A Single Nucleotide Polymorphism in the GDF5 Gene (rs143383) may
Journal of Bone Research

Journal of Bone Research
Open Access

ISSN: 2572-4916

+44 7868 792050

Research Article - (2017) Volume 5, Issue 3

A Single Nucleotide Polymorphism in the GDF5 Gene (rs143383) may contribute to the Increased Risk of Osteoarthritis and Lumbar Disc Degeneration: an Updated Meta-Analysis

Liying Jiang1, Yidan Wang1, Xiaoyue Zhu1, Peng Hu1, Dandong Wu1 and Aidong Liu2*
1Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, PR China
2Applied Nutrition Division, China National Center for Food Safety Risk Assessment, Beijing, PR China
*Corresponding Author: Aidong Liu, Applied Nutrition Division, China National Center for Food Safety Risk Assessment, Beijing, PR China, Tel: 86-1052165520 Email:


Background: Although previous studies have investigated the association between GDF5 polymorphism rs143383 and osteoarthritis (OA) or lumbar disc degeneration (LDD), the results were inconsistent. Given the availability of more recent data, we performed a meta-analysis to access the association between GDF5 polymorphism rs143383 and OA or LDD as well as whether the association vary by ethnicity, sex, study design and disease sites.

Method: Published literature from PubMed, Embase, SCOPUS, Google Scholar, and China National Knowledge Infrastructure (CNKI) databases were retrieved. ORs and 95%CIs were calculated to estimate the strength of the association between the GDF5 polymorphism rs143383 and the risk of OA or LDD.

Results: A total of 15 articles containing 33 studies were enrolled in this meta-analysis. Overall, a statistically association was found between the GDF5 rs143383 polymorphism and the risk of OA or LDD in the allele model(OR=0.86, 95%CI=0.81- 0.91) and dominant model(OR=0.86, 95%CI=0.79-0.91). In the subgroup analyses by ethnicity, sex, study design and disease site, we observed a significant association in Caucasian subgroup (allele model, OR=0.91,95%CI=0.87-0.95, dominant model, OR=0.89, 95%CI=0.82-0.96), Asian subgroup (allele model, OR=0.72, 95%CI=0.61-0.84, dominant model, OR=0.69, 95%CI=0.56-0.85), case-control study subgroup (allele model, OR=0.80, 95%CI=0.73-0.88, dominant model, OR=0.80, 95%CI=0.70-0.91), cohort study subgroup (allele model, OR=0.91, 95%CI=0.86-0.97, dominant model, OR=0.87,95%CI=0.79-0.96), males and females subgroup(allele model, OR=0.86, 95%CI=0.81-0.92, dominant model, OR=0.84, 95%CI=0.77-0.92), and weight-bearing joints subgroup(allele model, OR=0.83,95%CI=0.78-0.89, dominant model, OR=0.80, 95%CI=0.73-0.88).

Conclusion: Our study demonstrated significant associations between the rs143383 polymorphism and the susceptibility to OA and LDD.


Keywords: Osteoarthritis; Lumbar disc degeneration; Polymorphism


Osteoarthritis (OA), a major cause of pain and disability among the elderly, is the most common type of articular cartilage degeneration around the world [1,2]. According to published studies on the prevalence of OA, out of 100 people aged 60 years and over, approximately 10 people have clinical problems that might be attributable to OA [3]. The health care cost and financial burden of OA is increasing commensurate with the obesity prevalence and longevity [4]. OA definitely include diverse clinical types, such as knee, hip, hand, and temporomandibular joint OA [5]. Although the high prevalence and substantial public health concerns, the etiology of OA is still not well understood. Growing evidence have implicated that genetic predisposition, aging, obesity, occupation, smoking, physical activities, and traumatic injury may predispose to OA development [6-8].

Lumbar Disc Degeneration (LDD) is a kind of age-related skeletal disease, which is a common cause of disability and loss of productivity [9,10]. Epidemiologic evidence suggested that approximately 20% of patients with LDD required a surgical treatment owing to prolonged or aggravated leg pain [11,12]. OA is a multifactorial disease characterized by the degeneration of articulating synovial joints, while LDD is common in fibrocartilage and known to be a cause of low back pain. Although they are different type of cartilage, both of them can be viewed as sharing similar etiological routes including multiple abnormalities of joint and dysfunctions in bones and appendicular skeleton [13,14].

Growth differentiation factor 5(GDF5), an extracellular signaling molecule, is a member of the transforming growth factor-β(TGF-β) superfamily. It participates in the development, maintenance and repair of articular cartilage and synovial joint [15,16]. The GDF5 gene is located on chromosome 20q11.2 and spans 21.43 kb [17]. The mutations of the GDF5 gene may result in a series of skeletal disorders such as brachydactyly and chondrodysplasia [18-20]. Rs143383 is one of the most common studied polymorphisms in the 5’-UTR of GDF5, which has been proved to be a risk factor of OA and LDD [21]. T to C substitution of rs143383 may have an effect on transcriptional activity and the expression of GDF5 production, with lower GDF5 expression of the OA-associated risk allele [22,23].Several animal models have further confirmed the evidence supporting a crucial role of GDF5 in the development of OA [24-27]. The above evidence implies that the GDF5 polymorphism may play an essential role in the aetiology and pathogenesis of OA or LDD.A variety of previous studies have focused on the functions of the GDF5 polymorphism in the development of OA and/or LDD [28-43]. Most studies reported a positive association between rs143383 polymorphism and the risk of OA and LDD [28,29,31-38,40-43], while few studies generated negative results[30,39]. Two previous meta-analyses have reported that the rs143383 polymorphism was important in the progression of knee OA [44,45]. Zhang et al. performed an updated meta-analysis to explore the association between the genetic variant and OA in common affected sites [46]. However, they did not conduct subgroup analysis between case-control and cohort studies. Also, Williams et al. conducted the association of GDF5 with LDD risk in 3 cohorts from Northern Europe and indicated that a variant in the GDF5 gene may increase the risk of LDD in women. In view of the shared genetic risk and epidemiological characteristics between OA and LDD [13], it is necessary to perform a meta-analysis to explore a real association between this gene variation and these diseases. Most importantly, the associations between the rs143383 polymorphism and susceptibility to OA and LDD lack a quantitatively assessment. Therefore, we conducted this study to explore whether the associations vary by ethnicity, sex, study design, and disease sites.


