GLP-1 medications are making more patients viable for surgery, but the muscle loss, bone changes and nutritional gaps that come with rapid weight loss may be working against the outcomes surgeons are optimizing for.
Patients are arriving in surgeons’ offices having been heavier for longer stretches of their lives, then losing significant weight rapidly before ever reaching the operating table. Five orthopedic surgeons who spoke with Becker’s say that the shift has already changed who qualifies for surgery — but what’s still flying under the radar is what’s happening beneath the number on the scale.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: GLP-1s are reshaping how patients arrive at your OR — heavier for longer, then rapidly lighter. What’s the orthopedic community still not talking about enough regarding these drugs?
Harpreet Bawa, MD. Orthopedic Surgeon, DISC Sports & Spine Center (Thousand Oaks, Calif.): GLP-1 drugs have revolutionized perioperative optimization by driving historic weight reduction, stabilizing HbA1c and mitigating modifiable cardiovascular risks, allowing orthopedic surgeons to safely bring previously high-risk patients to the operating room. However, this rapid weight loss introduces a complex paradox: While lower BMIs reduce static joint loads, the accompanying surge in physical activity frequently unmasks underlying osteoarthritis that was previously asymptomatic.
Furthermore, patients often experience a loss of lean muscle mass alongside hidden subclinical malnutrition, which can compromise wound healing and rehabilitation. Future GLP-1 medications intend to preserve skeletal muscle mass; however, they are not yet FDA approved. These drugs remain relatively new, and we are still learning their full effects, beneficial and adverse, on patients and surgical outcomes.
Lisa K. Cannada, MD. Orthopaedic Trauma Surgeon, University of North Carolina Department of Orthopaedics; Adjunct Professor, UNC Charlotte School of Medicine (Chapel Hill, N.C.): As an orthopaedic trauma surgeon, I am concerned, as the research picture is unsettling — we do not know the long-term effects, and that’s getting lost in the general conversation about GLP-1s. The drugs are readily available and used more as a quick fix rather than for the long-term habit changes that could actually improve bone health through exercise.
Mechanistically, GLP-1 receptor agonists appear to favor osteoblast activity and suppress bone resorption markers, and several trials show modest bone mineral density gains at the spine and hip. Yet population-based cohort and case-control data have consistently failed to show a corresponding reduction in fracture risk, and new data presented at AAOS 2026 actually flagged a possible signal toward increased osteoporosis and gout risk with these agents.
What deserves more attention from the orthopaedic trauma community specifically is the compound effect of rapid, sustained weight loss on frailty: concurrent lean mass loss and sarcopenia, changes in fall risk from deconditioning, and how pre-injury nutritional status should factor into our plans.
On the anesthesia side, the more immediate and known problem is delayed gastric emptying and aspiration risk under sedation or general anesthesia, which has already prompted American Society of Anesthesiologists guidance on preoperative GLP-1 management — but that guidance doesn’t account for trauma, where patients need timely fixation and we can’t wait for a washout period. There’s a real gap and area for improvement there. As I said at the outset, more long-term studies are needed, and I’m concerned about what they’ll show.
Eric Cohen, MD. Orthopedic Surgeon, University Orthopedics and Brown Health (East Providence, R.I.): We’re seeing more and more patients on these medications. What the orthopedic community isn’t talking about enough is body composition, not just weight loss. GLP-1s can help patients lose significant weight, but rapid weight loss can also lead to loss of lean muscle mass and poor nutrition if protein intake and strength training are neglected. For surgical patients, being lighter doesn’t always mean being healthier.
At the same time, emerging studies suggest GLP-1 users may have lower rates of readmission, infection and revision after total joint arthroplasty. The key is education: adequate protein intake, resistance training and sustainable weight loss. GLP-1s are powerful tools, but there are no shortcuts to better health. Medications and physicians can help, but long-term success still depends on healthy habits.
Rajiv Sethi, MD, PhD. Professor and Spine Division Chief, Department of Orthopaedic Surgery, UCSF; Co-Director, UCSF Spine (San Francisco, Cal.): We have published a recent systematic review of GLP-1s in spine patients with Iyan Younus, MD, from Vanderbilt neurosurgery, who served as first author on that publication. While recent articles show minimal risk, one must be vigilant about the effects of GLP-1-induced sarcopenia on surgical outcomes for all patients taking these medications. Sarcopenia can be a major contributor to adjacent segment and junctional complications in spine deformity patients. At UCSF, we’re working to understand this phenomenon better through clinical and basic science studies currently underway within the spine division.
Mark Wichman, MD. Orthopedic Surgeon; Chief of Orthopedic Sports Medicine, Advocate Health Care (Wauwatosa, Wis.): Briefly, GLP-1 medications work tremendously well for some patients. This can lead to rapid weight loss, which might make a patient who was not previously a good surgical candidate for elective orthopedic surgery become a more attractive and suitable one.
However, there are hidden issues beneath the surface, such as metabolic disorders, poor nutrition — yes, many obese patients are poorly nourished — as well as muscle loss commonly reported with GLP-1 medications. That can be a big problem for orthopedic patients.
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