Women With PCOS May be at a Greater Risk of Developing Osteoarthritis


Women with polycystic ovary syndrome (PCOS) are more likely to suffer from knee-related symptoms and impaired activities of daily living, indicating a possible link between hyperandrogenism and early clinical osteoarthritis.

Patients with polycystic ovary syndrome (PCOS) reported more knee-related symptoms and impaired activities of daily living (ADL) when compared with a control group, which may indicate a link between hyperandrogenism and early clinical osteoarthritis (OA), according to a study published in Springer.1 Investigators also noted a greater knee femoral cartilage thickness in patients with PCOS and that while lower levels of serum cartilage oligomeric matrix protein (sCOMP) may be inherent to a PCOS diagnosis, sCOMP levels were not significantly different between both groups.

OA, the most prevalent chronic joint disease, and PCOS are both associated with cardiovascular events and metabolic syndrome. The lipid, metabolic, and humoral factors greatly impact pathogenesis, onset and progression. Additionally, both conditions are known to be the result of systemic and local factors.

“Observational and interventional studies have shown that OA onset and progression in women is significantly affected by sex hormones and this has led to the introduction of the term ‘hormone-dependent’ osteoarthritis,” stated investigators. “This statement is supported by the fact that, in 64% of women with OA of the knee joint, symptoms begin within the first 5 years after menopause.”

In this cross-sectional, observational study, 54 patients with PCOS were compared with 26 age- and body mass index (BMI)-matched controls. The study was approved by the local ethics committee of the Medical University–Sofia. Investigators chose to only include phenotype A, B, and C, as clinical and/or biochemical hyperandrogenism is a required characteristic. Information about medical history, self-reported measures, sCOMP measurements, laboratory tests, and results of a clinical examination was collected. Participants were excluded for a number of factors, including preexisting inflammatory or autoimmune rheumatic disease, current pregnancy, or pulmonary disease or/and endocrine disorder diagnosis.

BMI, waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR) information was collected. Participants also filled out a Knee Injury and Osteoarthritis Outcome Score (KOOS). Investigators analyzed knee-related pain, quality of life (QoL), ADL, symptoms, and sport function in both groups.

Blood samples were taken during the menstrual cycle which measured for fasting plasma glucose (FPG), serum immunoreactive insulin (IRI), total testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, sex hormone-binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol. The free androgen index (FAI) was then calculated. Clinical features, increased levels of androgens (total testosterone [≥ 1.6nmol/l]), and FAI (≥ 5) determined the presence of hyperandrogenism.

The thickness of the femoral cartilage was scanned in 41 patients with PCOS and 15 participants from the control cohort.

Results indicated that patients with PCOS had more knee-related symptoms (p = 0.035) and impaired ADL (p = 0.001) when compared with the control group. Additionally, the cartilage thickness was significantly greater in the randomly selected patients in the PCOS cohort when compared with the control group. Patients with PCOS had higher levels of testosterone, DHEAS, androstenedione (all p < 0.001), FAI (p = 0.002), and an elevated LH/FSH ratio (p = 0.035). COMP had a negative correlation with testosterone levels (p = 0.029, r =− 0.297) in the PCOS group, which remained after controlling for BMI.

KOOS scores for knee pain, QoL, and sport function were similar in both groups, however, the PCOS group indicated more severe knee-related symptoms and impaired ADL.

Limitations included the small sample size, cross-sectional, and exploratory design of the study, intended to lead into more large-scale prospective studies. Additionally, cartilage thickness was only assessed in randomly selected patients. Investigators excluded patients with inflammatory and autoimmune rheumatic comorbidities as well as pulmonary diseases that are associated with higher sCOMP levels in order to avoid confusion with knee osteoarthritis (KOA) indication. Lastly, localizations of joint symptoms were not accounted for.

“Young women with PCOS may experience more prominent knee-related symptoms and more impaired ADL than age- and BMI-matched controls. PCOS patients have greater cartilage thickness of the femoral condyles in comparison to age- and BMI-matched controls,” concluded investigators. “Lower serum levels of COMP, a biomarker of cartilage turnover, could be inherent to PCOS patients with higher testosterone levels.”


Kabakchieva P, Georgiev T, Gateva A, Hristova J, Kamenov Z. Polycystic ovary syndrome and (pre)osteoarthritis: assessing the link between hyperandrogenism in young women and cartilage oligomeric matrix protein as a marker of cartilage breakdown [published online ahead of print, 2021 May 4]. Clin Rheumatol. 2021;10.1007/s10067-021-05753-0. doi:10.1007/s10067-021-05753-0

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