Joint HypermobilityNCT07157930
Prenatal Hormonal Markers and Sleep Characteristics in Young Adults With Joint Hypermobility
An observational study of Joint Hypermobility and Healty Controls, run by Nigde Omer Halisdemir University at 1 site in Turkey (Türkiye).
Trial summary
Joint hypermobility is a clinical condition characterized by joints having a range of motion beyond their normal limits. Hormonal factors are thought to play a role in the development of joint hypermobility. Read more about this study
- Who is it for?
- Ages 18 to 35 yearsHealthy volunteers can take part
- Conditions the study is for
- Joint Hypermobility, Healty Controls, Sleep
- What is being tested?
- The Beighton Scoring system and 2D:4D Digit Ratio
- Type of treatment
- Lifestyle or therapy programme
- How many people
- 180 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 20 Aug 2025to 17 Dec 2025
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 35 years
- All sexes
- Healthy volunteers accepted
- Adult
Study population: The study planned to include individuals with (Beighton skorlamasına göre 9 üzerinden 5 ve daha fazla puan alan) and without joint hypermobility. Individuals between the ages of 18 and 35 will be included.
Who may be able to join
- Individuals aged 18-35
- Individuals who scored 5 out of 9 or higher on the Beighton score
- Control group: Those with a Beighton score of ≤ 4
Who cannot join
- Individuals with any pathology related to the musculoskeletal system
- Individuals diagnosed with metabolic, neurological, or genetic diseases (tissue diseases such as Ehlers-Danlos syndrome and Marfan syndrome)
- Those with a history of surgery within the last 6 months
- Those who are pregnant or breastfeeding
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Relationship Between Prenatal Hormonal Markers in Young Adults With Joint Hypermobility: The Role of the 2D:4D Digit Ratio
Joint hypermobility is a clinical condition characterized by joints having a range of motion beyond their normal limits. Hormonal factors are thought to play a role in the development of joint hypermobility. One of the most significant indicators of prenatal androgen exposure is considered the ratio of the lengths of the second and fourth fingers (2D:4D). The 2D:4D digit ratio refers to the ratio of the lengths of the second finger (2D; index digit ) and the fourth finger (4D; ring digit). Evidence suggests that the 2D:4D ratio is developmentally stable and stabilizes from the second trimester of pregnancy onward.
To our knowledge, intrauterine androgen exposure (2D:4D) has not been examined in populations with joint hypermobility.
Therefore, the planned study aimed to examine the 2D:4D digit ratio in young adults with joint hypermobility and compare it with that of individuals without joint hypermobility.
Read the detailed description
Estrogen affects collagen metabolism and connective tissue structure, which can lead to increased ligament laxity at high levels. Increased estrogen and progesterone during pregnancy cause significant loosening of connective tissue, which can contribute to temporary joint hypermobility. Physiological conditions such as pregnancy and menopause can cause hormonal changes, increasing the risk of joint hypermobility through fluid retention and connective tissue changes.
Testosterone, on the other hand, is a hormone that strengthens muscle mass and tendon structure, while at low levels it can cause connective tissue to remain looser. Therefore, the combination of high estrogen and relatively low testosterone, particularly in women of reproductive age, may contribute to the higher prevalence of hypermobility.
Therefore, the aim of the planned study was to examine the 2D:4D digit ratio in young adults with joint hypermobility and compare this ratio with individuals without joint hypermobility.
- Conditions
- Joint Hypermobility, Healty Controls, Sleep, Androgen Effect, Hormonal
- Being tested
- The Beighton Scoring system, 2D:4D Digit Ratio
- Keywords
- joint hypermobility, sleep, 2D:4D, digit ratios
- Medical subject headings
- Joint Instability
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
The Beighton Scoring systemBehavioural
The Beighton Scoring System is widely used to distinguish individuals with generalized joint hypermobility from those without. The Beighton Scoring System consists of: • Passive dorsiflexion of the fifth metacarpophalangeal joint • Passive hyperextension of the elbow • Passive hyperextension of the knee joint • Passive placement of the thumb on the flexor side of the forearm • Forward flexion of the trunk In adults up to 50 years of age, a score of ≥5 out of 9 indicates joint hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for joint hypermobility.
2D:4D Digit RatioBehavioural
The lengths of the second (2D) and fourth (4D) digits will be measured separately on both hands. Measurements will be taken with the participants' hands placed on a flat surface with the palms facing upward. Digit length will be defined as the distance from the midpoint of the proximal crease at the base of the finger to the distal tip of the finger. A digital caliper with a precision of 0.01 mm will be used, and two separate measurements will be obtained for each finger, with the mean value recorded. Based on these measurements, the 2D:4D digit ratio will be calculated for each hand by dividing the length of the second digit by that of the fourth digit. To enhance reliability, assessments will be performed independently by two different researchers, and inter-rater agreement will be evaluated.
| Study group | Role | What they receive |
|---|---|---|
| Young Adults With Joint Hypermobility | Joint hypermobility makes individuals more vulnerable to trauma through increased joint range of motion, changes in neuromuscular reflexes, and decreased joint position sense. The Beighton Scoring system is widely used to distinguish individuals with generalized joint hypermobility from those without.In adults up to 50 years of age, a score of ≥5 out of 9 indicates hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for hypermobility.