Data sources

To identify those pertinent papers that explored the correlations of GDF5 rs143383 polymorphism with the susceptibility to OA and LDD, we comprehensively searched PubMed, Embase, SCOPUS, Google Scholar, and China National Knowledge Infrastructure (CNKI) databases (last updated search in March 30,2017). We utilized the following keywords regarding the GDF5 gene, OA, and LDD (“Growth Differentiation Factor 5” or “GDF5” or “rs143383” or “Cartilagederived Morphogenetic Protein 1” or “CDMP1”) for the exposure factors, and (“osteoarthritis” or “OA”) and (“lumbar disc degeneration” or “LDD”) for the outcome factors. No restriction was set on the language of the article. We also further scrutinized the bibliographies of relevant articles manually to identify all possible studies. When the enrolled papers supplied unclear data about their original publications, we would contact the first author and asked for clarifications.

Selection criteria

We searched for all human case-control studies and cohort studies providing genotypic data for GDF5 genetic polymorphisms, including subjects with OA and LDD. The enrolled studies reported sufficient information to estimate the odds ratio (OR) and 95% confidence intervals (CIs). We only selected studies that supplied the sample number and sufficient information about GDF5 genetic variants. Those studies with incomplete information would be excluded. OA and LDD were diagnosed based on clinical and/or radiographic evaluation, or ascertained by total joint replacement [44,45]. We merely enrolled the most recent and complete publications when multiple studies were published by the same authors on the same study population [46]. Studies based on family or sibling pairs were excluded because of linkage considerations [47,48].

Data extraction

In order to reduce bias and enhance credibility, two investigators independently extracted information from all included papers and arrived at a consensus on all the items through discussion and reexamination. The following relevant data were extracted from eligible studies: first author, year of publication, ethnicity and country of origin, primary reported disease, study design, source of controls, sample size, age, sex, genotyping method, BMI, OA definition criteria, available genotype, genotype and mutation frequencies, HWE evidence in controls. All authors approved the final determination of these studies.

Statistical analysis

We assessed Hardy-Weinberg equilibrium (HWE) separately in the control group in different studies. Deviation from HWE was considered statistically significant when P < 0.05. To calculate the effect size for each study, the summary ORs with 95% CIs were used the allele model(mutant allele C versus wild allele T), dominant model (TC+CC versus TT), and recessive model (CC versus TC+TT) with the utilization of Z test. In order to supply quantitative evidence of all included studies and minimized the variance of the summary ORs with 95% CIs, we conducted the current statistical meta-analysis by employing a randomeffect model or a fixed-effect model. The subgroup meta-analysis was also conducted by ethnicity, disease site, sex, and study design to explore potential effect modification, and heterogeneity was evaluated by the Cochran’s Q-statistic (P<0.05 was regarded as statistically significant) [49]. As a result of the low statistical power of the Cochran’s Q-statistic, the I2 test (0%, no heterogeneity; 100%, maximal heterogeneity) was also conducted to reflect the possibility of heterogeneity [50]. The sensitivity analysis was performed by omitting each study in our metaanalysis to reflect the influence of the individual data set on the pooled ORs. The funnel plot was constructed to assess publication bias, which might affect the validity of the estimates. The symmetry of the funnel plot was further evaluated by Egger’s linear regression test [51]. P value of <0.05 was regarded as statistically significant. All statistical analyses were performed with STATA 14.0 software (Stata Corporation, College Station, TX).


Characteristics of studies

The flow chart of screening displayed the detailed process of the study selection (Figure 1). A total of 97 papers were obtained after an initial literature search from these electronic database through screening the title and abstract. We then excluded duplicates (n=14), letters (n=2), reviews or meta-analysis (n=8), non-human studies (n=16), and studies not associated with our research topics (n=19). The remaining studies (n=38) were reviewed and additional 22 studies were excluded for not being case-control or cohort studies (n=6), not relevant to the GDF5 gene (n=3), not related to OA or LDD (n=7), or unavailable genotyping data (n=6). In the final analysis, there were 15 articles that were combined to perform an association analysis of rs143383 with OA and/ or LDD [28-33,35-43].The characteristics of these included articles were presented in Table 1. All the studies conformed to HWE in the control group. Among these available articles, there were 9 case-control studies and 6 cohort studies including 18732 patients and 24335 controls. Seven studies Table 2 were conducted in Asian populations, while eight studies were based on Caucasians. Two studies only covered females, whereas other studies contained males and females. The weight-bearing joints involved knee and hip sites, while non-weight-bearing joints affected hand and temporomandibular joints. The definition of OA or LDD contained radiographic criteria (Kellgren-Lawrence grade ≥ II), clinical criteria (the American College of Rheumatology), and total joint replacement.


