Orthopedic Outcomes and GLPs: More than Glucose and Weight Loss

GLP-1 receptor agonists (GLP-1 RAs), commonly prescribed for type 2 diabetes (T2DM) and obesity, may affect orthopedic outcomes beyond glucose control. This study evaluated whether preoperative use of GLP-1 RAs affects postoperative outcomes in T2DM patients undergoing ankle fracture surgery.

Study design and patient matching

Researchers conducted a retrospective cohort analysis of adults with T2DM who underwent ankle fracture repair. Patients were grouped based on GLP-1 RA use within 180 days pre-surgery. After 1:1 propensity matching for demographics, comorbidities, and lab values, outcomes were assessed across three domains: 

• 90-day medical complications

• 90-180-day operative/implant-related issuesHealth care use at 30, 90, and 190 days post-op

Key findings

Matched cohorts included 1,107 patients each. Compared to non-users, GLP-1 users showed:

• Lower all-cause mortality: OR 0.33; P = .011; NNT = 56

• Higher incidence of fall-related injuries: OR 1.32; P = .011; NNH = 15

• No differences in infection, wound healing, opioid use, or posttraumatic arthritis

Clinical implications

Preoperative GLP-1 RA use in T2DM patients undergoing ankle fracture repair may lower mortality but increase fall risk. These findings highlight that orthopedic surgical care in the context of GLP-1 therapy and the need for ongoing study.