GLP-1 Agonists Linked to Nutritional Deficiencies Before Total Joint Arthroplasty

For many residents in San Antonio, the journey toward a total joint arthroplasty (TJA) often begins with a frustrating paradox: the very weight that makes a joint replacement necessary can sometimes be the same factor that prevents a surgeon from scheduling the procedure. In the corridors of the South Texas Medical Center, the rise of glucagon-like peptide-1 (GLP-1) receptor agonists has provided a powerful tool for weight management and diabetes control, helping more patients finally qualify for these life-changing elective surgeries. Though, new data suggests that this path to surgical eligibility may come with a hidden nutritional cost that San Antonio patients and their care teams cannot afford to ignore.

Recent findings presented at the American Academy of Orthopaedic Surgeons Annual Meeting have shed light on a concerning trend regarding preoperative health. According to research conducted by a team at the UT Health Science Center San Antonio, including Dr. William H. Young and Dr. Zachary Jodoin, patients utilizing GLP-1 agonists prior to their joint replacement are experiencing significantly higher rates of nutritional deficiencies. This creates a complex clinical challenge: even as these medications successfully reduce the risks associated with obesity, they may simultaneously introduce the risks associated with malnutrition, potentially complicating the recovery process.

The Data Behind the Deficiency

The study conducted at a high-volume center provides a stark look at the numbers. Between January 1 and May 1, 2025, researchers performed a retrospective chart review of 165 patients who underwent elective primary TJA. Within this group, 29 patients—roughly 17.6% of the cohort—were actively using GLP-1 receptor agonists. When the researchers matched these cohorts for comorbidities to ensure a fair comparison, the disparity in nutritional status became glaringly apparent.

The study defined malnutrition as having one or more laboratory deficiencies, with severe malnutrition defined as two or more. The results indicated that GLP-1 users were significantly more likely to fall into these categories. Specifically, 38% of GLP-1 users suffered from malnutrition, compared to only 8.8% of non-users. This represents an odds ratio of 6.2, meaning these patients are over six times more likely to be malnourished heading into surgery. The gap widens even further when looking at severe malnutrition; 17.2% of GLP-1 users met this criteria, compared to just 2.9% of the control group, resulting in an odds ratio of 6.88.

To understand why this is happening, it is helpful to look at the specific markers the UT Health Science Center San Antonio team tracked. The researchers monitored hemoglobin, albumin, total protein, prealbumin, calcium, alkaline phosphatase and 25-hydroxy vitamin D. The data revealed that GLP-1 users had significantly lower levels of albumin, prealbumin, and total protein. These markers are critical for wound healing and immune function, both of which are paramount for a patient recovering from a major orthopedic procedure in a post-surgical environment.

Balancing Weight Loss and Surgical Readiness

The expansion of GLP-1 receptor agonists beyond diabetes care into general weight management has been a game-changer for many. Because obesity is strongly associated with suboptimal total joint arthroplasty outcomes, the ability to shed pounds before surgery is generally viewed as a positive. However, the mechanism by which these drugs work—often by suppressing appetite and slowing gastric emptying—can lead to a decrease in the overall intake of essential proteins and micronutrients.

When a patient enters surgery in a state of malnutrition, the stakes are higher. Protein deficiency, indicated by the lower albumin and total protein levels found in the study, can lead to slower tissue repair and an increased risk of postoperative complications. For those navigating their preoperative care plans in San Antonio, this means that weight loss cannot be the only metric of success. The quality of the weight loss—specifically the preservation of lean muscle mass and the maintenance of protein levels—is just as vital as the number on the scale.

This research underscores the need for a multidisciplinary approach to surgical preparation. It is no longer enough to simply monitor a patient’s BMI. The integration of nutritional screening into the preoperative workflow is becoming essential, especially for those on metabolic medications. By identifying these deficiencies early, clinicians can implement nutritional interventions to ensure the patient is not just “thin enough” for surgery, but “strong enough” to recover from it.

Navigating Local Nutritional Support in San Antonio

Given my background in analyzing regional health trends, the intersection of metabolic medicine and orthopedics requires a specialized support system. If you or a loved one in the San Antonio area are utilizing GLP-1 medications while preparing for a joint replacement, Try to not rely solely on a general surgical checklist. You need a targeted team to ensure your internal chemistry is as ready as your joints are.

To mitigate the risks of preoperative malnutrition, I recommend seeking out these three specific types of local professionals, focusing on the following criteria:

Clinical Registered Dietitians (Specializing in Metabolic Health)

Look for professionals who have specific experience with “malnutrition coding” and preoperative optimization. You want a dietitian who doesn’t just provide a general meal plan, but one who can analyze blood markers like prealbumin and albumin to create a high-protein, nutrient-dense diet that compensates for the appetite suppression caused by GLP-1s.

Board-Certified Endocrinologists

When managing medications like GLP-1 receptor agonists, a specialist is necessary to coordinate the timing of the medication with the surgery. Ensure your endocrinologist is in direct communication with your surgeon to discuss whether dosage adjustments or temporary pauses are necessary to optimize your nutritional status before the operation.

Orthopedic Surgeons with Metabolic Integration

Seek out surgeons who utilize comprehensive joint health protocols that include mandatory preoperative nutritional labs. The right surgeon will not only look at your weight but will actively review your protein and vitamin D levels, treating nutritional deficiency with the same urgency as they would high blood pressure or uncontrolled diabetes.

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