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2D:4D finger length ratio and radiographic hand osteoarthritis


To evaluate the association between the index and ring finger’s (2D:4D) length ratio with the prevalence and severity of radiographic hand osteoarthritis (OA). A population-based sample included 802 males (mean age 46.98 ± 17.10 years) and 738 females (mean age 48.65 ± 16.62 years) who had participated in a Chuvashian skeletal aging study. Age, sex, basic demographics, anthropometric data and X-rays of both hands were acquired. Each hand was visually classified on X-ray as either type 1—index finger longer than the ring finger; type 2—index and ring finger equal in length; or type 3—index finger shorter than the ring finger. Hand OA was defined by the number of affected joints (Kellgren–Lawrence score ≥ 2) in both hands and the sum total of Kellgren–Lawrence scores (total OA score). After comparing the OA variables of individuals with different finger length ratio types (after adjustment for age and BMI) significant differences were found only in females between finger ratio types of the right hand in a number of affected joints (F = 3.153, p = 0.043) and finger ratio types of the left (F = 3.330, p = 0.036) and right (F = 2.397, p = 0.047) hands of the total OA score. Females with type 3 ratios had the highest adjusted values of hand OA parameters. We found that finger length ratios are associated with hand OA parameters. Females with a type 3 finger length pattern showed significantly higher hand OA values than those with types 1 and 2.

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  1. 1.

    Lutchmaya S, Baron-Cohen S, Raggatt P, Knickmeyer R, Manning JT (2004) 2nd to 4th digit ratios, fetal testosterone and estradiol. Early Hum Dev 77(1–2):23–28. doi:10.1016/j.earlhumdev.2003.12.002

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    McIntyre MH (2006) The use of digit ratios as markers for perinatal androgen action. Reprod Biol Endocrinol 4:10. doi:10.1186/1477-7827-4-10

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Putz D, Gaulin S, Sporter R, McBurney D (2004) Sex hormones and finger length: What does 2D: 4D indicate? Evol Hum Behav 25:182–199

    Article  Google Scholar 

  4. 4.

    Manning JT, Taylor RP (2001) Second to fourth digit ratio and male ability in sport: implications for sexual selection in humans. Evol Hum Behav 22:61–69

    Article  PubMed  Google Scholar 

  5. 5.

    Paul SN, Kato BS, Hunkin JL, Vivekanandan S, Spector TD (2006) The big finger: the second to fourth digit ratio is a predictor of sporting ability in women. Br J Sports Med 40(12):981–983. doi:10.1136/bjsm.2006.027193

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Manning JT, Bundred PE (2000) The ratio of 2nd to 4th digit length: a new predictor of disease predisposition? Med Hypotheses 54(5):855–857. doi:10.1054/mehy.1999.1150

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Vehmas T, Solovieva S, Leino-Arjas P (2006) Radiographic 2D: 4D index in females: no relation to anthropometric, behavioural, nutritional, health-related, occupational or fertility variables. J Negat Results Biomed 5:12. doi:10.1186/1477-5751-5-12

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Arazi H, Eghbali E, Saeedi T, Moghadam R (2016) The relationship of physical activity and anthropometric and physiological characteristics to bone mineral density in postmenopausal women. J Clin Densitom 19(3):382–388. doi:10.1016/j.jocd.2016.01.005

    Article  PubMed  Google Scholar 

  9. 9.

    Hussain SM, Wang Y, Muller DC, Wluka AE, Giles GG, Manning JT, Graves S, Cicuttini FM (2014) Association between index-to-ring finger length ratio and risk of severe knee and hip osteoarthritis requiring total joint replacement. Rheumatology (Oxford) 53(7):1200–1207. doi:10.1093/rheumatology/keu021

    Article  Google Scholar 

  10. 10.

    de Kruijf M, Kerkhof HJ, Peters MJ, Bierma-Zeinstra S, Hofman A, Uitterlinden AG, Huggen FJ, van Meurs JB (2014) Finger length pattern as a biomarker for osteoarthritis and chronic joint pain: a population-based study and meta-analysis after systematic review. Arthritis Care Res (Hoboken) 66(9):1337–1343. doi:10.1002/acr.22320

    Article  Google Scholar 

  11. 11.

    Sigurjonsdottir K, Bjorgulfsson TM, Aspelund T, Eiriksdottir G, Sigurdsson S, Ingvarsson T, Harris TB, Launer L, Gudnason V, Jonsson H (2013) Type 3 finger length pattern is associated with total knee replacements due to osteoarthritis but not with hip replacements or hand osteoarthritis in the elderly: the AGES-Reykjavik study. BMC Musculoskelet Disord 14:112. doi:10.1186/1471-2474-14-112

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Ferraro B, Wilder FV, Leaverton PE (2010) Site specific osteoarthritis and the index to ring finger length ratio. Osteoarthr Cartil 18(3):354–357. doi:10.1016/j.joca.2009.11.001

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Zhang W, Robertson J, Doherty S, Liu JJ, Maciewicz RA, Muir KR, Doherty M (2008) Index to ring finger length ratio and the risk of osteoarthritis. Arthritis Rheum 58(1):137–144. doi:10.1002/art.23237

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Kalichman L, Malkin I, Livshits G, Kobyliansky E (2006) The association between morbidity and radiographic hand osteoarthritis: a population-based study. Jt Bone Spine 73(4):406–410. doi:10.1016/j.jbspin.2005.11.013

    Article  Google Scholar 

  15. 15.

