Studies suggest an association between elevated total serum cholesterol (TC), particularly low‐density lipoprotein (LDL), and osteoarthritis (OA). We evaluated the association between total cholesterol, LDL, high‐density lipoprotein (HDL), and knee OA risk.

We studied participants from the Multicenter Osteoarthritis Study (MOST) cohort at risk of developing knee OA. From baseline through 7 years, repeated knee x‐rays and MRIs were obtained, and knee symptoms were queried. From baseline fasting blood samples, lipids and lipoproteins were analyzed using standard assays. After excluding participants with baseline OA, we defined two sets of cases: those developing radiographic OA and those developing symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined the worsening of cartilage loss and synovitis on MRI and knee pain using the WOMAC scale. We carried out logistic regression adjusting for age, sex, BMI, education, baseline pain, and depressive symptoms, testing total cholesterol and lipoproteins as continuous measures, and did sensitivity analyses examining whether commonly used thresholds for high cholesterol, LDL, or low HDL increased risk.

We studied 337 cases with incident symptomatic OA and 283 cases with incident radiographic OA. The mean age at baseline was 62 years (55% women). Neither total cholesterol, LDL nor HDL showed a significant association with radiographic or symptomatic OA. Additionally, we found no association of these lipid measures with cartilage loss, worsening synovitis, or worsening knee pain.

Our data do not support an association between total cholesterol, LDL, or HDL with OA outcomes.