Associations between allostatic load and osteoarthritis: a cross-sectional study from NHANES 1999-2020

This study aims to investigate the relationship between allostatic load score (AL score) and osteoarthritis. The study utilized cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 1999-2020), including 33,423 participants. Each of nine routinely measured indicators spanning the cardiovascular, metabolic, renal, nutritional and inflammatory domains was assigned one point if it fell within the highest-risk quartile. The points were then summed to calculate the AL score. Weighted logistic regression models assessed the association between AL score and the odds of osteoarthritis, with subgroup analyzes by age, sex, race/ethnicity, comorbidities and medication use. Elevated AL score was associated with an increased odds of osteoarthritis (odds ratio: 1.06, 95% confidence interval: 1.03–1.09). Compared to AL score < 3, participants with AL score ≥ 3 had higher odds of osteoarthritis. Consistent findings between AL score and osteoarthritis were found across subgroups of age, sex, cardiovascular disease, chronic kidney disease, and without medication use (analgesics, muscle relaxants, adrenal cortical steroids, and nonsteroidal anti-inflammatory agents) (P < 0.05). Our results presented an association between elevated AL score and increased odds of osteoarthritis, suggesting that greater cumulative physiological stress burden is associated with higher odds of osteoarthritis. These findings provide new insights into osteoarthritis pathogenesis and highlight the potential value of managing stress and inflammation in osteoarthritis prevention. Future longitudinal and mechanistic studies are needed to verify our findings.