GLP-1 Agonists: Surgical Benefits and Long-Term Musculoskeletal Risks

Research presented at the 2026 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) has highlighted a complex relationship between glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, and musculoskeletal health. While these medications provide clear benefits for weight loss and glycaemic control, the sources indicate they may simultaneously offer short-term postoperative advantages while presenting significant long-term risks to bone and joint health.

Postoperative Outcomes and Surgical Trends

One retrospective study analysed national claims data from 2010 to 2023 to evaluate how GLP-1 RA use affects recovery after common orthopaedic procedures, including hip and knee replacements. The findings include:

• Reduced Complications: Use of these medications was associated with significantly lower odds of emergency department visits following surgery.
• Lower Infection Rates: Patients undergoing total hip and knee arthroplasty saw significantly lower surgical site infection rates.
• Varied Revision Rates: While revision rates were lower for total knee replacements, they actually increased for patients undergoing carpal tunnel release.
• Increased Utilisation: There has been a marked rise in GLP-1 RA use among orthopaedic patients, particularly since 2019.

Long-Term Musculoskeletal Risks

A second major study focused on the five-year risk of developing bone and joint disorders in adults with Type 2 diabetes and obesity. This research compared 73,483 GLP-1 RA users against a matched control group, finding that medication use was independently associated with a statistically significant increase in three specific conditions:

• Osteoporosis: The incidence was 4.1% in users compared to 3.2% in non-users.
• Osteomalacia: This condition showed the greatest relative risk increase, with the incidence doubling from 0.1% to 0.2%.
• Gout: GLP-1 RA users had a higher incidence of 7.4% compared to 6.6% in the control group.

Clinical Implications These findings are noteworthy because they contradict earlier suggestions that GLP-1 RAs might offer protective effects for the musculoskeletal system. Instead, the data suggests these agents may cause altered calcium homeostasis and bone turnover. Because these medications are being rapidly adopted for both diabetic and weight-loss indications, experts suggest that clinicians should consider immediate bone health surveillance and long-term monitoring for at-risk populations to prevent or manage these delayed-onset complications.