A
Trends in Glucagon-like peptide-1 Receptor Agonists for Weight Loss prior to Total Joint ArthroplastyA
A
Yuan-HsinChen
MD, MPH
1,2AndrewR.Grant
BA
3Ya-WenChen
MD, MPH
1,2HannahI.Travers
MS
3KatharineP.Playter
BS
3,4✉Phone978-987-9282Emailkplayter@nebh.orgBrianL.Hollenbeck
MD
3DarrenZ.Nin
PhD
1,2RuijiaNiu
MPH
3CarlT.Talmo
MD
3DavidC.Chang
PhD, MPH, MBA
1,2EricL.Smith
MD
31
A
Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusetts2
A
Codman Center for Clinical Effectiveness in SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusetts3
A
Department of Orthopedic SurgeryNew England Baptist HospitalBostonMassachusetts4
A
Department of Orthopedic Surgery, New England Baptist Hospital125 Parker Hill Avenue02120BostonMAYuan-Hsin Chen, MD, MPH1,2, a; Andrew R. Grant, BA3, a; Ya-Wen Chen, MD, MPH1,2; Hannah I. Travers, MS3; Katharine P. Playter, BS3; Brian L. Hollenbeck, MD3; Darren Z. Nin, PhD1,2; Ruijia Niu, MPH3; Carl T. Talmo, MD3; David C. Chang, PhD, MPH, MBA1,2; Eric L. Smith, MD3
1Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
2Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
3Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
Corresponding author: Katharine P. Playter. Department of Orthopedic Surgery, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120. Phone: 978-987-9282. Email: kplayter@nebh.org
Yuan-Hsin Chen MD, MPH and Andrew R. Grant BA contributed equally to this work.
A
Conflict of Interest Statement:Katharine Playter owns stock in Intuitive Surgical & Medtronic
Carl T. Talmo is an employee of Astra-Zeneca, receives IP royalties for DJ Orthopaedics, and is a paid consultant for Zimmer and DJ Orthopaedics
Eric L. Smith Receives IP royalties from DePuy Synthes, has other professional activities with DePuy Synthes and ConforMIS, Inc, and is on the board of directors or is a committee member of AAOS, AAHKS, and The Knee Society
Yuan-Hsin Chen, Andrew Grant, Ya-Wen Chen, Hannah I. Travers, Ruijia Niu, Brian Hollenbeck, Darren Z. Nin, David C. Chang: None
A
ABSTRACT
Background
Obesity is a recognized risk factor for postoperative complications in total joint arthroplasty (TJA), and interventions to reduce weight are often performed for patients planning to undergo surgery. While metabolic and bariatric surgery (MBS) is an established method for achieving preoperative weight loss in TJA candidates, the popular glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may have shifted the landscape of weight loss interventions. However, this trend and its characteristics have not been described. Therefore, this study aimed to identify patient demographics and characteristics associated with GLP-1 RAs usage or MBS interventions in the TJA population.
Methods
A
The MarketScan Database was queried to identify patients with obesity who had an inpatient admission and underwent primary total hip/knee arthroplasty (THA/TKA) between January 1, 2021 and December 31, 2022. The primary exposure was the utilization of GLP-1 RAs or MBS within the year before TJA. The demographic, geographic, and time of weight loss interventions were assessed. Multivariable logistic regressions were performed, adjusting for the above covariates.Results
Our study identified 31,300 patients who underwent TKA (n = 20,604) or THA (n = 10,696). Patients with obesity using GLP-1 RAs were more likely to be women (TKA odds ratio [OR] 1.50, 95% CI 1.30–1.72; THA OR 1.55, 95% CI 1.26–1.90; both P < 0.001) and aged under 55. The usage of GLP-1 RAs increased from 2021 to 2022 (TKA OR 1.88, 95% CI 1.64–2.15; THA OR 1.57, 95% CI 1.28–1.94; both P < 0.001), while the rates of MBS remained relatively stable over the same period. The increasing trend in GLP-1 RAs usage was observed in both diabetic and non-diabetic patients.
Conclusion
Our study found that patients under 55 and women were more likely to utilize MBS or GLP-1 RAs prior to TJA. We also identified an increase in GLP-1 RAs usage from 2021 to 2022, independent of diabetes status.