Figure 1: Flow chart of literature search and study selection.

First author Year of publication Ethnicity Primary report Study design Source of controls Mean age BMI(kb/m2) Genotyping method OA definition
Cases Controls Cases Controls
Southam[28] 2007 Caucasian OA(knee,hip ,hand) Case-control HB 65.0 69.0 NA NA PCR-RFLP,
Miyamoto [29] 2007 Asian OA(knee,hip) Case-control HB 58.8 56.8 24.9 23.6 Taqman,Invader,DNA fragment analysis,
direct sequence
Tsezou [30] 2007 Caucasian Knee OA Case-control HB 67.9 65.2 29.5 25.0 Direct sequence Radiographic
Yao [31] 2008 Asian Knee OA Case-control PB 58.8 56.8 24.8 23.6 Real-time PCR Radiographic,clinical+
Chapman [32] 2008 Caucasian OA(knee,hip,hand) Cohort study PB 60.4 59.4 NA NA Mass spectrometry Radiographic
Vaes [33] 2009 Caucasian OA(knee, hip,hand) Cohort study PB ?55.0 ?55.0 25.5 25.6 Taqman Radiographic
Evangelo [34] 2009 Caucasian Knee OA Cohort study PB 74.8 74.8 NA NA Centaurus platform Radiographic,
Valdes [35] 2009 Caucasian OA(knee,hip) Cohort study PB 68.5 66.9 26.8 25.2 Allele-specific PCR Radiographic
Cao [36] 2010 Asian Knee OA Case-control PB 63.0 44.0 NA NA PCR-RFLP TKR
Valdes [37] 2011 Caucasian Knee OA Cohort study PB 65.5 65.5 27.7 24.1 Allele-specific PCR Radiographic
Tawonsawatruk [38] 2011 Asian Knee OA Case-control HB 68.5 59.3 26.6 24.5 PCR-RFLP TKR
Shin [39] 2012 Asian Knee OA Cohort study PB 67.4 62.7 25.3 24.1 High resolution melting analysis Radiographic
Mishra [40] 2013 Asian Knee OA Case-control HB 54.0 55.2 25.5 23.7 PCR-RFLP Radiographic,clinical
Bijsterbosch [41] 2013 Caucasian Hand OA Case-control PB 60.0 61.0 27.2 26.2 Mass spectrometry Radiographic
Williams [42] 2011 Caucasian LDD Cohort study PB 65.7 62.9 26.3 25.0 Illumina paltform Radiographic
Xiao [43] 2015 Asian TMJOA Case-control HB 47.8 41.2 NA NA Direct sequence Radiographic
NA data not available, HB hospital-based, PB population-based, LDD lumbar disc degeneration, TMJOA temporomandibular joint osteoarthritis, TKR total knee replacement, BMI body mass index.
*Radiographic criteria (Kellgren-Lawrence grade≥?)
+Clinical criteria are based on the American College of Rheumatology

Table 1: Principle characteristics of all studies for GDF5 rs143383 polymorphism included in the meta-analysis.

