Porto Joshua R, Lavu Monish S, Hecht Christian J, Kaelber David C, Sculco Peter K, Heckmann Nathanael D, Kamath Atul F
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA.
Orthop J Sports Med. 2025 Jan 13;13(1):23259671241297157. doi: 10.1177/23259671241297157. eCollection 2025 Jan.
The growing popularity of glucagon-like peptide-1 receptor agonists (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 total joint arthroplasty (TJA), recent evidence also indicates that GLP-1-RAs may have direct joint-protective, anti-inflammatory effects.
To evaluate the association between GLP-1-RA use and the onset and progression of hip and knee OA in an obese population.
Cohort study; Level of evidence, 3.
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.
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.
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.
胰高血糖素样肽-1受体激动剂（GLP-1-RAs）在减肥方面越来越受欢迎，这可能会对关节保护和关节置换产生重大影响。虽然这在一定程度上是由肥胖、骨关节炎（OA）和全关节置换术（TJA）之间的关联驱动的，但最近的证据也表明，GLP-1-RAs可能具有直接的关节保护、抗炎作用。
评估肥胖人群中使用GLP-1-RA与髋部和膝部OA的发病及进展之间的关联。
队列研究；证据等级，3级。
查询一个全国性健康网络，以获取2021年6月1日至2023年1月1日期间进行首次就诊且体重指数（BMI）≥30的患者。患者被分为无（n = 1,092,225）和有（n = 237,043）既往髋部和/或膝部OA的组。采用一对一倾向评分匹配法，根据年龄、性别、种族、BMI和合并2型糖尿病情况来平衡GLP-1-RA的使用。主要结局是1年内髋部OA、膝部OA、主要关节注射、全髋关节置换术（THA）和全膝关节置换术（TKA）的发生率。使用Cox比例风险模型来估计使用和未使用GLP-1-RAs的队列之间的风险比（HRs）。
在有既往OA的患者中，使用GLP-1-RA与1年内转为THA（1.1%对2.2%；HR，0.6；95%CI，0.5至0.8）和TKA（1.4%对2.1%；HR，0.8；95%CI，0.6至0.9）的几率降低相关。在无既往OA的患者中，使用GLP-1-RA与髋部OA发生率增加（0.9%对0.7%；HR，1.4；95%CI，1.2至1.6）、膝部OA（2.1%对1.9%；HR，1.3；95%CI，1.2至3.1）、主要关节注射（2.2%对1.8%；HR，1.4；95%CI，1.3至1.5）以及TKA（0.09%对0.04%；HR，2.6；95%CI，1.6至4.3）相关。比较无既往OA的队列，使用GLP-1-RA的患者在首次就诊后1年时BMI的下降幅度（-1.00；95%CI，-1.06至-0.96）略大于未使用GLP-1-RA的患者（-0.90；95%CI，-0.94至-0.84）。然而，在既往诊断为髋部或膝部OA的患者中，BMI变化无差异。
对于已有OA诊断的患者，GLP-1-RAs可能具有直接的病情改善作用，表现为转为TJA的风险降低，且这一降低并非由体重减轻所致。还需要进一步研究来阐明在无既往OA诊断的患者中使用GLP-1-RA与OA诊断发生率增加以及转为TKA之间的关联。