A
A
A
A
A
INTRODUCTION
Obesity is a prevalent and considerable challenge in total joint arthroplasty (TJA) due to the increased risk of complications.1,2 Preoperative optimization of this comorbidity is crucial, and the American Association of Hip and Knee Surgeons recommends a body mass index (BMI) cutoff of 40 for safe TJA.3,4 Many patients with obesity often have arthritis necessitating surgery and, therefore, utilize weight loss strategies to become eligible for TJA.5,6 Metabolic and bariatric surgery (MBS) is an established method for achieving preoperative weight loss in TJA candidates. However, the indications for MBS limit patient eligibility, and concerns about surgical risks deter patients with comorbidities.7
Recently, non-surgical interventions have been shown to be effective in reducing BMI before surgery.8,9 Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are established treatments for glycemic control in diabetes and have been increasingly utilized for weight loss following Food and Drug Administration approval.6,10 Multiple studies have explored the impact of GLP-1 RAs in orthopaedics, with some indicating a beneficial effect on bone mineral density and fracture risk.11–14 Additionally, recent research has discussed their potential role in preoperative weight loss for TJA.6,15,16 However, the extent of their usage and implications in TJA have not yet been comprehensively demonstrated.15,17,18
The rapid increase in GLP-1 RAs utilization warrants further investigation. Although studies have found that GLP-1 RAs may be disease-modifying therapies for knee osteoarthritis by mediating weight loss as well as inflammatory pathways, their perioperative impacts remain uncertain,19–22 with some studies reporting risks of kidney injury, myocardial infarction, and pneumonia, while others have found no significant risks.23–25 There is limited data on whether there has been a significant change in the strategies used for weight loss in the TJA population. Therefore, we aim to identify patient demographics and characteristics associated with GLP-1 RAs usage or MBS interventions in the TJA population.
METHODS
Data Source
The MarketScan Database includes over 273 million unique patients annually, comprising insured employees, retirees, their spouses, and dependents under employer-sponsored private health insurance in the United States.26 The databases enable longitudinal tracking of patients across different institutions and providers. The Commercial Claims and Encounters database contains medical and pharmaceutical data sourced from employers and health plans.
A
This study was approved by the New England Baptist Hospital Institutional Review Board.Cohort Selection
We conducted a retrospective study that included patients with obesity who had an inpatient admission and underwent total hip arthroplasty (THA; Current Procedural Terminology [CPT] 27130) or total knee arthroplasty (TKA; CPT 27447) between January 1, 2021 and December 31, 2022. Obesity was identified via the International Classification of Diseases, 10th Revision (ICD-10) codes (Supplement Table 1). Patients without continuous enrollment during the study period and patients who used non-GLP-1 RAs weight loss drugs within 1 year prior to TJA were excluded. These weight loss drugs were Bupropion-naltrexone (Contrave/Mysimba), Orlistat (Xenical, Alli), Phentermine-topiramate (Qsymia), and Setmelanotide (Imcivree).27
Without weight loss strategies (control group) | GLP-1 RAs | P value1 | MBS | P value2 | |||
|---|---|---|---|---|---|---|---|
Patient number | 10,198 | 417 | 81 | ||||
Mean age (SD) | 60.8 (10.0) | 58.0 (7.8) | < 0.001 | 54.7 (8.7) | < 0.001 | ||
Women | 5,002 (49.0%) | 227 (54.4%) | 0.031 | 54 (66.7%) | 0.002 | ||
Region | |||||||
Northeast | 1,277 (12.5%) | 49 (11.8%) | < 0.001 | 16 (19.8%) | 0.26 | ||
Midwest | 3,992 (39.2%) | 117 (28.1%) | 29 (35.8%) | ||||
South | 3,958 (38.8%) | 221 (53.0%) | 30 (37.0%) | ||||
West | 969 (9.5%) | 30 (7.2%) | 6 (7.4%) | ||||
Comorbidities | |||||||
Diabetes | 2,381 (23.3%) | 284 (68.1%) | < 0.001 | 21 (25.9%) | 0.58 | ||
