Metabolic Syndrome and Hand Osteoarthritis in Postmenopausal Women: Association With Disease Severity and Bone Mineral Density

Introduction: Hand osteoarthritis (HOA) is highly prevalent in postmenopausal women and may reflect an underlying metabolic disorder.Chronic low-grade inflammation driven by obesity, hyperglycemia, and estrogen deficiency may contribute to this metabolic phenotype.This study aimed to investigate the association between metabolic syndrome (MetS), its individual components, and HOA, and to explore its relationship with bone mineral density (BMD).Methods: We conducted a retrospective observational study, with descriptive and analytical components, including 252 postmenopausal women aged ≥50 years presenting with hand pain.MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria.HOA was assessed clinically and radiographically using the Kellgren-Lawrence (K&L) grading system.BMD was measured using dual-energy X-ray absorptiometry (DEXA), and vertebral fractures were evaluated using vertebral fracture assessment (VFA).Results: The mean age of participants was 62.6 ± 7.3 years, with a mean body mass index (BMI) of 32.3 ± 6.5 kg/m².The prevalence of symptomatic HOA was 28.3%, while radiographic HOA was observed in 19.1% of patients.MetS was present in 30.3% (n=76) of the cohort.HOA was significantly associated with advanced age, higher BMI, and MetS (p < 0.001).Radiographic severity of HOA increased significantly with age, body weight, duration of menopause, and metabolic abnormalities.Increased severity was also associated with lower BMD and a higher prevalence of vertebral fractures (p < 0.001).In multivariate analysis, MetS was independently associated with symptomatic HOA (OR 4.3; 95% CI: 1.92-9.12;p < 0.001), along with hypertension.While no overall association was found between HOA and BMD, lower BMD and vertebral fractures were significantly associated with increased radiographic severity of HOA.Conclusion: HOA in postmenopausal women is strongly associated with MetS, supporting the concept of a metabolic phenotype of osteoarthritis.These findings emphasize the importance of comprehensive cardiometabolic risk assessment in the management of HOA and suggest a link between disease severity and bone fragility.As the first study of its kind conducted in Morocco, further large-scale multicenter studies are needed to confirm these findings.