The pathogenesis of OA is complex and not completely explained, but adverse lifestyles and health conditions, including excessive physical labor (4), drinking alcohol (5), smoking (6), Type 2 diabetes, and obesity (7, 8), as well as an increase of sex hormone-binding globulin (SHBG), calcium, testosterone (T) and estradiol (E2) (9), and an overburden of pathologic factors such as inflammatory cytokines and matrix degradation are known to contribute (10, 11). This evidence concerns the gene SHBG and obesity due to melanocortin 4 receptor deficiency.