Hypertension | 7,226 (70.9%) | 336 (80.6%) | < 0.001 | 67 (82.7%) | 0.019 | ||
Hypercholesterolemia | 6,562 (64.3%) | 309 (74.1%) | < 0.001 | 45 (55.6%) | 0.10 | ||
Cancer | 1,139 (11.2%) | 45 (10.8%) | 0.81 | 3 (3.7%) | 0.033 | ||
Year of THA | |||||||
2021 | 5,116 (50.2%) | 164 (39.3%) | < 0.001 | 38 (46.9%) | 0.56 | ||
2022 | 5,082 (49.8%) | 253 (60.7%) | 43 (53.1%) | ||||
BMI | |||||||
30-34.9 | 2,707 (43.6%) | 57 (19.3%) | < 0.001 | 3 (3.9%) | < 0.001 | ||
35-39.9 | 1,767 (28.5%) | 72 (24.4%) | 7 (9.1%) | ||||
≥ 40 | 1,567 (25.2%) | 163 (55.3%) | 67 (87.0%) | ||||
| 1: P value comparing no weight loss strategies and GLP-1 RAs; 2: P value comparing no weight loss strategies and MBS. | |||||||
| Abbreviations: total hip arthroplasty (THA); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); metabolic and bariatric surgery (MBS); standard deviation (SD); body mass index (BMI). | |||||||
Defining Weight Loss Interventions and Covariates
Patients were identified to have utilized GLP-1 RAs or undergone MBS within a year leading up to TJA. GLP-1 RAs included liraglutide, semaglutide, and tripeptide. Covariates were patient demographics, comorbidities, and year of TJA. Patient demographics included age, sex, and geographic region (Northeast, Midwest, South, or West). Patient comorbidities were diabetes, hypertension, hypercholesterolemia, and cancer, identified with ICD-10 codes.
Data Analyses
The demographic, geographic, and temporal characteristics of GLP-1 RAs and MBS utilization were assessed using Chi-squared analyses. Multivariate logistic regressions were performed, adjusting for patient demographics, comorbidities, and year of TJA using STATA (Version.17.0; StataCorp). Additionally, we conducted a sensitivity analysis to test whether a subgroup of TJA patients with obesity and without diabetes exhibited similar trends. This analysis was performed because GLP-1 RAs are commonly prescribed for diabetic patients. By focusing on non-diabetic patients, we can evaluate the use of GLP-1 RAs for weight loss beyond diabetes management. A P-value cutoff of < 0.05 was used for statistical significance. All effect estimates were reported with corresponding 95% confidence intervals (CIs).
Baseline Population Demographics
A total of 31,300 patients were included in the study, with a median age of 61 years (Interquartile range, 56 to 66) and 17,734 (56.7%) women. There were 20,604 (65.8%) patients who underwent TKA, and 10,696 (34.2%) patients who underwent THA.
RESULTS
Patient Characteristics with GLP-1 RAs and MBS Usage among TKA Patients
Table 1A shows that patients who received GLP-1 RAs before TKA (n = 1,033) were significantly younger average age and were more likely to be women. These patients were also more likely to be diagnosed with higher BMI, diabetes, hypertension, hypercholesterolemia, and cancer compared to patients who did not receive GLP-1 RAs. Additionally, patients who received MBS before TKA (n = 170) exhibited similar characteristics but did not demonstrate higher likelihood of hypercholesterolemia and cancer. Figure 1A illustrates the trend of GLP-1 RAs and MBS usage among TKA patients from 2021 to 2022. There was a significant increase in the use of GLP-1 RAs among TKA patients in 2022 compared to 2021, while the usage of MBS remained relatively stable over this period.
In the adjusted analysis (Fig. 2A), patients using GLP-1 RAs before TKA were more likely to be women (odds ratio [OR] 1.50, 95% CI 1.30–1.72, P < 0.001) or aged under 55. Specifically, the likelihood of using GLP-1 RAs decreased with age (OR for ages 55–59, 60–64, and ≥ 65 were 0.78, 0.69, and 0.21, respectively; all P ≤ 0.01). Moreover, there was a significant increase in GLP-1 RAs usage in 2022 compared to 2021 (OR 1.88, 95% CI 1.64–2.15, P < 0.001). On sensitivity analysis focusing on TKA patients with obesity and without diabetes TKA patients, the results were consistent with the overall findings. Among non-diabetic patients, the usage of GLP-1 RAs also increased from 2021 to 2022.
