The news marks a shift in thinking about orthopedic treatment. Instead of focusing solely on the mechanical aspects of joint problems, it recognizes the importance of overall metabolic health in patients’ surgical and long-term outcomes.

People’s weight can also have a significant impact on their ability to safely undergo joint replacement surgery. Physiatrist Heidi Prather, DO, is head of the HSS Lifestyle Medicine Program, which is available for HSS patients whether or not they need surgery. Lifestyle medicine focuses on six “pillars”: nutrition, physical activity, stress management, social connections, healthy sleep, and avoidance of risky substances such as alcohol and tobacco. 

For people whose joint problems are related to or made worse by weight gain, making behavioral lifestyle changes can be particularly difficult. “The average person in the Lifestyle Medicine Program comes to us reporting no physical activity because they can’t move,” says Dr. Prather, who specializes in the nonsurgical treatment of musculoskeletal conditions. “They can’t walk. They can’t get on a bike. [It creates] an unhealthy feedback loop: The thing they need to do to help control their pain is too painful for them to do.”

The Benefits of GLP-1 Drugs

By helping patients lose weight, GLP-1s may enable them to have a surgery that could restore their movement and reduce their pain enough to be able to resume exercise. The drugs may also help reduce systemic inflammation, which is when the body’s immune system goes into overdrive trying to protect it from false threats. Lowering systemic inflammation reduces pain and improves movement, multiplying the health benefits of these medications.

“When people start seeing success, that success can really get them motivated to make changes,” Dr. Prather says. “My hope is that GLP-1 drugs can act as jump-starters for people who are trying to make the necessary lifestyle changes to improve their joint pain and overall health.”

The Role of Inflammation

A wide range of health conditions, including obesity, type 2 diabetes, cardiovascular disease, and certain cancers, are rooted in systemic inflammation. This same systemic inflammation is linked to osteoarthritis. “In fact,” says Dr. Prather, “a subtype of osteoarthritis—metabolic osteoarthritis—progresses in relationship to metabolic conditions including type 2 diabetes, obesity, hypertension, hyperlipidemia and cardiovascular disease. Treating the metabolic conditions becomes part of treating the osteoarthritis.” 
 
Research has shown that patients with type 2 diabetes are more likely to have severe osteoarthritis as well as a higher likelihood of needing revision surgeries after knee replacements. “Now, a medicine created to help improve type-2 diabetes management—GLP-1 drugs—may also help patients manage their osteoarthritis through weight loss,” she adds.

One of the key areas of interest for researchers will be to study how GLP-1 agonists might enhance recovery and outcomes for people who have had joint replacement surgery. Potential benefits could include reduced need for revision surgeries, lower readmission rates and fewer post-operative infections. 

Dr. Prather says these medications’ impact on weight loss and, thereby, reduced systemic inflammation could become an important tool for treating patients at high risk due to poor type 2 diabetes control and obesity before surgery—or even helping them to avoid surgery in the first place.

The potential of GLP-1 agonists extends beyond the physical, too. Patients taking these medications often report reduced food cravings and less “noise” from thoughts about food on a persistent basis. Similar effects have been noted in patients who are not on GLP-1 medication but who switch to anti-inflammatory diets focused on eating whole foods.  

On the Horizon

Researchers are writing the story of GLP-1s in real time. One of the challenges they face is the need for long-term follow-up. While these drugs may provide immediate results, the goal is for patients to maintain their those results over time, even after stopping the medication. 

The HSS Lifestyle Medicine team is also interested in studying how GLP-1 agonists might interact with other treatments that promote behavioral change. While GLP-1s clearly are effective for weight loss, experts may be concerned if their patients do not make other lifestyle changes, for example, changing their diet or being more active.

Dr. Prather emphasizes that GLP-1 agonists are no cure-all and should be part of a comprehensive approach to improving one’s overall health. “These medications may be a way to enhance behavioral change,” she says. “However, in the end, if these changes are not made, true health benefits may not be realized, and the patient would need the medication indefinitely to manage their weight.”

But the promise is real. “Improving health and reducing health risks is more than just a number on a scale,” Dr. Prather said. “But weight loss is crucial for many osteoarthritis patients, and these medications offer a huge opportunity to instigate successful change. The challenging work of actual nutritional improvement and other lifestyle improvements must also happen to improve a person’s health and longevity.”

Published 10/10/2024

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