Author Year Country Disease Study participants(females) Genotypes distribution PHWEa
Cases Controls
Southam 2007 Spain Knee OA 274(178) 1196(614) 102 136 36 340 208 439 563 194 1441 951 0.550
Southam 2007 Spain Hip OA 304(197) 1196(614) 102 157 45 361 247 439 563 194 1441 951 0.550
Southam 2007 Spain Hand OA 240(156) 1196(614) 98 105 37 301 179 439 563 194 1441 951 0.550
Southam 2007 UK Knee OA 509(331) 822(422) 219 238 52 676 342 324 372 126 1020 624 0.262
Southam 2007 UK Hip OA 1290(839) 822(422) 519 607 164 1645 935 324 372 126 1020 624 0.262
Southam 2007 UK Hand OA 515(335) 822(422) 233 226 56 692 338 324 372 126 1020 624 0.262
Miyamoto 2007 China Knee OA 313(205) 485(316) 197 97 19 491 135 244 193 48 681 289 0.283
Miyamoto 2007 Japan Knee OA 718(664) 861(405) 444 243 31 1131 305 473 330 58 1276 446 0.966
Miyamoto 2007 Japan Hip OA 998(923) 983(462) 701 266 31 1668 328 542 371 70 1455 511 0.552
Tsezou 2007 Greece Knee OA 251(205) 268(169) 95 126 30 316 186 99 125 44 323 213 0.669
Yao 2008 China Knee OA 298(207) 452(316) 189 93 16 471 125 232 182 38 646 258 0.785
Chapman 2008 Netherland Knee OA 142(NA) 724(NA) 54 72 16 180 104 289 331 104 909 539 0.558
Chapman 2008 Netherland Hip OA 106(NA) 724(NA) 43 50 13 136 76 289 331 104 909 539 0.558
Chapman 2008 Netherland Hand OA 200(NA) 724(NA) 64 111 25 239 161 289 331 104 909 539 0.558
Vaes 2009 Netherland Knee OA 667(306) 2097(1007) 276 298 93 850 484 752 1014 331 2518 1676 0.724
Vaes 2009 Netherland Hip OA 287(NA) 2757(NA) 111 131 45 353 221 1040 1298 419 3378 2136 0.672
Vaes 2009 Netherland Hand OA 870(395) 2080(1036) 367 391 112 1125 615 790 1041 249 2621 1539 0.080
Evangelou 2009 UK Knee OA 1003(NA) 647(NA) NA NA NA NA NA NA NA NA NA NA -
Evangelou 2009 Iceland Knee OA 1071(NA) 1169(NA) NA NA NA NA NA NA NA NA NA NA -
Evangelou 2009 UK Hip OA 790(NA) 921(NA) NA NA NA NA NA NA NA NA NA NA -
Evangelou 2009 Iceland Hip OA 1724(NA) 1160(NA) NA NA NA NA NA NA NA NA NA NA -
Evangelou 2009 Iceland Hand OA 2510(NA) 1169(NA) NA NA NA NA NA NA NA NA NA NA -
Valdes 2009 UK1 Knee OA 259(259) 509(509) 126 98 35 350 168 181 244 84 606 412 0.908
Valdes 2009 UK2 Knee OA 735(631) 646(309) 337 313 85 987 483 238 329 79 805 487 0.320
Valdes 2009 UK1 Hip OA 77(NA) 509(NA) 32 27 18 91 63 181 244 84 606 412 0.908
Valdes 2009 UK2 Hip OA 787(NA) 646(NA) 345 339 103 1029 545 238 329 79 805 487 0.320
Cao 2010 Korea Knee OA 276(226) 298(135) 150 115 11 415 137 159 113 26 431 165 0.361
Valdes 2011 Estonia Knee OA 65(45) 427(295) 32 24 9 88 42 168 179 80 515 339 0.056
Valdes 2011 Netherland Knee OA 867(417) 758(521) 413 361 93 1187 547 294 354 110 942 574 0.837
Valdes 2011 UK Knee OA 1141(560) 536(371) 467 511 163 1445 837 219 237 80 675 397 0.229
Tawonsawatruk 2011 Thailand Knee OA 90(79) 103(93) 38 41 11 117 63 33 47 23 113 93 0.425
Shin 2012 Korea Knee OA 725(554) 1737(855) 382 305 38 1069 381 942 689 106 2573 901 0.176
Mishra 2013 India Knee OA 300(196) 300(177) 124 130 46 378 222 84 160 56 328 272 0.188
Bijsterbosch 2013 Netherland Hand OA 248(201) 725(587) 86 131 31 303 193 290 330 105 910 540 0.480
Williams 2011 Netherland1 LDD 519(519) 944(944) 194 247 78 635 403 340 443 161 1123 765 0.418
Williams 2011 Netherland2 LDD 124(124) 448(448) 48 51 25 147 101 160 215 73 535 361 0.957
Williams 2011 London LDD 189(189) 569(569) 73 85 31 231 147 225 250 94 700 438 0.086
Xiao 2015 China TMJOA 114(114) 126(126) 62 47 5 171 57 53 54 19 160 92 0.397
NA data not available, LDD lumbar disc degeneration, TMJOA temporomandibular joint osteoarthritis.
aP value for Hardy-Weinberg equilibrium test in controls

Table 2: Genotypes distribution of GDF5 rs143383 polymorphism among cases and controls.

Overall population

Our meta-analysis had a total of 33 separate studies to explore the association between the rs143383 polymorphism and OA and/or LDD. As shown in Table 3, the results of overall comparison showed that significant associations were observed under the allele model (OR=0.86, 95%CI=0.81-0.91) and dominant model (OR=0.86, 95%CI=0.79-0.91).