Patient Characteristics with GLP-1 RAs and MBS Usage among THA Patients
The results among THA patients are qualitatively similar. As shown in Table 1B, patients who received GLP-1 RAs before THA (n = 417) were significantly younger and more likely to be women. These patients were also more likely to be diagnosed with higher BMI, diabetes, hypertension, and hypercholesterolemia compared to those who did not receive GLP-1 RAs. For patients who received MBS before THA (n = 81), similar characteristics were observed, except for the absence of diabetes and hypercholesterolemia. The trend in the use of GLP-1 RAs and MBS among THA patients from 2021 to 2022 is depicted in Fig. 1B. There was a marked increase in the use of GLP-1 RAs among THA patients in 2022 compared to 2021, while the usage of MBS remained relatively stable during this period.
Adjusted analysis (Fig. 2B) revealed that patients using GLP-1 RAs before THA were more likely to be women (OR 1.55, 95% CI 1.26–1.90, P < 0.001) and less likely to age 60 or older. Furthermore, there was a significant increase in GLP-1 RAs usage in 2022 compared to 2021 (OR 1.57, 95% CI 1.28–1.94, P < 0.001). In the sensitivity analysis focusing on THA patients with obesity and without diabetes, we observed similar results. The usage of GLP-1 RAs among non-diabetic patients increased from 2021 to 2022.
DISCUSSION
Given the rapid increase in the utilization of GLP-1 RAs in the United States and theoretical implications for its usage in the TJA patients, we sought to better characterize the trends of GLP-1 RAs usage in this population. Our study found that patients with obesity using GLP-1 RAs prior to TKA or THA were more likely to be women or aged under 55. Also, among patients who underwent TKA or THA, the usage of GLP-1 RAs increased from 2021 to 2022, while the rates of MBS remained relatively stable over the same period. The increasing trend of GLP-1 RAs usage was observed in both diabetic and non-diabetic patients.
The literature on the demographic characteristics of GLP-1 RAs usage in TJA is limited. Most previous studies did not focus on surgical patients. Among the general population, GLP-1 RAs users are more likely to be women and younger compared to non-users.28–30 According to a report done by Blue Cross Blue Shield Association, the majority of GLP-1 RAs users were women and between ages of 35 and 54.28 Besides, a recent study similarly indicated that new GLP-1 RAs users were disproportionately women.29 To the best of our knowledge, our analysis of the demographic trends of GLP-1 RAs use in TJA is novel, revealing that GLP-1 RAs users were more likely to be under 55 or women. This finding aligns with the higher morbidity rates associated with elderly patients, making it reasonable that GLP-1 RAs users tend to be younger.31 However, the association between women and higher GLP-1 RAs use remains unclear. It is possible that women often seek medical care more regularly and are more proactive in weight management, which may account for the higher prevalence of GLP-1 RAs use among them.32
A recent report by the American Academy of Orthopaedic Surgeons demonstrated an increasing trend in the use of GLP-1 RAs before TJA from 2019 to 2023 among patients with a BMI between 35 and 45.33 Additionally, an evidence shows that more new prescriptions for GLP-1 RAs have been written in recent years, with the proportion of new users with a BMI of 30 or higher rising from 47% to over 66% from 2011 to 2023.29 Our study expands the current understanding by demonstrating that patients with obesity increased their usage of GLP-1 RAs before TJA, and this trend was observed among both diabetic and non-diabetic patients. This suggests that GLP-1 RAs represent a strong option for patients needing to lose weight prior to TJA. A recent editorial even suggested that GLP-1 RAs could increase the number of eligible patients for elective TJA.18 On the other hand, our study showed that the volume of MBS remained relatively stable from 2021 to 2022. This seems to conflict with the understanding that the rising popularity of GLP-1 RAs might reduce the demand for MBS.34 It is unclear why MBS didn’t decrease in the present study. The possible reason for this may be that GLP-1 RAs and MBS are not at odds, due to the effectiveness and durability of weight loss. A systematic review found that MBS produces greater and more durable weight loss than GLP-1 RAs, while the effects of GLP-1 RAs are durable only with sustained use of the medications.35 Furthermore, sustained weight loss from MBS is associated with a lower risk of comorbidities. Therefore, both GLP-1 RAs and MBS have a place in providing treatment options for patients needing to lose weight.
