Generalized joint hypermobility in adults: a systematic review with meta-analysis to identify data-driven cut-offs using the Beighton score

Objective: The aim of this study was to systematically review the literature and undertake a meta-analysis to describe joint hypermobility, measured by Beighton score, in the general adult population and identify appropriate cut-offs to use for screening for generalized joint hypermobility (GJH). Methods: We searched Allied and Complementary Medicine, Ovid MEDLINE, Embase, and CINAHL from inception to June 2024. We included studies reporting Beighton score in the general population and adults ≥18 years. We extracted country of data collection, age, sex, and Beighton score data. Data were grouped into participant ages. Meta-analysis was performed when two or more studies were available. We considered 2.5% prevalence as an indicator for typical variance. Results: There were 46 studies (n = 23,000), with 38 studies included in the age group analysis and 45 studies included in the analysis by sex. Overall, GJH prevalence at six or more of nine was 2% (95% confidence interval [CI] 0.6–6.6) and considered the threshold score indicating GJH outside typical variance. Subanalysis of age groups indicated a prevalence of 5.0% (95% CI 1.2–18.0) at six or more for young adults (18–25 years). For adults (26–65 years), five or more indicated a prevalence of 1.5% (95% CI 0.2–9.5), and older adults (≥65 years) had a prevalence of 6.5% (95% CI 5.5–7.7) at four or more, higher than the threshold, but there were insufficient data for meta-analysis of five or more. There were no statistically significant differences between female and male subjects at any cut-off (all P ≥ 0.17). Conclusion: Beighton score cut-offs should vary with age. For adults 18 to 25 years old, 26 to 65 years old, and >65 years old, Beighton score cut-offs to screen for GJH should be six or more of nine, five or more of nine, and four or more of nine, respectively.