SHBG and Obesity: 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).