Our study has several strengths. It utilized a nationwide commercial claims database, allowing for a representative exploration of trends in the use of GLP-1 RAs and MBS. This database also enabled longitudinal tracking of patients across various providers and facilities, enhancing the generalizability of our findings. However, there are limitations to our study. We did not include most patients with Medicare, as our analysis utilized a commercial claims database. Despite this exclusion, the elderly represent a relatively small proportion of those undergoing weight loss interventions, so our results remain valid even without their inclusion.
CONCLUSION
Our study found that patients who aged under 55 and women were more likely to utilize MBS or GLP-1 RAs. We also identified a significant increase in the proportion of TJA patients utilizing GLP-1 RAs from 2021 to 2022 that seemed to be independent of diabetes status. We anticipate that the findings of this study will increase physician awareness of the strategies being utilized in their patient population, and aid them and their patients in choosing a weight loss intervention when necessary prior to TJA.
Without weight loss strategies (control group) | GLP-1 RAs | P value1 | MBS | P value2 | |||
|---|---|---|---|---|---|---|---|
Patient number | 19,401 | 1,033 | 170 | ||||
Mean age (SD) | 61.9 (8.8) | 58.6 (7.2) | < 0.001 | 56.1 (7.3) | < 0.001 | ||
Women | 11,638 (60.0%) | 680 (65.8%) | 0.001 | 133 (78.2%) | < 0.001 | ||
Region | |||||||
Northeast | 2,057 (10.6%) | 145 (14.0%) | < 0.001 | 13 (7.6%) | 0.016 | ||
Midwest | 7,579 (39.1%) | 279 (27.0%) | 57 (33.5%) | ||||
South | 8,019 (41.3%) | 532 (51.5%) | 74 (43.5%) | ||||
West | 1,740 (9.0%) | 77 (7.5%) | 26 (15.3%) | ||||
Comorbidities | |||||||
Diabetes | 5,030 (25.9%) | 753 (72.9%) | < 0.001 | 62 (36.5%) | 0.002 | ||
Hypertension | 14,299 (73.7%) | 847 (82.0%) | < 0.001 | 139 (81.8%) | 0.017 | ||
Hypercholesterolemia | 12,700 (65.5%) | 792 (76.7%) | < 0.001 | 105 (61.8%) | 0.31 | ||
Cancer | 2,067 (10.7%) | 81 (7.8%) | 0.004 | 13 (7.6%) | 0.21 | ||
Year of TKA | |||||||
2021 | 9,702 (50.0%) | 360 (34.8%) | < 0.001 | 89 (52.4%) | 0.54 | ||
2022 | 9,699 (50.0%) | 673 (65.2%) | 81 (47.6%) | ||||
BMI | |||||||
30-34.9 | 4,342 (35.8%) | 141 (19.6%) | < 0.001 | 4 (2.5%) | < 0.001 | ||
35-39.9 | 3,686 (30.4%) | 212 (29.4%) | 19 (11.8%) | ||||
≥ 40 | 3,871 (31.9%) | 363 (50.3%) | 138 (85.7%) |
1: P value comparing no weight loss strategies and GLP-1 RAs; 2: P value comparing no weight loss strategies and MBS.
A
A
Abbreviations:
total knee arthroplasty (TKA)
glucagon
like peptide-1 receptor agonists (GLP-1 RAs)
metabolic and bariatric surgery (MBS)
standard deviation (SD)
body mass index (BMI).
Electronic Supplementary Material
Below is the link to the electronic supplementary material
REFERENCES
1.
Smith EL, Shahien AA, Chung M, Stoker G, Niu R, Schwarzkopf R. The Obesity Paradox: Body Mass Index Complication Rates Vary by Gender and Age Among Primary Total Hip Arthroplasty Patients. J Arthroplasty. 2020;35(9):2658–2665. doi:10.1016/j.arth.2020.04.094
2.
Zusmanovich M, Kester BS, Schwarzkopf R. Postoperative Complications of Total Joint Arthroplasty in Patients Stratified by BMI. J Arthroplasty. 2018;33(3):856–864. doi:10.1016/j.arth.2017.09.067
3.
MacMahon A, Rao SS, Chaudhry YP, et al. Preoperative Patient Optimization in Total Joint Arthroplasty-The Paradigm Shift from Preoperative Clearance: A Narrative Review. HSS J. 2022;18(3):418–427. doi:10.1177/15563316211030923
4.
Obesity and Total Joint Arthroplasty: A Literature Based Review. The Journal of Arthroplasty. 2013;28(5):714–721. doi:10.1016/j.arth.2013.02.011
5.
