Osteoarthritis Risk Factors and Modulating Influences

Osteoarthritis is a multifactorial disorder characterised by progressive degeneration of articular cartilage, subchondral bone remodelling and synovial inflammation. Non-modifiable risk factors include advancing age, female sex and genetic predisposition, while modifiable determinants encompass obesity, prior joint injury and occupational joint loading. Excess body weight increases mechanical stress on weight-bearing joints and promotes low-grade systemic inflammation through adipokine release. Previous trauma or overuse accelerates cartilage breakdown by altering joint biomechanics. Lifestyle factors such as physical inactivity and prolonged sitting exacerbate symptom burden and functional decline, whereas regular low-impact exercise fosters cartilage health through mechanotransduction. Emerging evidence suggests that tobacco smoking may exert deleterious effects on cartilage via oxidative stress, although epidemiological findings remain inconsistent. Alcohol consumption has been variously linked to both increased and decreased osteoarthritis risk, reflecting confounding by lifestyle and sociodemographic factors. Understanding the interplay between biomechanical forces, systemic inflammation and health behaviours is critical for developing personalised prevention and management strategies in a globally ageing population.

Research from Nature Portfolio

Recent analysis of a large national health survey revealed that both current and former smokers exhibit a higher prevalence of osteoarthritis after accounting for age, sex, body mass index and comorbidities. This finding indicates that tobacco exposure may contribute to cartilage vulnerability and subchondral bone changes beyond its effects on body weight. A longitudinal cohort study of middle-aged women examined lifestyle trajectories around osteoarthritis diagnosis and found that although a substantial proportion adopted positive changes—such as meaningful weight loss and reduced sitting time—others experienced weight gain and increased sedentary behaviour. These divergent patterns highlight the need for ongoing clinical support to reinforce beneficial habits and address barriers to healthy behaviour change following diagnosis.

Osteoarthritis Risk Factors and Modulating Influences publication trend

The graph below shows the total number of articles in osteoarthritis risk factors and modulating influences across all publications each year (not limited to Nature Index journals).

Technical terms

Body mass index (BMI): A ratio of weight to height squared, used to classify underweight, normal weight, overweight and obesity.

Kellgren-Lawrence grade: A radiographic scale from 0 to 4 assessing osteoarthritis severity based on joint space narrowing, osteophytes and subchondral changes.

Chondrocyte: The specialised cell type responsible for maintaining cartilage matrix and mediating repair processes.

References

1. Association of smoking and osteoarthritis in US (NHANES 1999–2018). Scientific Reports (2023).
2. Lifestyle behaviour changes associated with osteoarthritis: a prospective cohort study. Scientific Reports (2024).
3. Evidence on risk factors for knee osteoarthritis in middle-older aged: a systematic review and meta analysis. Journal of Orthopaedic Surgery and Research (2023).
4. The association between alcohol consumption and osteoarthritis: a meta-analysis and meta-regression of observational studies. Rheumatology International (2021).