Scoping Review · Metabolic & Joint Health

GLP-1 receptor agonists and weight-loss strategies for individuals with obesity and hip or knee osteoarthritis

A scoping review conducted in accordance with the PRISMA-ScR framework

McCann C, Clement N, Murray A, Kearney R, Madigan S, Gee C, Walmsley P, Morrison S, Chopra S, Hall A

British Journal of Sports Medicine 2026;0:1–16 · Epub ahead of print · doi:10.1136/bjsports-2025-111225

199

Included Studies

GLP-1-RA Studies

70.9%

Knee OA-Focused

Databases Searched

Page 1 · As Published GLP-1 receptor agonists and weight-loss strategies for individuals with obesity and hip or knee osteoarthritis, as published in the British Journal of Sports Medicine

GLP-1 receptor agonists and weight-loss strategies for individuals with obesity and hip or knee osteoarthritis, as published in the British Journal of Sports Medicine

This scoping review was published as a Systematic Review in the British Journal of Sports Medicine, part of the BMJ Journals family. BJSM is one of the leading peer-reviewed journals in sports and exercise medicine, indexed in PubMed and Web of Science.

Journal Br J Sports Med

Publisher BMJ Group

Article Type Systematic Review

Status Epub ahead of print

Read on bjsm.bmj.com

Abstract

Objective

To map current strategies for weight loss in hip and knee osteoarthritis (OA), with emphasis on the emerging role of glucagon-like peptide-1 receptor agonists (GLP-1-RAs) as tools in achieving weight loss and impacting symptoms, disease progression and perioperative outcomes in individuals with obesity.

Design

Scoping review conducted in accordance with the PRISMA-ScR framework and methodological guidance from the Joanna Briggs Institute and Arksey and O'Malley.

Data Sources

PubMed, Web of Science, Directory of Open Access Journals, Scopus, ProQuest Central (1 January 2010 to 18 August 2025).

Eligibility Criteria

Studies focused on adults (≥18 years) with obesity and hip or knee OA, examining weight-loss strategies (nutritional, physical activity, surgical or pharmacological) including GLP-1-RAs.

Results

Of 199 included studies, 36 (18.1%) directly assessed GLP-1-RAs and of these, 14/36 (38.9%) reported original data. Evidence was heavily skewed towards knee OA, with limited hip-specific data. Descriptive analysis revealed a narrow geographical distribution of studies and a rapidly increasing focus on GLP-1-RAs; most studies involving GLP-1-RAs (29/36, 80.6%) were published between 2024 and 2025 and were of a low level of evidence (19/36, 52.8% level 5). Randomised and cohort data in knee OA indicate that GLP-1-RAs are associated with substantial weight loss, with accompanying improvements in pain/function and reduced progression to arthroplasty. In contrast, evidence in hip OA is sparse with weaker associations.

Conclusion

GLP-1-RAs represent a promising adjunct for managing individuals with OA complicated by obesity. Until further evidence emerges, GLP-1-RAs should be integrated into supervised, multimodal musculoskeletal care rather than used as standalone weight-loss agents.

Evidence Mapping

The state of the evidence base

80.6%

GLP-1-RA studies from 2024–2025

Reflecting a rapid recent surge in research interest in the field

52.8%

Level 5 evidence

Of GLP-1-RA studies; predominantly observational, low-quality designs

44.2%

Studies originating from the USA

Over 75% from six high-income countries; low- and middle-income regions largely absent

2 RCTs

Randomised controlled trials

Both knee-only, with dietary run-ins and no structural outcomes

Clinical Findings by Joint

Knee OA evidence vs hip OA evidence

Knee Osteoarthritis

Randomised and cohort data indicate substantial weight loss with GLP-1-RA use, alongside improvements in pain and function.

Semaglutide 2.4mg associated with a 14.1-point greater reduction in WOMAC pain versus placebo over 68 weeks in a large RCT.

Cohort data suggest reduced progression to TKA in GLP-1-RA users, with one study reporting TKR incidence of 10.48% vs 18.82% in non-users.

Signals for improved perioperative outcomes in selected populations, including lower readmission and prosthetic joint infection rates.

Hip Osteoarthritis

Evidence is sparse, with only 14/134 (10.4%) of original-data studies focused specifically on hip OA.

Associations between obesity and hip OA are weaker and less consistent than in knee OA across the broader literature.

No clear weight-loss-related symptomatic benefit has been demonstrated in hip OA populations to date.

Most hip-specific data derive from perioperative cohort studies around THA rather than disease-modifying or symptomatic outcomes.

Perioperative Findings

GLP-1-RA use around arthroplasty: a mixed picture

Outcome domain	Direction in GLP-1-RA users	Representative finding
Prosthetic joint infection	Lower	THA: 1.6% vs 2.9% (OR 0.56); TKA: 2.1% vs 3.0% (OR 0.70)
90-day readmission	Lower	THA: 6.2% vs 8.8%; TKA: 7.0% vs 9.4%
2-year revision	Lower	THA: 1.8% vs 2.8%; TKA: 4.0% vs 4.5%
Blood transfusion / anaemia	Lower	Acute blood loss anaemia OR 0.57; transfusion OR 0.53
Myocardial infarction	Higher	OR 1.49 within 90 days post-TKA
Acute kidney injury	Higher	OR 1.28 within 90 days post-TKA
Pneumonia	Higher	OR 1.67 within 90 days post-TKA
GI complications (nausea, ulceration)	Higher	Postoperative vomiting 18.2% vs 6.0% (THA); GI ulcer OR 1.31 (TKA)

Findings are drawn from retrospective cohort studies of variable quality; this review was not exhaustive for assessing perioperative complications, and several studies outside its scope have suggested a protective role for GLP-1-RAs perioperatively.

Research Priorities

Key knowledge gaps

What is the relationship between obesity and OA in hip versus knee joints?

Obesity shows a strong, consistent association with knee OA; evidence in hip OA is weaker and more variable across large studies.

Does weight loss have equivalent clinical benefit in hip and knee OA?

Weight loss shows a dose-dependent symptomatic benefit in knee OA; evidence in hip OA remains limited and inconsistent.

Does GLP-1-RA-mediated weight loss differ from conventional weight loss in OA?

Unclear whether clinical effects are mediated solely by weight reduction or by additional metabolic/anti-inflammatory mechanisms.

How can GLP-1-RA-related lean muscle loss and sarcopenia be mitigated?

Up to 15–40% of weight lost may be lean mass, conferring an increased sarcopenia risk in an already vulnerable population.

Does preoperative GLP-1-RA use influence arthroplasty outcomes?

Postoperative outcome data are mixed; large-scale pragmatic trials and registry analyses are needed.

How can equity and access to GLP-1-RA therapy be improved globally?

High costs and limited access restrict availability; populations with the greatest OA burden remain under-represented in the evidence base.