Blankstein M, Browne JA, Sonn KA, Ashkenazi I, Schwarzkopf R. Go Big or Go Home: Obesity and Total Joint Arthroplasty. J Arthroplasty. 2023;38(10):1928–1937. doi:10.1016/j.arth.2023.07.001
6.
Mayfield CK, Mont MA, Lieberman JR, Heckmann ND. Medical Weight Optimization for Arthroplasty Patients: A Primer of Emerging Therapies for the Joint Arthroplasty Surgeon. The Journal of Arthroplasty. 2024;39(1):38–43. doi:10.1016/j.arth.2023.07.017
7.
De Luca M, Angrisani L, Himpens J, et al. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–1696. doi:10.1007/s11695-016-2271-4
8.
Seward MW, Briggs LG, Bain PA, Chen AF. Preoperative Nonsurgical Weight Loss Interventions Before Total Hip and Knee Arthroplasty: A Systematic Review. J Arthroplasty. 2021;36(11):3796–3806.e8. doi:10.1016/j.arth.2021.06.021
9.
Laperche J, Feinn R, Myrick K, Halawi MJ. Obesity and total joint arthroplasty: Does weight loss in the preoperative period improve perioperative outcomes? Arthroplasty. 2022;4(1):47. doi:10.1186/s42836-022-00149-0
10.
Nauck MA, Quast DR, Wefers J, Meier JJ. GLP-1 receptor agonists in the treatment of type 2 diabetes - state-of-the-art. Mol Metab. 2021;46:101102. doi:10.1016/j.molmet.2020.101102
11.
Cai TT, Li HQ, Jiang LL, et al. Effects of GLP-1 Receptor Agonists on Bone Mineral Density in Patients with Type 2 Diabetes Mellitus: A 52-Week Clinical Study. Biomed Res Int. 2021;2021:3361309. doi:10.1155/2021/3361309
12.
Iepsen EW, Lundgren JR, Hartmann B, et al. GLP-1 Receptor Agonist Treatment Increases Bone Formation and Prevents Bone Loss in Weight-Reduced Obese Women. J Clin Endocrinol Metab. 2015;100(8):2909–2917. doi:10.1210/jc.2015-1176
13.
Herrou J, Mabilleau G, Lecerf JM, Thomas T, Biver E, Paccou J. Narrative Review of Effects of Glucagon-Like Peptide-1 Receptor Agonists on Bone Health in People Living with Obesity. Calcif Tissue Int. 2024;114(2):86–97. doi:10.1007/s00223-023-01150-8
14.
Zhang YS, Weng WY, Xie BC, et al. Glucagon-like peptide-1 receptor agonists and fracture risk: a network meta-analysis of randomized clinical trials. Osteoporos Int. 2018;29(12):2639–2644. doi:10.1007/s00198-018-4649-8
15.
Chan PYW, Mika AP, Martin JR, Wilson JM. Glucagon-like Peptide-1 Agonists: What the Orthopaedic Surgeon Needs to Know. JBJS Rev. 2024;12(1). doi:10.2106/JBJS.RVW.23.00167
16.
Trujillo J. Safety and tolerability of once-weekly GLP-1 receptor agonists in type 2 diabetes. J Clin Pharm Ther. 2020;45 Suppl 1(Suppl 1):43–60. doi:10.1111/jcpt.13225
17.
Jacofsky DJ, Springer BD, Mont MA, Ushakumari DS, Sladen RN. The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations. J Arthroplasty. 2024;39(6):1455–1458. doi:10.1016/j.arth.2023.12.002
18.
Magruder ML, Jacofsky D, Springer B, Scuderi GR, Hameed D, Mont MA. Semaglutide and Other GLP-1 Agonists: A Boon for the Arthroplasty Industry? J Arthroplasty. 2024;39(2):277–282. doi:10.1016/j.arth.2023.12.014
19.
Meurot C, Martin C, Sudre L, et al. Liraglutide, a glucagon-like peptide 1 receptor agonist, exerts analgesic, anti-inflammatory and anti-degradative actions in osteoarthritis. Sci Rep. 2022;12(1):1567. doi:10.1038/s41598-022-05323-7
20.