Subgroup Genetic model No. of studies Type of model Test of heterogeneity Test of association
I2(%) P-value OR 95% CI
Overall C vs. T 33 Random 65.6 0.000 0.86 0.81-0.91
  CC vs. TT 33 Random 42.9 0.005 0.75 0.68-0.83
  CT vs. TT 33 Random 67.8 0.000 0.86 0.79-0.94
  CC+CT vs. TT(Dominant model) 33 Random 68.5 0.000 0.83 0.77-0.91
  CC vs. CT+TT(Recessive model) 33 Random 35.1 0.026 0.82 0.75-0.89
Caucasian C vs. T 24 Fixed 28.0 0.101 0.91 0.87-0.95
  CC vs. TT 24 Fixed 0 0.500 0.83 0.77-0.89
  CT vs. TT 24 Random 57.9 0.000 0.90 0.83-0.99
  CC+CT vs. TT(Dominant model) 24 Random 51.2 0.002 0.88 0.82-0.96
  CC vs. CT+TT(Recessive model) 24 Fixed 1.3 0.444 0.88 0.82-0.95
Asian C vs. T 9 Random 78.9 0.000 0.72 0.61-0.84
  CC vs. TT 9 Fixed 41.8 0.088 0.51 0.40-0.65
  CT vs. TT 9 Random 77.8 0.000 0.74 0.60-0.91
  CC+CT vs. TT(Dominant model) 9 Random 88.0 0.000 0.69 0.56-0.85
  CC vs. CT+TT(Recessive model) 9 Fixed 28.5 0.191 0.59 0.48-0.73
Study design              
Case-control C vs. T 16 Random 72.9 0.000 0.80 0.73-0.88
  CC vs. TT 16 Random 49.5 0.013 0.63 0.54-0.75
  CT vs. TT 16 Random 73.2 0.000 0.85 0.74-0.98
  CC+CT vs. TT(Dominant model) 16 Random 74.7 0.000 0.80 0.70-0.91
  CC vs. CT+TT(Recessive model) 16 Fixed 23.5 0.188 0.69 0.61-0.79
Cohort study C vs. T 17 Random 39.2 0.049 0.91 0.86-0.97
  CC vs. TT 17 Fixed 0 0.530 0.85 0.78-0.94
  CT vs. TT 17 Random 63.0 0.000 0.87 0.78-0.97
  CC+CT vs. TT(Dominant model) 17 Random 59.1 0.001 0.87 0.79-0.96
  CC vs. CT+TT(Recessive model) 17 Fixed 0 0.624 0.93 0.85-1.02
Males and females C vs. T 28 Random 67.1 0.000 0.86 0.81-0.92
  CC vs. TT 28 Random 41.4 0.012 0.75 0.68-0.83
  CT vs. TT 28 Random 70.4 0.000 0.87 0.79-0.95
  CC+CT vs. TT(Dominant model) 28 Random 70.6 0.000 0.84 0.77-0.92
  CC vs. CT+TT(Recessive model) 28 Random 33.4 0.046 0.81 0.74-0.89
Only females C vs. T 5 Random 63.6 0.027 0.85 0.71-1.02
  CC vs. TT 5 Random 59.2 0.044 0.77 0.54-1.10
  CT vs. TT 5 Fixed 52.3 0.079 0.82 0.65-1.04
  CC+CT vs. TT(Dominant model) 5 Random 58.7 0.046 0.81 0.64-1.02
  CC vs. CT+TT(Recessive model) 5 Fixed 52.2 0.079 0.86 0.64-1.17
Disease site              
Weight-bearing joints C vs. T 24 Random 67.7 0.000 0.83 0.78-0.89
  CC vs. TT 24 Random 39.8 0.024 0.72 0.64-0.80
  CT vs. TT 24 Random 70.0 0.000 0.83 0.75-0.92
  CC+CT vs. TT(Dominant model) 24 Random 70.6 0.000 0.80 0.73-0.88
  CC vs. CT+TT(Recessive model) 24 Fixed 30.5 0.079 0.79 0.72-0.87
Nonweight-bearing joints C vs. T 6 Random 63.3 0.018 0.91 0.80-1.04
  CC vs. TT 6 Random 56.6 0.042 0.82 0.62-1.07
  CT vs. TT 6 Random 70.9 0.004 0.97 0.78-1.21
  CC+CT vs. TT(Dominant model) 6 Random 69.4 0.006 0.93 0.76-1.14
  CC vs. CT+TT(Recessive model) 6 Random 55.2 0.048 0.83 0.65-1.06
LDD C vs. T 3 Fixed 0 0.772 1.04 0.92-1.17
  CC vs. TT 3 Fixed 0 0.622 1.07 0.84-1.36
  CT vs. TT 3 Fixed 0 0.612 1.04 0.87-1.25
  CC+CT vs. TT(Dominant model) 3 Fixed 0 0.815 1.05 0.88-1.24
  CC vs. CT+TT(Recessive model) 3 Fixed 0 0.383 0.96 0.77-1.20
OR odds ratio, CI confidence interval, LDD lumbar disc degeneration.

Table 3: Summary ORs and 95%CIs of the association between GDF5 rs143383 polymorphism and OA susceptibility

Subgroup analyses by ethnicity

In the subgroup analyses based on ethnicity (Figure 2), studies were divided into Asian and Caucasian. Rs143383 polymorphism was positively related to the risk of OA and LDD in Asian (allele model: OR=0.72, 95%CI=0.61-0.84; dominant model: OR=0.69,95%CI=0.56-0.85). A similar correlation was also observed in Caucasian (allele model: OR=0.91,95%CI=0.87-0.95; dominant model: OR=0.89,95%CI=0.82-0.96).


Figure 2: Subgroup analysis for the correlations of rs143383 between the risks of OA and LDD (A) Ethnicity: allele model; (B) Study design: allele model; (C) Sex: allele model; (D) Disease site: allele model; (E) Ethnicity: dominant model; (F) Study design: dominant model; (G) Sex: dominant model; (H) Disease site: dominant model.

Subgroup analyses by study design

After stratified by study design (Figure 3), the T allele of GDF5 was found to be significantly associated with OA and LDD in case-control study(allele model: OR=0.80, 95%CI=0.73-0.88; dominant model: OR=0.80, 95%CI=0.70-0.91) and cohort study(allele model: OR=0.91, 95%CI=0.86-0.97; dominant model: OR=0.87, 95%CI=0.79-0.96).


Figure 3: Sensitivity analysis of the summary ORs in the allele model and dominant model (A) Allele model; (B) Dominant model.

Subgroup analyses by sex

The significant association between rs143383 polymorphism and the risk of OA and/or LDD was only observed in the males and females subgroup under the allele model (OR=0.86, 95%CI=0.81-0.92) and dominant model (OR=0.84, 95%CI=0.77-0.92). However, the statistically significant association was not seen only for women under the allele model (OR=0.85, 95%CI=0.71-1.02) and dominant model (OR=0.81, 95%CI=0.64-1.02).

Subgroup analyses by disease sites

Further subgroup analyses based on disease sites implied that rs143383 polymorphism was positively related to the occurrence of weight-bearing joints under both allele model (OR=0.83, 95%CI=0.78- 0.89) and dominant model (OR=0.80, 95%CI=0.73-0.88). Whereas, the association of rs143383 with the occurrence of non-weight-bearing joints and LDD was not observed under the allele model (nonweight- bearing joints: OR=0.91, 95%CI=0.80-1.04; LDD: OR=0.93, 95%CI=0.76-1.14) and dominant model (non-weight-bearing joints: OR=1.04, 95%CI=0.92-1.17; LDD: OR=1.05, 95%CI=0.88-1.24).

