Impact of obesity and metabolic drugs on orthopedic outcomes: A narrative review

Obesity is a global health concern with significant implications for orthopedic outcomes. This narrative review explores the complex interplay between obesity, metabolic pharmacotherapy, and orthopedic health. Obesity increases the risk of osteoarthritis, alters joint biomechanics, and poses challenges in orthopedic surgery, leading to higher complication rates and poorer outcomes. While obesity may paradoxically increase bone mineral density, it can also elevate fracture risk due to poor bone quality and increased fall risk. Metabolic drugs, including antidiabetic agents and weight loss medications, are emerging as potential tools for improving orthopedic outcomes in obese patients. Metformin has shown promise in reducing osteoarthritis progression and improving bone healing, while SGLT2 inhibitors and GLP-1 receptor agonists promote weight loss and may indirectly benefit joint health. However, the effects of these drugs on bone metabolism should be considered carefully. Weight-loss medications can reduce joint pain and improve function in obese patients with osteoarthritis; however, rapid weight loss may transiently decrease bone density. Preoperative weight reduction and multidisciplinary collaboration are crucial for optimizing outcomes in obese patients undergoing orthopedic interventions. Future research should focus on clarifying the long-term effects of metabolic drugs on bone and joint health and developing integrated care protocols that combine pharmacological, surgical, and rehabilitation strategies.