The study will include young adults aged 18-35 with joint hypermobility. It has been reported in the literature that estrogen may be associated with connective tissue laxity and joint hypermobility. The 2D:4D digit ratio will be assessed and compared with young adults without joint hypermobility. Receives: Behavioral: The Beighton Scoring system; Behavioral: 2D:4D Digit Ratio | |
| Healthy Controls (without joint hypermobility) | This group consisted of individuals without generalized joint hypermobility, confirmed by a Beighton score below the diagnostic cut-off. This study will include young adults aged 18-35 who do not have joint hypermobility.The Beighton Scoring system is widely used to distinguish individuals with generalized joint hypermobility from those without.In adults up to 50 years of age, a score of ≥5 out of 9 indicates hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for hypermobility. Individuals with musculoskeletal, neurological, or systemic conditions that may affect joint mobility will be excluded from the study. Receives: Behavioral: The Beighton Scoring system; Behavioral: 2D:4D Digit Ratio |
What is being measured
The primary outcome is the main question the study is designed to answer.
Beighton Scoring System
Individuals will be assessed for joint hypermobility (Beighton Scoring System) by a physical therapist. The Beighton Scoring System is widely used to distinguish individuals with generalized joint hypermobility from those without. The Beighton Scoring System consists of:
- Passive dorsiflexion of the fifth metacarpophalangeal joint
- Passive hyperextension of the elbow
- Passive hyperextension of the knee joint
- Passive placement of the thumb on the flexor side of the forearm
- Forward flexion of the trunk In adults up to 50 years of age, a score of ≥5 out of 9 indicates joint hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for joint hypermobility.
Measured: 1 month
2D:4D Digit Ratio
The lengths of the second (2D) and fourth (4D) digits will be measured separately on both hands. Measurements will be taken with the participants' hands placed on a flat surface with the palms facing upward. Digit length will be defined as the distance from the midpoint of the proximal crease at the base of the finger to the distal tip of the finger. A digital caliper with a precision of 0.01 mm will be used, and two separate measurements will be obtained for each finger, with the mean value recorded. Based on these measurements, the 2D:4D digit ratio will be calculated for each hand by dividing the length of the second digit by that of the fourth digit. To enhance reliability, assessments will be performed independently by two different researchers, and inter-rater agreement will be evaluated.
Measured: 1 month
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Sep 2025
- Study start20 Aug 2025
- Primary completion17 Dec 2025
- Study completion17 Dec 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Joint HypermobilityStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Prospective
- Enrolment
- 180 participants (actual)
Sponsor and investigators
- Lead sponsor
- Nigde Omer Halisdemir University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Rabia ZORLULAR, Nigde Omer Halisdemir University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07157930
- Sponsor's protocol ID
- Joint Hypermobility and 2D:4D
- Status last verified
- Aug 2025
- First submitted
- 28 Aug 2025
- Last updated
- 24 Dec 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Fink B, Manning JT, Neave N. The 2nd-4th digit ratio (2D:4D) and neck circumference: implications for risk factors in coronary heart disease. Int J Obes (Lond). 2006 Apr;30(4):711-4. doi: 10.1038/sj.ijo.0803154.
PubMed 16261185Engelbert RH, Bank RA, Sakkers RJ, Helders PJ, Beemer FA, Uiterwaal CS. Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? Pediatrics. 2003 Mar;111(3):e248-54. doi: 10.1542/peds.111.3.e248.
PubMed 12612280Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr. 2011 Jan;158(1):119-23, 123.e1-4. doi: 10.1016/j.jpeds.2010.07.021. Epub 2010 Sep 17.
PubMed 20850761Yildiz R, Yildiz A, Zorlular R, Elbasan B. Relationship between sensory processing skills and motor skills in 12-month-old infants. Brain Behav. 2024 Sep;14(9):e70052. doi: 10.1002/brb3.70052.
PubMed 39317996Zorlular R, Zorlular A. Prenatal Hormonal Markers in Individuals With Joint Hypermobility: The Role of the 2D:4D Digit Ratio. Am J Hum Biol. 2026 Feb;38(2):e70217. doi: 10.1002/ajhb.70217.