Sensitivity analysis

We also performed a sensitivity analysis to evaluate the stability of the overall results. When each individual study was omitted, the pooled ORs of the allele model and dominant model were not substantially changed (Figure 3). This indicated that results were statistically robust.

Publication bias

The funnel plots for ORs of the allele model and dominant model were presented in Figure 4. Shape of the funnel plot did not reveal any evidence of obvious asymmetry. Subsequently, results of Egger’s test did not suggest any evidence of publication bias (allele model: OR=0.49, 95%CI=-2.72-1.33; dominant model: OR=0.89, 95%CI=-1.94-2.22).


Figure 4: Begg's funnel plot of GDF5 rs143383 polymorphism and OA/LDD under the allele model and dominant model (A) Allele model (B) Dominant model.


Several studies have revealed the facts that GDF5 participated in controlling bone formation and resorption of OA and LDD [52-54]. In consideration of similar etiological routes and a shared genetic risk between OA and LDD, we also examined the relationship between GDF5 polymorphism and LDD susceptibility. To the best of our knowledge, this is the first meta-analysis which comprehensively assessed the association between rs143383 polymorphism and the risk of OA and LDD. The results indicated that GDF5 rs143383 polymorphism was highly related to the development of OA with protective associations for the C allele, which has been demonstrated in different populations. Also, the study indicated that the SNP in the GDF5 gene exerted its influence on LDD risk, including direct effects on the disc or indirect effects on spinal ligaments. Recently, we have noticed that three metaanalyses have been conducted to explore the association between GDF5 polymorphism and knee OA based on case-control studies, illustrating that the T allele might increase susceptibility to knee OA in Asian and Caucasian populations [55,56]. With the update of data, the latest comprehensive meta-analysis was performed to explore the association between genetic variants of GDF5 and OA of knee, hip and hand using all published case-control and cohort studies [52]. The results demonstrated that GDF5 polymorphism was significantly correlated with OA risk in knee and hip sites among different ethnicities. However, the findings did not distinguish the bias of observational studies, that of case-control study is recall bias and that of cohort study is withdraw bias, which may distort the results of the meta-analysis. In our study, significant heterogeneity was observed in our overall effect. The diversity in ethnicity, study design, sex, and OA sites would further complicate the heterogeneity. Moreover, OA cases were defined with different criteria in different studies, which might be one of sources of observed heterogeneity. Some studies defined their patients using the K/L classification and/or ACR criteria [29-35,37,39-43], while other studies defined their patients using the TKR [28,36,38]. This discrepancy on those key characteristics of the participants?such as age and BMI, might also lead to the heterogeneity [34]. In order to further clarify the source of heterogeneity and attenuate the heterogeneity, we performed subgroup analyses. When being stratified by ethnicity, study design, sex, and disease sites, the results further strengthened our conclusion that GDF5 polymorphism rs143383 was related to the susceptibility to OA/LDD. Additionally, we also performed a sensitivity analysis omitting each study, which indicated that the overall results should be relatively stable. Although the primary results of this meta-analysis were suggestive, several potential limitations should be acknowledged. First of all, we explored only one SNP(rs143383) in the GDF5 locus. The evidence may be relatively weak due to one genetic marker. And, we have not addressed the interactions of genegene and gene-environment owing to the lack of relevant information. What’s more, the number of studies in non-weight-bearing joints was definitely insufficient, indicating that this study may not have enough power on exploring the association between GDF5 rs143383 and OA, especially for LDD. Last but not the least, body mass index, age, and other potential confounding factors were definitely recognized as important risk factors of OA. A more precise analysis based on adjusted estimates could be conducted if these data were available. In conclusion, this meta-analysis demonstrated a significant association between the rs143383 polymorphism and the susceptibility to OA and LDD. C allele of rs143383, located in the 5’-UTR of GDF5, is a protective factor and can confer susceptibility to OA and LDD in these subjects. Given the fact that the genetic factors may vary with different gender and populations, further research should be conducted in large and more diverse populations.

Ethics approval and consent to participate: Not applicable

Consent to Publish: Not applicable

Availability of Data and Materials

All of the data for this study are contained in the manuscript, the additional files, or the individuals included in this systematic review.

Competing Interests

The authors are fully responsible for all content and editorial decisions, and they have declared that no conflicts of the interests exist.


No funding was obtained for this study.

Authors’ Contributions

Liying Jiang drafted the protocol and wrote the final manuscript. Aidong Liu contributed to the research design and made critical revisions. Yidan Wang and Xiaoyue Zhu were responsible for the statistical design of trial and wrote portions of the statistical methods, data handing and monitoring sections. All authors have read and approved the final manuscript.


The authors acknowledge the contribution of Minjie Chu in the quality appraisal of included articles.


