Preoperative GLP-1 receptor agonist use is not associated with increased risk of pseudoarthrosis following midfoot fusion: a propensity-matched analysis

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly utilized for the management of Type 2 Diabetes Mellitus (T2DM) and weight loss. While their metabolic benefits are established, their influence on bone metabolism and arthrodesis remains uncertain.

This study aimed to evaluate the association between GLP-1RA use and the incidence of midfoot pseudoarthrosis in diabetic patients.

Retrospective cohort study METHODS: A retrospective analysis was performed using the TriNetX US database. Adults ≥40 years with type 2 diabetes who underwent midfoot arthrodesis were identified. The exposed group included diabetic patients with GLP-1RA exposure within six months preoperatively (n = 767), while the control group comprised patients without GLP-1RA use (n = 7,306). After 1:1 propensity score matching, 766 patients remained in each cohort. The primary outcome was pseudoarthrosis (ICD-10 code M96.0) within five years. Secondary outcomes included hardware infection, wound complications, and hardware removal within five years.

After propensity matching, GLP-1RA users had no statistically significant difference in pseudoarthrosis incidence compared with non-users at 6 months (8.3% vs 6.5%, P>.05), 1 (12.4% vs 9.8%, P>.05), 2 (14.3% vs 11.3%, P>.05), and 5 years (15.0% vs 12.6%, P>.05) postoperatively. At 5 years postoperatively, GLP-1RA exposure was not associated with increased risk of hardware infection, wound complications, or hardware removal.

Preoperative GLP-1RA exposure was not associated with a higher incidence of pseudoarthrosis following midfoot fusion. These findings support GLP-1RA use in patients undergoing midfoot fusion and contribute to the growing body of literature on GLP-1RA impact on bone metabolism.

Level III, retrospective cohort study.