Metformin does not decrease the incidence of shoulder arthroplasty in patients with glenohumeral joint osteoarthritis
Tarek Haj Shehadeh1, Jawaad Chaudhry1, Ahmed Abdeen1
1Department of Orthopedics and Rehabilitation, Penn State Health, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
JSES Reviews, Reports, and Techniques
|November 3, 2025
Summary
Metformin use in shoulder osteoarthritis patients was associated with a higher likelihood of shoulder arthroplasty, contrary to knee osteoarthritis findings. Despite lower inflammatory markers, metformin increased arthroplasty risk, warranting further investigation into its shoulder OA mechanisms.
Area of Science:
- Orthopedics
- Pharmacology
- Rheumatology
Background:
- Osteoarthritis (OA) is a degenerative joint disease.
- Metformin, an antidiabetic drug, may modify OA progression.
- Previous studies suggest metformin benefits knee OA, but its effect on shoulder OA is unknown.
Purpose of the Study:
- To investigate the association between metformin prescription and the likelihood of shoulder arthroplasty in patients with shoulder OA.
- To compare shoulder arthroplasty incidence in metformin users versus non-users with shoulder OA.
Main Methods:
- Utilized the TriNetX database to identify patients with shoulder OA.
- Formed two propensity score-matched cohorts: metformin users and non-users (26,327 patients each).
- Assessed incidence of shoulder arthroplasty and serum inflammatory markers (CRP, ESR, Cortisol) over 10 years.
Main Results:
- Metformin users had a significantly increased risk of shoulder arthroplasty (1.075% higher risk, OR=1.309, P < .0001).
- Metformin group showed significantly lower mean ESR and CRP levels (P < .0001).
- Cortisol levels did not differ significantly between groups (P = .779).
Conclusions:
- Metformin prescription in shoulder OA patients is linked to a higher likelihood of undergoing shoulder arthroplasty.
- This finding contrasts with potential benefits observed in knee OA, suggesting different mechanisms.
- Further research is required to understand metformin's complex effects on shoulder OA.
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