Conference Coverage

GLP-1 Agonists Linked to Lower Infection but Higher Fracture Risk After Total Knee Arthroplasty

Kate Young

A study conducted at Pennsylvania State University found that patients prescribed glucagon-like peptide-1 (GLP-1) agonists had lower rates of periprosthetic joint infection (PJI) but higher rates of periprosthetic fractures following total knee arthroplasty (TKA). The retrospective cohort study, which was presented at the American Academy of Orthopaedic Surgeons 2025 Annual Meeting in San Diego, CA, utilized the TriNetX institutional research consortium database, which integrates pharmacy claims data, to compare outcomes between patients who received GLP-1 agonists and those who did not.

A total of 4700 patients on GLP-1 agonists were matched 1:1 with 4700 patients not on these medications. Propensity matching accounted for age, race, sex, nicotine use, body mass index, hemoglobin A1c, and estimated glomerular filtration rate. The study assessed rates of PJI, periprosthetic fracture, and all-cause revision at 90 days and one year postoperatively.

The PJI rate was lower in the GLP-1 agonist group at both 90 days (0.9% vs. 1.5%; P = .02) and one year (1.2% vs. 2.0%; P = .002). The periprosthetic fracture rate was higher in the GLP-1 cohort at 90 days (0.5% vs. 0.2%; P = 0.03) and 1 year (0.7% vs. 0.3%; P = .02). All-cause revision rates did not differ significantly between groups at 90 days (0.5% vs. 0.7%; P = .2) or one year (1.3% vs. 1.6%; P = .1).

The study concludes that GLP-1 agonists were associated with a lower risk of PJI but a higher risk of periprosthetic fractures after primary TKA.

“Understanding the effects of GLP-1 agonists on bone mineral density might help mitigate fracture risk while maintaining the decreased risk of PJI associated with these agents,” the study authors concluded.

Reference:
Levidy M, Kirchner GJ, Vatsia S, Rowe N, Haines, NM. GLP-1 agonists decrease infection but increase fracture risk following TKA. Presented at: American Academy of Orthopaedic Surgeons. March 10-24; San Diego, CA. Accessed March 6, 2025. https://submissions.mirasmart.com/AAOS2025/Itinerary/PresentationDetail.aspx?evdid=692.