Sex dimorphism in the association of cardiometabolic characteristics and osteophytes-defined radiographic knee osteoarthritis among obese and non-obese adults: NHANES III

Osteoarthritis Cartilage. 2012 Jul;20(7):614-21. doi: 10.1016/j.joca.2012.02.644. Epub 2012 Apr 19.


Objective: To examine the relationship of knee osteoarthritis (OA) with cardiovascular and metabolic risk factors by obesity status and gender.

Methods: Data from 1,066 National Health and Nutrition Examination Survey III participants (≥60 years of age) was used to examine relationships of osteophytes-defined radiographic knee OA and cardiovascular and metabolic measures. Analyses were considered among obese [body mass index (BMI)≥30 kg/m(2)] and non-obese (BMI<30 kg/m(2)) men and women.

Results: The prevalence of osteophytes-defined radiographic knee OA was 34%. Leptin levels and homeostatic model assessment-insulin resistance (HOMA-IR), a proxy measure of insulin resistance, were significantly associated with knee OA; those with knee OA had 35% higher HOMA-IR values and 52% higher leptin levels compared to those without knee OA. The magnitude of the association between HOMA-IR and knee OA was strongest among men, regardless of obesity status; odds ratios (ORs) for HOMA-IR were 34% greater among non-obese men (OR=1.18) vs obese women (OR=0.88). Among obese women, a 5-μg/L higher leptin was associated with nearly 30% higher odds of having knee OA (OR=1.28). Among men, ORs for the association of leptin and knee OA were in the opposite direction.

Conclusions: Cardiometabolic dysfunction is related to osteophytes-defined radiographic knee OA prevalence and persists within subgroups defined by obesity status and gender. A sex dimorphism in the direction and magnitude of cardiometabolic risk factors with respect to knee OA was described including HOMA-IR being associated with OA prevalence among men while leptin levels were most important among women.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Body Mass Index
  • Female
  • Health Surveys
  • Humans
  • Insulin Resistance / physiology
  • Leptin / blood
  • Lipids / blood
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / epidemiology
  • Obesity / physiopathology
  • Osteoarthritis, Knee / blood
  • Osteoarthritis, Knee / epidemiology
  • Osteoarthritis, Knee / etiology*
  • Osteoarthritis, Knee / physiopathology
  • Osteophyte / blood
  • Osteophyte / epidemiology
  • Osteophyte / etiology*
  • Osteophyte / physiopathology
  • Prevalence
  • Risk Factors
  • Sex Characteristics*
  • United States / epidemiology


  • Leptin
  • Lipids