(B-180) Comparative Risk of Hip and Knee Arthroplasty Among Medicare Beneficiaries Initiating GLP-1 Receptor Agonists vs. SGLT2 Inhibitors

Background: Hip and knee arthroplasty procedures represent significant healthcare burdens, particularly among older adults with type 2 diabetes (T2D). Osteoarthritis, a leading indication for these surgeries, is linked to metabolic and inflammatory pathways potentially modulated by antidiabetic therapies. Emerging evidence suggests glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) may differentially impact joint health, necessitating further investigation.

Objectives: To evaluate the risk of hip and knee arthroplasty among Medicare beneficiaries aged ≥66 years with T2D initiating GLP-1 RAs compared to SGLT2is.

Methods: This retrospective cohort study emulated a target trial using Medicare claims data from 2017–2020. Eligible patients were aged ≥66 years, had T2D, and initiated GLP-1 RAs or SGLT2is without prior use of these drugs or history of hip or knee arthroplasty. Propensity score matching (1:1) was performed to balance baseline characteristics. Cox proportional hazards models estimated hazard ratios (HRs) for the primary outcome of hip or knee arthroplasty, with sensitivity analyses for hip arthroplasty or knee arthroplasty respectively, and subgroup analyses by age, sex, race and frailty index. Competing risk analyses accounted for mortality.

Results: Among matched cohorts (n = 21,010 per group), the incidence rate (IR) of hip or knee arthroplasty per 1,000 person-years was 21.33 (95% CI: 19.79–22.81) for GLP-1 RAs and 19.72 (95% CI: 18.32–21.22) for SGLT2is. The HR was 1.112 (95% CI: 1.004–1.232). Subgroup analyses revealed higher relative risks among patients aged < 75 years. Sensitivity analyses supported the robustness of findings.

Conclusions: In older adults with T2D, initiation of GLP-1 RAs was associated with a modestly higher risk of hip and knee arthroplasty compared to SGLT2is. These results underscore the need for further research to clarify the musculoskeletal implications of antidiabetic therapies, potentially guiding personalized treatment strategies for this population.