX platform.

RESULTS: Initially, the SGLT2is and GLP-1 RA groups comprised 51,177 and 52,977 patients, respectively. After matching, each group comprised 37,676 patients. The mean age of the patients was 59.5 years. Approximately 45% of the patients in both groups were women. The SGLT2is group had significantly lower risks of new-onset osteoarthritis (HR: 0.951; 95% CI: 0.916-0.988) and joint replacement surgery (HR: 0.703; 95% CI: 0.550-0.898) than the GLP-1 RA group.

CONCLUSIONS: SGLT2is use was associated with reduced risks of new-onset osteoarthritis and joint replacement surgery compared with GLP-1 RA use in patients with type 2 diabetes mellitus. Future prospective studies are warranted to confirm our findings.

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Risk of Osteoarthritis and Joint Replacement in Type 2 Diabetes Patients Using SGLT2 Inhibitors Compared to GLP-1 Receptor Agonists

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