Zhu H, Zhou L, Wang Q, et al. Glucagon-like peptide-1 receptor agonists as a disease-modifying therapy for knee osteoarthritis mediated by weight loss: findings from the Shanghai Osteoarthritis Cohort. Ann Rheum Dis. 2023;82(9):1218–1226. doi:10.1136/ard-2023-223845
21.
Salis Z, Sainsbury A, I Keen H, Gallego B, Jin X. Weight loss is associated with reduced risk of knee and hip replacement: a survival analysis using Osteoarthritis Initiative data. Int J Obes (Lond). 2022;46(4):874–884. doi:10.1038/s41366-021-01046-3
22.
Que Q, Guo X, Zhan L, et al. The GLP-1 agonist, liraglutide, ameliorates inflammation through the activation of the PKA/CREB pathway in a rat model of knee osteoarthritis. J Inflamm (Lond). 2019;16:13. doi:10.1186/s12950-019-0218-y
23.
Aldhaleei WA, Abegaz TM, Bhagavathula AS. Glucagon-like Peptide-1 Receptor Agonists Associated Gastrointestinal Adverse Events: A Cross-Sectional Analysis of the National Institutes of Health All of Us Cohort. Pharmaceuticals (Basel). 2024;17(2):199. doi:10.3390/ph17020199
24.
Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M. Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA. 2023;330(18):1795–1797. doi:10.1001/jama.2023.19574
25.
Klonoff DC, Kim SH, Galindo RJ, et al. Risks of peri- and postoperative complications with glucagon-like peptide-1 receptor agonists. Diabetes Obes Metab. Published online May 14, 2024. doi:10.1111/dom.15636
26.
Merative Marketscan Research Databases. Accessed November 29, 2023. https://www.merative.com/documents/brief/marketscan-explainer-general
27.
Chakhtoura M, Haber R, Ghezzawi M, Rhayem C, Tcheroyan R, Mantzoros CS. Pharmacotherapy of obesity: an update on the available medications and drugs under investigation. eClinicalMedicine. 2023;58:101882. doi:10.1016/j.eclinm.2023.101882
28.
Issue Brief by Blue Health Intelligence for Blue Cross Blue Shield Association. Real-World Trends in GLP-1 Treatment Persistence and Prescribing for Weight Management. Published online May 2024. Accessed July 23, 2024. https://www.bcbs.com/sites/default/files/BHI_Issue_Brief_GLP1_Trends.pdf
29.
Yeo YH, Rezaie A, Hsieh TYJ, et al. Shifting Trends in the Indication of Glucagon-like Peptide-1 Receptor Agonist Prescriptions: A Nationwide Analysis. Ann Intern Med. Published online July 23, 2024. doi:10.7326/M24-0019
30.
Watanabe JH, Kwon J, Nan B, Reikes A. Trends in glucagon-like peptide 1 receptor agonist use, 2014 to 2022. J Am Pharm Assoc (2003). 2024;64(1):133–138. doi:10.1016/j.japh.2023.10.002
31.
Karagiannis T, Tsapas A, Athanasiadou E, et al. GLP-1 receptor agonists and SGLT2 inhibitors for older people with type 2 diabetes: A systematic review and meta-analysis. Diabetes Research and Clinical Practice. 2021;174:108737. doi:10.1016/j.diabres.2021.108737
32.
Eberly LA, Yang L, Essien UR, et al. Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US. JAMA Health Forum. 2021;2(12):e214182. doi:10.1001/jamahealthforum.2021.4182
33.
Fleeter T. How Will the Rising Use of GLP-1 Medications Impact Patients and Orthopaedics? AAOS Now. June 20, 2024. Accessed July 23, 2024. https://www.aaos.org/aaosnow/2024/jun/clinical/clinical01/
34.
Center for Metabolic and Weight Loss Surgery. State of the Union: Weight Loss Surgery in 2024. Columbia Surgery. Accessed July 23, 2024. https://columbiasurgery.org/news/state-union-weight-loss-surgery-2020
35.
Jenkins ME, Hafermann JO, Fielding C, Prager G, Kurian M, Health NL. Effectiveness and durability of common weight loss methods. In: ASMBS. https://pharmaceutical-journal.com/wp-content/uploads/2024/06/Obesity-management-ASMBS-Poster-2024_D3_24052389-Read-Only.pdf
FIGURE LEGENDS
Figure 1A. Trends of metabolic and bariatric surgery and glucagon-like peptide-1 receptor agonists usage among patients underwent total knee arthroplasty
Abbreviations: metabolic and bariatric surgery (MBS); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); total knee arthroplasty (TKA).
