Wang Y, et al. - Researchers investigated the association of metformin use with knee cartilage volume loss over 4 years and risk of total knee replacement over 6 years in obese individuals with knee osteoarthritis. Osteoarthritis Initiative participants with radiographic knee osteoarthritis (Kellgren-Lawrence grade ≥ 2) with body mass index [BMI] ≥ 30 kg/m² were analyzed in this work. Metformin users were those who self-reported regular metformin use at baseline, 1-year and 2-year follow-up (n = 56) and non-users of metformin were those who did not report the use of metformin at any visit from baseline to 4-year follow-up (n = 762). Outcomes suggest that patients with knee osteoarthritis and obesity benefit from metformin use in terms of long-term knee joint outcomes. Metformin users showed a lower rate of medial cartilage volume loss and indicated a trend towards a significant decrease in risk of total knee replacement over 6 years, after adjustment for age, gender, BMI, Kellgren-Lawrence grade, pain score, and self-reported diabetes. compared with non-users