Content – Metabolic Syndrome Is Risk Factor for Osteoarthritis in Women

Núria Jansen, MD
Department of General Practice
Erasmus Medical Center
University Medical Center

Metabolic syndrome (MetS)—a clustering of abdominal obesity and other metabolic diseases such as type 2 diabetes or hypertension— is a risk factor for osteoarthritis (OA), explains Núria Jansen, MD. “Important contributions to this increased risk are mechanical factors related to body weight that increase the load across the knee,” she says. “However, an understanding of how metabolic factors contribute to OA progression is still lacking. Specifically, the role of MetS in relation to progression of knee OA remains unclear.”

For a study published in Osteoarthritis & Cartilage, Dr. Jansen and colleagues investigated whether MetS and its components are linked with progression of knee OA MRI features and assessed the interaction of MetS with menopause and progression of MRI features.

“After age 50, the rate of OA in women increases faster than that of men, indicating the role of menopause,” Dr. Jansen notes.” From previous studies, we know that menopause is associated with a 60% increased risk for MetS. It is important to understand how hormonal and inflammatory changes during menopause affect metabolic changes that might impact OA progression. Therefore, we set out to determine the role of MetS on knee OA progression and to evaluate the interaction of MetS with menopausal transition and OA progression in women in the general population.”

MetS Is a Key Risk Factor for Women with OA

The study team used data from a large cohort of women (N=682) who took part in a knee MRI sub-study with a 5-year follow-up. Multiple measurements were conducted, including acquisition of MRI images of both knees, collection of fasting blood samples, and assessment of body weight. The MRI scans were scored for multiple features that are related to OA, such as cartilage defects, osteophytes, bone marrow lesions, and synovitis. Multiple associations between MetS and the progression of these knee MRI features were analyzed.

“We observed that MetS is an important risk factor for OA in women,” Dr. Jansen says. “Additionally, we found that women with severe MetS are at risk for more structural knee OA progression.”

A key finding is that abdominal obesity, measured by waist circumference, was most often associated with the progression of knee OA MRI features, according to the study team Table. “The results suggest an important role of abdominal obesity in OA progression,” Dr. Jansen points out. “Therefore, future intervention studies should focus primarily on reducing abdominal obesity.”

 More Targeted Treatment for Women Should Be Considered

 Since hormonal and inflammatory changes occur during menopause, Dr. Jansen and colleagues emphasize that researchers should consider more targeted treatment for women. However, they agree that this requires a better understanding of the female-specific pathways that are involved in OA disease.

No interaction between menopausal transition with MetS and knee OA MRI features was found, Dr. Jansen notes. “However, our results are likely to be influenced by the high number of women in the study who were postmenopausal. Therefore, future studies should investigate how hormonal changes during menopause result in metabolic changes that affect OA progression to help develop sex-specific OA treatments.”

Age-Adjusted Link Between MetS Components at Baseline With the Change in MRI Features*


Osteophytes             BMLs

TF Medial

Cartilage Defects      Osteophytes

TF Lateral


WC, cm 1.03 (1.01-1.05) 0.99 (0.98-1.01) 1.03 (1.01-1.05) 1.03 (1.01-1.05) 1.03 (1.01-1.05)
Triglycerides, mmol/l 1.02 (0.75-1.37) 1.18 (0.92-1.50) 0.85 (0.56-1.28) 1.08 (0.84-1.38) 1.26 (0.96-1.65)
HDL cholesterol, mmol/l


1.25 (0.72-2.17) 0.88 (0.61-1.26) 0.92 (0.55-1.54) 1.62 (1.04-2.51) 1.93 (1.10-3.37)
Glucose, mmol/l 1.19 (1.03-1.38) 1.12 (0.99-1.26) 0.94 (0.79-1.11) 1.16 (1.01-1.34) 1.13 (0.97-1.32)
Hypertension, N 1.01 (0.66-1.53) 0.88 (0.67-1.16) 1.16 (0.77-1.75) 1.08 (0.74-1.59) 1.19 (0.74-1.93)

Note: ORs and 95% CIs with statistically significant associations are shown bolded.
Abbreviations: BML, bone marrow lesions; HDL, high-density lipoprotein; MetS, metabolic syndrome; PF, patellofemoral; TF, tibiofemoral; WC, waist circumference.

*Only the MRI features that were associated (P<0.05) with the change in z-MetS at baseline were analyzed.

 Source: Adapted from Jansen NEJ, et al. Osteoarthritis Cartilage. 2023, Feb 16 [ePub ahead of print]. Available at