We incorporated related risk factors for OA (diabetes [ebi-a-GCST90013891] and smoking [ieu-b-4857, ukb-b-2047]) along with the use of exogenous insulin (ukb-b-7350) in a multivariable MR analysis to evaluate the direct effect of exogenous insulin use (ukb-b-7350) on OA (ieu-a-1169). Here, INS is linked to diabetes mellitus.