Association between low-density lipoprotein and structural changes in the knee joint of patients with symptomatic osteoarthritis is mediated by relative fat mass

RFM outperforms BMI in predicting structural damage in KOA, particularly cartilage volume loss. The identified statistically significant indirect pathway (LDL → RFM → cartilage volume) provides a novel framework for understanding how dyslipidemia may be associated with cartilage degeneration through adiposity, offering potential targets for metabolic intervention strategies in KOA prevention.