The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Do Glucagon Like Peptide-1 Receptor Agonists Modify Progression of Primary Glenohumeral Osteoarthritis? A Propensity Score–Matched Evaluation of Shoulder Arthroplasty Incidence

Document Type : RESEARCH PAPER

Authors
Tarek Haj Shehadeh 1
Joseph A. Abboud 2
1 Department of Orthopedic Surgery, Cleveland Clinic Foundation, Weston, Florida, USA
2 Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
10.22038/abjs.2026.95223.4279
Abstract
Objectives: Glenohumeral osteoarthritis (OA) is a common degenerative condition, and total shoulder arthroplasty (TSA) often represents the definitive treatment for end-stage disease. The use of glucagon-like peptide-1 receptor agonists (GLP-1RA) has increased substantially, and recent evidence suggests potential disease-modifying effects and reduced arthroplasty rates in lower-extremity joints. This study evaluated whether GLP-1RA use is associated with progression from primary shoulder OA to TSA.
Methods: A retrospective database query was performed to identify patients diagnosed with primary shoulder OA, excluding those with other shoulder pathologies. Patients were stratified according to prediagnosis GLP-1RA prescription status and were 1:1 propensity-score matched to balance relevant comorbidities. Outcomes included the incidence of TSA, TSA-free survival assessed using Kaplan–Meier survival analysis, major joint injections, and mean levels of inflammatory biomarkers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and cortisol. A significance threshold of P < 0.05 was applied.
Results: After matching, each cohort included 24,669 patients. The GLP-1RA cohort had a significantly shorter follow-up duration than the non-GLP-1RA cohort (731 ± 694 vs. 1,220 ± 1,006 days; P < 0.001). TSA incidence was higher among GLP-1RA users than among non-users (2.25% vs. 1.77%; P < 0.001), and TSA-free survival was lower in the GLP-1RA cohort (95.50% vs. 97.23%; log-rank P < 0.001). A greater proportion of patients in the GLP-1RA cohort received major joint injections (18.93% vs. 16.87%; P < 0.001), although the mean number of injections per patient was lower in this group (2.48 ± 2.86 vs. 2.74 ± 3.23; P < 0.001). GLP-1RA users also demonstrated significantly lower mean CRP and ESR levels (both P < 0.001), while mean cortisol levels were similar between cohorts.
Conclusion: In contrast to findings reported for hip and knee OA, GLP-1RA use was not associated with a protective effect against progression to TSA in patients with primary shoulder OA. Further studies are warranted to clarify the joint-specific mechanisms that may underlie these differences.
Level of evidence: III
Keywords
GLP-1 receptor agonist
Primary osteoarthritis
Progression
Shoulder osteoarthritis
Shoulder Replacement
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 11
November 2026
Pages 722-728

  • Receive Date 22 April 2026
  • Accept Date 16 May 2026