  1. Guillemin F, Rat AC, Mazieres B (2011) Prevalence of symptomatic hip and knee osteoarthritis: A two-phase population-based survey. OsteoarthrCartil 19:1314-1322.
  2. Cornelis FM, Luyten FP, Lories RJ (2011) Functional effects of susceptibility genes in osteoarthritis. Discov Med 12:129-139.
  3. Pereira D, Peleteiro B, Araujo J (2011) The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. OsteoarthrCartil 19:1270-1285.
  4. LluchGirbes E,Nijs J, Torres-Cueco R (2013) Pain treatment for patients with osteoarthritis and central sensitization. Physical therapy 93:842-851.
  5. Chen H,Capellini TD, Schoor M (2016) Heads, Shoulders, Elbows, Knees, and Toes: Modular Gdf5 Enhancers Control Different Joints in the Vertebrate Skeleton. PLOS Genet 12:e1006454.
  6. Inanir A, Yigit S, Tural S (2013) MTHFR gene C677T mutation and ACE gene I/D polymorphism in Turkish patients with osteoarthritis. Dis Markers 34:17-22.
  7. Daans M, Luyten FP, Lories RJ (2011) GDF5 deficiency in mice is associated with instability-driven joint damage, gait and subchondral bone changes Ann Rheum Dis 70:208-213.
  8. Raje M, Botre C, Ashma R (2013) Genetic epidemiology of osteoporosis across four microsatellite markers near the VDR gene.Int J MolEpidemiol Genet 4:101-118.
  9. Livshits G, Ermakov S, Popham M (2010) Evidence that bone mineral density plays a role in degenerative disc disease: the UK Twin Spine study. Ann Rheum Dis 69:2102-2106.
  10. Salo S,Leinonen V, Rikkonen T (2014) Association between bone mineral density and lumbar disc degeneration. Maturitas 79:449-455.
  11. Dagenais S, Caro J, Haldeman S (2008) A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 8:8-20.
  12. Lee YC, Zotti MG, Osti OL (2016) Operative Management of Lumbar Degenerative Disc Disease.Asian Spine J 10:801-819.
  13. Loughlin J (2011) Knee osteoarthritis, lumbar-disc degeneration and developmental dysplasia of the hip--an emerging genetic overlap. Arthritis Res Ther 13:108.
  14. Ikegawa S (2013) The genetics of common degenerative skeletal disorders: osteoarthritis and degenerative disc disease. Annu Rev Genomics Hum Genet 14:245-56.
  15. Ratnayake M, Ploger F, Santibanez-Koref M (2014) Human chondrocytes respond discordantly to the protein encoded by the osteoarthritis susceptibility gene GDF5. PloS one 9:e86590
  16. Degenkolbe E, Schwarz C, Ott CE (2015) Improved bone defect healing by a superagonistic GDF5 variant derived from a patient with multiplesynostoses syndrome. Bone 73:111-119.
  17. Chapman K, Valdes AM (2012) Genetic factors in OA pathogenesis. Bone 51:258-264.
  18. Al-QattanMM, Al-Motairi MI, Al Balwi MA (2015) Two novel homozygous missense mutations in the GDF5 gene cause brachydactyly type C. Am J Med Genet 167:1621-1626.
  19. Farooq M, Nakai H, Fujimoto A (2013) Characterization of a novel missense mutation in the prodomain of GDF5, which underlies brachydactyly type C and mild Grebe type chondrodysplasia in a large Pakistani family. Hum Genet 132:1253-1264.
  20. Khan S, Basit S, Khan MA (2016) Genetics of human isolated acromesomelic dysplasia. Eur J Med Genet 59:198-203.
  21. Dario AB, Ferreira ML, Refshauge KM (2015) The relationship between obesity, low back pain, and lumbar disc degeneration when genetics and the environment are considered: a systematic review of twin studies. Spine J 15:1106-1117.
  22. Egli RJ, Southam L, Wilkins JM (2009) Functional analysis of the osteoarthritis susceptibility-associated GDF5 regulatory polymorphism. Arthritis Rheum 60:2055-2064.
  23. Kan A, Ikeda T, FukaiA (2013) SOX11 contributes to the regulation of GDF5 in joint maintenance. BMC Dev. Biol. 13.
  24. Harada M, Takahara M, Zhe P (2007) Developmental failure of the intra-articular ligaments in mice with absence of growth differentiation factor 5. OsteoarthrCartil 15:468-474.
  25. McHugh J (2017) Osteoarthritis: GDF5 modifies disease in OA rat model. Nat RevRheumatol 13:3.
  26. Parrish WR, Byers BA, Su D (2016) Intra-articular therapy with recombinant human GDF5 arrests disease progression and stimulates cartilage repair in the rat medial meniscus transection (MMT) model of osteoarthritis. OsteoarthrCartil.
  27. MasuyaH, Nishida K, Furuichi T (2007) A novel dominant-negative mutation in Gdf5 generated by ENU mutagenesis impairs joint formation and causes osteoarthritis in mice.HumMol Genet 16:2366-2375.
  28. Southam L, Rodriguez-Lopez J, Wilkins JM (2007) An SNP in the 5'-UTR of GDF5 is associated with osteoarthritis susceptibility in Europeans and with in vivo differences in allelic expression in articular cartilage. HumMolGenet 16:2226-2232.
  29. Miyamoto Y, Mabuchi A, Shi D (2007) A functional polymorphism in the 5' UTR of GDF5 is associated with susceptibility to osteoarthritis Nat Genet 39:529-533.
  30. TsezouA, Satra M, Oikonomou P (2008) The growth differentiation factor 5 (GDF5) core promoter polymorphism is not associated with knee osteoarthritis in the Greek population. Journal of orthopaedicresearch :J Orthop Res 26:136-140.
