Knee osteoarthritis in two ethnic groups in southern Israel: Risk factors and the role of Muslim prayer

doi:10.5312/wjo.121442

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Jul 18, 2026; 17(7): 121442
Published online Jul 18, 2026. doi: 10.5312/wjo.121442

Knee osteoarthritis in two ethnic groups in southern Israel: Risk factors and the role of Muslim prayer

Gasem Aziadna, Majed Abu Rashid, Yulia Treister-Goltzman

Gasem Aziadna, Majed Abu Rashid, Yulia Treister-Goltzman, Family Medicine, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel

Co-first authors: Gasem Aziadna and Majed Abu Rashid.

Author contributions: Aziadna G contributed to the conceptualization and methodology of the study, investigation, validation, and writing-review and editing; Abu Rashid M contributed to the conceptualization and methodology of the study, investigation, validation, and writing-review and editing; Treister-Goltzman Y contributed to the conceptualization and methodology of the study, data curation, formal analysis, software, supervision, visualization, validation, writing-original draft, and writing-review & editing. Aziadna G and Abu Rashid M contributed equally to this work as co-first authors.

AI contribution statement: AI tools were not used during manuscript preparation. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.

Supported by Faculty of Health Sciences, Ben-Gurion University of the Negev.

Institutional review board statement: Prior to recruitment approval was obtained from our institutional/regional/national research ethics committee: The Ethics Committee of Clalit health Services (approval No. com1-0085-17).

Informed consent statement: The privacy rights of human subjects have been observed, and informed consent was obtained from all the participants.

Conflict-of-interest statement: There is no conflict-of-interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items-and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Corresponding author: Yulia Treister-Goltzman, MD, PhD, Family Medicine, Ben-Gurion University of the Negev, POB 653, Beer-Sheva 84105, Israel. yuliatr@walla.com

Received: April 10, 2026
Revised: May 28, 2026
Accepted: June 24, 2026
Published online: July 18, 2026
Processing time: 108 Days and 12.4 Hours

Abstract

BACKGROUND

The unique characteristics of the principal ethnic populations of southern Israel could affect the prevalence osteoarthritis of knee (OAK). Traditional Muslim prayer, which involves bending of knees and standing with bent knees five times each day may be associated with lower odds of OAK.

AIM

To compare the prevalence of OAK and factors associated with it in two ethnic groups in southern Israel. Another aim was to assess the effect of traditional prayer on the prevalence of OAK and its severity.

METHODS

A cross-sectional study based on interviews of patients aged ≥ 50 years in primary care clinics in a Bedouin and Jewish cities in southern Israel. The participants completed sociodemographic and medical questionnaires, and the Western Ontario and McMaster Universities Osteoarthritis Index. Multivariable logistic models were developed for OAK in each of the ethnic sectors.

RESULTS

There were 182 participants from the Jewish sector and 171 from the Bedouin sector. Seven Bedouins (4%) took part in regular physical activity compared to 42 (23%) Jews. The prevalence of OAK in the two communities was about 29%. Among Bedouin participants, knee osteoarthritis was reported in 9.5% of those who performed the regular traditional prayer compared with 70.9% of those who did not. In the multivariable logistic analysis, body mass index (BMI) and diabetes were associated with higher odds of OAK [odds ratio (OR) = 1.18, P < 0.001 and OR = 2.64, P = 0.019, respectively] among Jews and participation in physical activities with lower odds (OR = 0.18, P = 0.031). Among Bedouins BMI was associated with higher (OR = 1.19, P = 0.008) and prayer with lower odds (OR = 0.045, P < 0.001).

CONCLUSION

There was an inverse association between traditional Muslim prayer and OAK. To improve OAK morbidity, efforts should be focused on physical activity, which is particularly low among Bedouins, and BMI.

Keywords: Knee osteoarthritis; Traditional prayer; Ethnic differences; Risk factors; Western Ontario and McMaster Universities Osteoarthritis Index

Core Tip: This cross-sectional study compared osteoarthritis of knee (OAK) prevalence and associated factors among Jewish and Bedouin adults aged ≥ 50 years in southern Israel. Despite distinct lifestyles, OAK prevalence and symptom severity were similar between the groups. Higher body mass index was positively associated with OAK in both populations, while diabetes was positively associated with OAK in Jews. Notably, traditional Muslim prayer was strongly associated with lower OAK prevalence and milder symptoms among Bedouins, suggesting a protective effect comparable to regular physical activity among Jews. These findings support culturally tailored preventive strategies, while acknowledging that causality cannot be inferred.