The interplay between metabolic disorders and tendinopathies: Systematic review and meta-analysis

To evaluate the prevalence of tendinopathies in relation to metabolic factors and to investigate associations between tendinopathies and metabolic conditions.

The current review synthesised screened articles in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines predesigned criterion which were from PubMed, Scopus and Web of Science published up to 31 March 2024. Eligible studies included cohort, case-control or cross-sectional designs.

Fifty-three studies were included. Achilles tendinopathy emerged as highly prevalent in diabetic individuals (6%; 95% confidence interval [CI]: 42%-91%). Moreover, diabetes was identified as a risk factor for Achilles tendinopathy development with an odds ratio (OR) of 7.22 (95% CI: 2.61-19.97). Diabetes was also linked to upper limb tendinopathies, including medial epicondylitis (OR: 11.27, 95% CI: 2.01-63.02) and trigger finger (OR: 3.79, 95% CI: 1.87-7.65). A pooled prevalence estimate found that 13% (95% CI: 4%-21%) of tendinopathy patients had hypercholesterolaemia and a prevalence of 38% (95% CI: 5%-80%) of tendinopathy was found among statin users. However, high study heterogeneity limited the reliability of these two findings. Even if body mass index alterations were observed in tendinopathy patients with a pooled prevalence of 64% (95% CI: 62%-66%), a causation could not be definitively established. The analysis of the impact of sex exhibited men higher rates of tendon pathology associated with dyslipidaemia, whereas diabetic women demonstrated a greater prevalence of trigger finger tendinopathy.

Results showed that diabetes, dyslipidaemia and obesity contribute to the tendinopathies development, highlighting their multifactorial aetiology with sex differences influencing specific pathologies. These findings suggested periodic metabolic evaluations in susceptible individuals to tendon overload, chronic pain or recurrent injuries.

Level III.