  31. Yao C, Jin D, Qin J (2008) A single nucleid polymorphisms (SNP)in the 5′UTR of GDF5 is associated with knee osteoarthritis. Jiangsu Med J 34:1198-1199.
  32. Chapman K, Takahashi A, Meulenbelt I (2008) A meta-analysis of European and Asian cohorts reveals a global role of a functional SNP in the 5' UTR of GDF5 with osteoarthritis susceptibility. HumMolGenet 17:1497-1504.
  33. Vaes RB, Rivadeneira F, Kerkhof JM (2009) Genetic variation in the GDF5 region is associated with osteoarthritis, height, hip axis length and fracture risk: the Rotterdam study. Ann Rheum Dis 68:1754-1760.
  34. Evangelou E, Chapman K, Meulenbelt I (2009) Large-scale analysis of association between GDF5 and FRZB variants and osteoarthritis of the hip, knee, and hand. Arthritis Rheum 60: 1710-1721
  35. Valdes AM, Spector TD, Doherty S (2009) Association of the DVWA and GDF5 polymorphisms with osteoarthritis in UK populations. AnnRheumDis 68:1916-1920.
  36. Cao Z, Lee HS, Song JH (2010) Growth Differentiation Factor 5 (GDF5) Core Promoter Polymorphism Is Not Associated with Susceptibility to Osteoarthritis of the Knee in the Korean Population. Korean J Pathol 44:404-409.
  37. Valdes AM, Evangelou E, Kerkhof HJ (2011) The GDF5 rs143383 polymorphism is associated with osteoarthritis of the knee with genome-wide statistical significance. Ann Rheum Dis 70:873-875.
  38. Tawonsawatruk T, Changthong T, Pingsuthiwong S (2011) A genetic association study between growth differentiation factor 5 (GDF 5) polymorphism and knee osteoarthritis in Thai population. J OrthopSurg Res. 6:47.
  39. Shin MH, Lee SJ, Kee SJ (2012) Genetic association analysis of GDF5 and ADAM12 for knee osteoarthritis. Joint, bone, spine: revue du rhumatisme 79:488-491.
  40. Mishra A, Sanghi D, Sharma C (2013) Association of polymorphism in growth and differentiation factor 5 gene with osteoarthritis knee. Am J BiochemBiotechnol 91:481-491
  41. Bijsterbosch J, Kloppenburg M, Reijnierse M (2013) Association study of candidate genes for the progression of hand osteoarthritis. OsteoarthrCartil 21:565-569.
  42. Williams FM, PophamM, Hart DJ (2011) GDF5 single-nucleotide polymorphism rs143383 is associated with lumbar disc degeneration in Northern European women. Arthritis Rheum 63:708-712
  43. Xiao JL, Meng JH, Gan YH (2015) Association of GDF5, SMAD3 and RUNX2 polymorphisms with temporomandibular joint osteoarthritis in female Han Chinese.J Oral Rehabil 42:529-536.
  44. Huetink K, van der Voort P, Bloem JL (2016) Genetic Contribution to the Development of Radiographic Knee Osteoarthritis in a Population Presenting with Nonacute Knee Symptoms a Decade Earlier. Clin Med Insights Arthritis MusculoskeletDisord9:57-63.
  45. Yoshiiwa T, Miyazaki M, Notani N (2016) Analysis of the Relationship between LigamentumFlavum Thickening and Lumbar Segmental Instability, Disc Degeneration, and Facet Joint Osteoarthritis in Lumbar Spinal Stenosis. Asian Spine J 10:1132-1140.
  46. Little J, Bradley L, Bray MS (2002) Reporting, appraising, and integrating data on genotype prevalence and gene-disease associations. Am J Epidemiol 156:300-310.
  47. Jackson D, White IR, Riley RD (2012) Quantifying the impact of between-study heterogeneity in multivariate meta-analyses Stat Med 31:3805-3820.
  48. Peters JL, Sutton AJ, Jones DR (2006) Comparison of two methods to detect publication bias in meta-analysis. Jama 295:676-80.
  49. Zintzaras E, Ioannidis JP (2005) HEGESMA: genome search meta-analysis and heterogeneity testing. Bioinformatics 21:3672-3673.
  50. Hao SW, Jin QH (2013) Association between the +104T/C polymorphism in the 5'UTR of GDF5 and susceptibility to knee osteoarthritis: a meta-analysisMol Med Rep 7:485-488.
  51. Liu J, Cai W, Zhang H (2013) Rs143383 in the growth differentiation factor 5 (GDF5) gene significantly associated with osteoarthritis (OA)-a comprehensive meta-analysis. Int J Med Sci 10:312-319.
  52. Zhang R, Yao J, Xu P (2015) A comprehensive meta-analysis of association between genetic variants of GDF5 and osteoarthritis of the knee, hip and hand. Inflammation research: Inflamm Res 64:405-414.
  53. Tan SL, Ahmad TS, Ng WM (2015) Identification of Pathways Mediating Growth Differentiation Factor5-Induced Tenogenic Differentiation in Human Bone Marrow Stromal Cells. PloS one 10:e0140869.
  54. Rodriguez-Fontenla C, Carr A, Gomez-Reino JJ (2012) Association of a BMP5 microsatellite with knee osteoarthritis: case-control study. Arthritis Res Ther 14:R257.
  55. Hart DJ,Mootoosamy I, Doyle DV (1994) The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study. Ann Rheum Dis 53:158-162.
  56. Spector TD, Williams FM (2006) The UK Adult Twin Registry (TwinsUK). Twin research and human genetics :Twin Res Hum Genet 9:899-906.
Citation: Jiang L, Wang Y, Zhu X, Hu P, Wu D, et al. (2017) A Single Nucleotide Polymorphism in the GDF5 Gene (rs143383) may contribute to the Increased Risk of Osteoarthritis and Lumbar Disc Degeneration: an Updated Meta-Analysis. J Bone Res 5: 183.

Copyright: © 2017 Jiang L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.