Risk factors and prognostic factors of hip
and knee osteoarthritis
Sita MA Bierma-Zeinstra* and Bart W Koes
Osteoarthritis (OA) is a common joint disease,
frequently experienced by middle-aged and older
OA is characterized by joint pain and
dysfunction, with the hip and knees being the
most symptomatic areas. The total economic
burden of arthritis is currently estimated to
be 1–2.5% of the gross national product of
Western countries, and OA accounts for most
of this burden.
As a greater part of the popula-
tion live longer, the prevalence of OA is expected
to increase substantially; in Western countries,
the prevalence of OA is expected to increase by
about 40% in the coming 20 years, making OA
the fourth most common cause of disability.
clear insight into the risk factors for the develop-
ment of OA and of risk factors for fast progres-
sion is desirable. This might lead to the discovery
of strategies for primary prevention of OA or
secondary prevention of disease progression.
Many epidemiologic studies on risk factors,
and, to a lesser degree, on prognostic factors, for
hip and knee OA have been conducted; however,
not all these studies have equal validity when the
study design, measurements taken, or analyses
performed are considered. Systematic reviews of
determinants of the development and progres-
sion of OA have, therefore, been conducted to
summarize scientific evidence, while taking
into account validity and including all available
evidence and excluding any coincidental effects.
In this Review, we summarize the evidence
available from the systematic reviews on deter-
minants of development and progression of
hip and knee OA. When applicable, informa-
tion from publications based on data from
the Rotterdam study
(open population aged
55 years and older) on the issues summarized
in the systematic reviews is also discussed.
RISK FACTORS FOR OA
There have been several systematic reviews on the
risk factors for hip OA.
The systematic reviews
included studies published
Osteoarthritis (OA) is a joint disease that most commonly affects middle-
aged and elderly people. As the prevalence of OA is expected to increase
substantially in the future, a clearer insight into the risk factors for disease
development and disease in progression is desirable. In this Review, we
summarize the evidence available from systematic reviews regarding
the determinants of the development and progression of hip and knee
osteoarthritis (OA). There is moderate to strong evidence that physical
workload (in hip and knee OA), high-intensity sporting activities (in hip
OA), and being overweight (in clinical hip OA) are risk factors for OA.
There is also moderate to strong evidence that having OA and a high