Figure 1B. Trends of metabolic and bariatric surgery and glucagon-like peptide-1 receptor agonists usage among patients underwent total hip arthroplasty
Abbreviations: metabolic and bariatric surgery (MBS); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); total hip arthroplasty (THA).
A
Fig. 2A
Odds ratio of undergoing glucagon-like peptide-1 receptor agonists among total knee arthroplasty patients.
Multivariable logistic regression was conducted, adjusting for patient characteristics such as sex, age, region, year of surgery, diabetes, hypertension, hypercholesterolemia, and cancer. Abbreviations: glucagon-like peptide-1 receptor agonists (GLP-1 RAs); odds ratio (OR); confidence interval (CI); total knee arthroplasty (TKA).
A
Fig. 2B
Odds ratio of undergoing glucagon-like peptide-1 receptor agonists among total hip arthroplasty patients.
Multivariable logistic regression was conducted, adjusting for patient characteristics such as sex, age, region, year of surgery, diabetes, hypertension, hypercholesterolemia, and cancer. Abbreviations: glucagon-like peptide-1 receptor agonists (GLP-1 RAs); odds ratio (OR); confidence interval (CI); total hip arthroplasty (THA).
A
Fig. 1A
Trends of metabolic and bariatric surgery and glucagon-like peptide-1 receptor agonists usage among patients underwent total knee arthroplasty
Abbreviations: metabolic and bariatric surgery (MBS); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); total knee arthroplasty (TKA).
A
Fig. 1B
Trends of metabolic and bariatric surgery and glucagon-like peptide-1 receptor agonists usage among patients underwent total hip arthroplasty
Abbreviations: metabolic and bariatric surgery (MBS); glucagon-like peptide-1 receptor agonists (GLP-1 RAs); total hip arthroplasty (THA).
A
Fig. 2A
Odds ratio of undergoing glucagon-like peptide-1 receptor agonists among total knee arthroplasty patients.
Characteristics | OR (95% CI) | Less likely to use GLP-1 RAs | More likely to use GLP-1 RAs | P value |
|---|---|---|---|---|
Sex | OR (95% CI) | |||
Men | Reference | |||
Women | 1.50 (1.30–1.72) | < 0.001 | ||
Age group | ||||
< 55 | Reference | |||
55–59 | 0.78 (0.65–0.94) | 0.01 | ||
60–64 | 0.69 (0.58–0.83) | < 0.001 | ||
≥ 65 | 0.21 (0.17–0.27) | < 0.001 | ||
Year of TKA | ||||
2021 | Reference | |||
2022 | 1.88 (1.64–2.15) | < 0.001 | ||
Multivariable logistic regression was conducted, adjusting for patient characteristics such as sex, age, region, year of surgery, diabetes, hypertension, hypercholesterolemia, and cancer. Abbreviations: glucagon-like peptide-1 receptor agonists (GLP-1 RAs); odds ratio (OR); confidence interval (CI); total knee arthroplasty (TKA). | ||||
A
Fig. 2B
Odds ratio of undergoing glucagon-like peptide-1 receptor agonists among total hip arthroplasty patients.
Characteristics | OR (95% CI) | Less likely to use GLP-1 RAs | More likely to use GLP-1 RAs | P value |
|---|---|---|---|---|
Sex | OR (95% CI) | |||
Men | Reference | |||
Women | 1.55 (1.26–1.90) | < 0.001 | ||
Age group | ||||
< 55 | Reference | |||
55–59 | 0.77 (0.58–1.02) | 0.07 | ||
60–64 | 0.69 (0.53–0.90) | 0.01 | ||
≥ 65 | 0.21 (0.14–0.30) | < 0.001 | ||
Year of THA | ||||
2021 | Reference | |||
2022 | 1.57 (1.28–1.94) | < 0.001 | ||
Multivariable logistic regression was conducted, adjusting for patient characteristics such as sex, age, region, year of surgery, diabetes, hypertension, hypercholesterolemia, and cancer. Abbreviations: glucagon-like peptide-1 receptor agonists (GLP-1 RAs); odds ratio (OR); confidence interval (CI); total hip arthroplasty (THA). | ||||