    Kalichman L, Cohen Z, Kobyliansky E, Livshits G (2002) Interrelationship between bone aging traits and basic anthropometric characteristics. Am J Hum Biol 14(3):380–390. doi:10.1002/ajhb.10051

    Article  PubMed  Google Scholar 

  16. 16.

    Kalichman L, Livshits G, Kobyliansky E (2006) Indices of body composition and chronic morbidity: a cross-sectional study of a rural population in central Russia. Am J Hum Biol 18(3):350–358. doi:10.1002/ajhb.20506

    Article  PubMed  Google Scholar 

  17. 17.

    Kobyliansky E, Livshits G, Pavlovsky O (1995) Population biology of human aging: methods of assessment and sex variation. Hum Biol 67(1):87–109

    CAS  PubMed  Google Scholar 

  18. 18.

    Pavlovsky O, Kobyliansky E (1997) Population biology of human aging angelo pontecorboli editore. Firenze, Italy

    Google Scholar 

  19. 19.

    Robertson J, Zhang W, Liu JJ, Muir KR, Maciewicz RA, Doherty M (2008) Radiographic assessment of the index to ring finger ratio (2D: 4D) in adults. J Anat 212(1):42–48. doi:10.1111/j.1469-7580.2007.00830.x

    CAS  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Kalichman L, Zorina D, Batsevich V, Kobyliansky E (2013) 2D: 4D finger length ratio in the Chuvashian population. Homo 64(3):233–240. doi:10.1016/j.jchb.2013.02.051

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Kellgren J, Lawrence J (1963) Atlas of standard radiographs: the epidemiology of chronic rheumatism, vol 2. Blackwell Scientific Publications, Oxford

    Google Scholar 

  22. 22.

    Cauley JA, Kwoh CK, Egeland G, Nevitt MC, Cooperstein L, Rohay J, Towers A, Gutai JP (1993) Serum sex hormones and severity of osteoarthritis of the hand. J Rheumatol 20(7):1170–1175

    CAS  PubMed  Google Scholar 

  23. 23.

    Demissie S, Cupples LA, Myers R, Aliabadi P, Levy D, Felson DT (2002) Genome scan for quantity of hand osteoarthritis: the Framingham Study. Arthritis Rheum 46(4):946–952. doi:10.1002/art.10149

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Dominick KL, Jordan JM, Renner JB, Kraus VB (2005) Relationship of radiographic and clinical variables to pinch and grip strength among individuals with osteoarthritis. Arthritis Rheum 52(5):1424–1430. doi:10.1002/art.21035

    Article  PubMed  Google Scholar 

  25. 25.

    Haugen IK, Niu J, Aliabadi P, Felson DT, Englund M (2011) The associations between finger length pattern, osteoarthritis, and knee injury: data from the Framingham community cohort. Arthritis Rheum 63(8):2284–2288. doi:10.1002/art.30408

    Article  PubMed  PubMed Central  Google Scholar 

  26. 26.

    Kalichman L, Kobyliansky E, Livshits G (2006) Characteristics of joint degeneration in hand osteoarthritis. Jt Bone Spine 73(1):72–76. doi:10.1016/j.jbspin.2004.05.018

    Article  Google Scholar 

  27. 27.

    Linn S, Murtaugh B, Casey E (2012) Role of sex hormones in the development of osteoarthritis. PM & R 4(5 Suppl):S169–S173. doi:10.1016/j.pmrj.2012.01.013

    Article  Google Scholar 

  28. 28.

    Tanamas SK, Wijethilake P, Wluka AE, Davies-Tuck ML, Urquhart DM, Wang Y, Cicuttini FM (2011) Sex hormones and structural changes in osteoarthritis: a systematic review. Maturitas 69(2):141–156. doi:10.1016/j.maturitas.2011.03.019

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Ma HL, Blanchet TJ, Peluso D, Hopkins B, Morris EA, Glasson SS (2007) Osteoarthritis severity is sex dependent in a surgical mouse model. Osteoarthr cartil 15(6):695–700. doi:10.1016/j.joca.2006.11.005

    Article  PubMed  Google Scholar 

  30. 30.

    Riggs BL (2000) The mechanisms of estrogen regulation of bone resorption. J Clin Investig 106(10):1203–1204. doi:10.1172/jci11468

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Tuck SP, Francis RM (2009) Testosterone, bone and osteoporosis. Front Horm Res 37:123–132. doi:10.1159/000176049

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Muller DC, Giles GG, Bassett J, Morris HA, Manning JT, Hopper JL, English DR, Severi G (2011) Second to fourth digit ratio (2D: 4D) and concentrations of circulating sex hormones in adulthood. Reprod Biol Endocrinol 9:57. doi:10.1186/1477-7827-9-57

    CAS  Article  PubMed  PubMed Central  Google Scholar 

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The authors thank Mrs Phyllis Curchack Kornspan for her editorial services.

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Correspondence to L. Kalichman.

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Kalichman, L., Batsevich, V. & Kobyliansky, E. 2D:4D finger length ratio and radiographic hand osteoarthritis. Rheumatol Int 38, 865–870 (2018).

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  • 2D:4D
  • Finger length ratio
  • Hand
  • Osteoarthritis
  • Chuvash