Semaglutide and other GLP-1 use tied to better joint surgery outcomes and higher bone risk

Two analyses presented March 2 at the American Academy of Orthopaedic Surgeons (AAOS) 2026 Annual Meeting in New Orleans link GLP-1 medications to better short-term results after some orthopedic operations, and to higher five-year rates of osteoporosis, gout and osteomalacia ^[1]. Both come from retrospective studies of patient records and insurance claims, not randomized trials ^[1].

In the surgical study, researchers used a national claims database to identify patients with obesity-related diagnoses who had 10 of the most common orthopedic procedures between 2010 and 2023 ^[1]. The operations included total hip replacement, total knee replacement, ACL repair, hip cephalomedullary nail, hip hemiarthroplasty, lumbar fusion, total shoulder replacement, carpal tunnel release, distal radius open reduction internal fixation and ankle ORIF ^[1]. Use of GLP-1 drugs and semaglutide rose steadily across those procedures, with a marked increase since 2019, the researchers reported ^[1].

Across several major procedures, GLP-1 use was associated with significantly lower odds of a postoperative emergency department visit, without an increase in surgical risk ^[1]. Surgical site infection rates were significantly lower among patients who had total knee or total hip replacement ^[1]. Revision rates were lower for GLP-1 users who had total knee replacement, but higher for patients who had carpal tunnel release ^[1]. The number of patients in that analysis has not been disclosed ^[1].

"Within orthopaedics, there has been relatively little research on how GLP-1 use affects postoperative outcomes," said Haroun Haque, a third-year medical student at SUNY Downstate College of Medicine and a co-author of the study ^[1].

The second study compared 73,483 patients with Type 2 diabetes and obesity (BMI of 30 or higher) who took a GLP-1 receptor agonist with matched controls, following both groups for five years ^[1]. Patients were matched for age, sex, race, BMI, hemoglobin A1c, tobacco use and conditions including chronic kidney disease, rheumatoid arthritis and baseline osteoporosis ^[1].

Over five years, GLP-1 users had:

• Osteoporosis: 4.1% versus 3.2% in controls; risk ratio 1.29 (95% CI 1.22-1.36), p<0.001 ^[1].
• Gout: 7.4% versus 6.6%; risk ratio 1.12 (95% CI 1.08-1.16), p<0.001 ^[1].
• Osteomalacia: 2% versus 0.1%; risk ratio 2.55 (95% CI 1.83-3.55), p<0.001 ^[1].

The release does not explain why the reported osteomalacia risk ratio does not match the listed incidences of 2% and 0.1% ^[1].

"Whenever you have a patient who is prone to osteoporosis, gout or osteomalacia, clinicians should consider bone health surveillance and monitor for delayed-onset complications in at-risk populations," said Muaaz Wajahath, a fourth-year medical student at Michigan State University College of Human Medicine and the study's primary investigator ^[1].

Why it matters for patients

Both studies describe patterns in groups of patients. They do not show that GLP-1 drugs cause or prevent any of these outcomes, and this type of study design cannot prove cause and effect ^[1].

The two sets of findings cover different time frames. The surgical results concern the period right after an operation, including emergency department visits and infections, while the bone findings build up over five years ^[1].

The absolute differences in the bone study were smaller than the relative risk numbers might suggest. Osteoporosis was just under 1 percentage point more common among GLP-1 users, and gout 0.8 points more common ^[1]. The gap for osteomalacia, a softening of the bones, was about 1.9 points, though the condition remained uncommon in both groups ^[1].

Several details that would help patients and their doctors are not in the released findings. It is not reported how long patients took GLP-1 drugs, what doses they used, whether they stopped before surgery, or whether risks differed among individual drugs ^[1].

What happens next

The findings were presented at the AAOS 2026 Annual Meeting. Whether the abstracts have been published in a peer-reviewed journal has not been disclosed ^[1]. Wajahath said five- and 10-year follow-up data for patients taking GLP-1 medications are just now becoming available, which is why the long-term effects on bone and joint health remain under study ^[1].