PubMed 41693451
Study at a glance
From the registry record, last updated by the sponsor on 24 Dec 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Relationship Between Prenatal Hormonal Markers in Young Adults With Joint Hypermobility: The Role of the 2D:4D Digit Ratio
- ClinicalTrials.gov ID
- NCT07157930
- Acronym / sponsor ID
- Joint Hypermobility and 2D:4D
- Conditions
- Joint Hypermobility, Healty Controls, Sleep, Androgen Effect, Hormonal
- Keywords
- joint hypermobility, sleep, 2D:4D, digit ratios
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 180 participants (actual)
- Lead sponsor
- Nigde Omer Halisdemir UniversityUniversity, hospital or other
- Study start
- 20 Aug 2025 (actual)
- Primary completion
- 17 Dec 2025 (actual)
- Study completion
- 17 Dec 2025 (actual)
- First posted
- 5 Sep 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Joint hypermobility is a clinical condition characterized by joints having a range of motion beyond their normal limits. Hormonal factors are thought to play a role in the development of joint hypermobility. One of the most significant indicators of prenatal androgen exposure is considered the ratio of the lengths of the second and fourth fingers (2D:4D). The 2D:4D digit ratio refers to the ratio of the lengths of the second finger (2D; index digit ) and the fourth finger (4D; ring digit). Evidence suggests that the 2D:4D ratio is developmentally stable and stabilizes from the second trimester of pregnancy onward.
To our knowledge, intrauterine androgen exposure (2D:4D) has not been examined in populations with joint hypermobility.
Therefore, the planned study aimed to examine the 2D:4D digit ratio in young adults with joint hypermobility and compare it with that of individuals without joint hypermobility.
Detailed description
Estrogen affects collagen metabolism and connective tissue structure, which can lead to increased ligament laxity at high levels. Increased estrogen and progesterone during pregnancy cause significant loosening of connective tissue, which can contribute to temporary joint hypermobility. Physiological conditions such as pregnancy and menopause can cause hormonal changes, increasing the risk of joint hypermobility through fluid retention and connective tissue changes.
Testosterone, on the other hand, is a hormone that strengthens muscle mass and tendon structure, while at low levels it can cause connective tissue to remain looser. Therefore, the combination of high estrogen and relatively low testosterone, particularly in women of reproductive age, may contribute to the higher prevalence of hypermobility.
Therefore, the aim of the planned study was to examine the 2D:4D digit ratio in young adults with joint hypermobility and compare this ratio with individuals without joint hypermobility.
Study design
- Observational model
- Case-control
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Young Adults With Joint Hypermobility | – | Behavioral: The Beighton Scoring system, Behavioral: 2D:4D Digit RatioJoint hypermobility makes individuals more vulnerable to trauma through increased joint range of motion, changes in neuromuscular reflexes, and decreased joint position sense. The Beighton Scoring system is widely used to distinguish individuals with generalized joint hypermobility from those without.In adults up to 50 years of age, a score of ≥5 out of 9 indicates hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for hypermobility. The study will include young adults aged 18-35 with joint hypermobility. It has been reported in the literature that estrogen may be associated with connective tissue laxity and joint hypermobility. The 2D:4D digit ratio will be assessed and compared with young adults without joint hypermobility. |
| Healthy Controls (without joint hypermobility) | – | Behavioral: The Beighton Scoring system, Behavioral: 2D:4D Digit RatioThis group consisted of individuals without generalized joint hypermobility, confirmed by a Beighton score below the diagnostic cut-off. This study will include young adults aged 18-35 who do not have joint hypermobility.The Beighton Scoring system is widely used to distinguish individuals with generalized joint hypermobility from those without.In adults up to 50 years of age, a score of ≥5 out of 9 indicates hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for hypermobility. Individuals with musculoskeletal, neurological, or systemic conditions that may affect joint mobility will be excluded from the study. |
Who may qualify
- Ages
- 18 to 35 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
- Study population
- The study planned to include individuals with (Beighton skorlamasına göre 9 üzerinden 5 ve daha fazla puan alan) and without joint hypermobility. Individuals between the ages of 18 and 35 will be included.
Key inclusion criteria (3 listed)
- Individuals aged 18-35
- Individuals who scored 5 out of 9 or higher on the Beighton score
- Control group: Those with a Beighton score of ≤ 4
Key exclusion criteria (4 listed)
- Individuals with any pathology related to the musculoskeletal system
- Individuals diagnosed with metabolic, neurological, or genetic diseases (tissue diseases such as Ehlers-Danlos syndrome and Marfan syndrome)
- Those with a history of surgery within the last 6 months
- Those who are pregnant or breastfeeding
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| The Beighton Scoring systemThe Beighton Scoring System is widely used to distinguish individuals with generalized joint hypermobility from those without. The Beighton Scoring System consists of: • Passive dorsiflexion of the fifth metacarpophalangeal joint • Passive hyperextension of the elbow • Passive hyperextension of the knee joint • Passive placement of the thumb on the flexor side of the forearm • Forward flexion of the trunk In adults up to 50 years of age, a score of ≥5 out of 9 indicates joint hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for joint hypermobility. | Behavioural | Healthy Controls (without joint hypermobility), Young Adults With Joint Hypermobility |
| 2D:4D Digit RatioThe lengths of the second (2D) and fourth (4D) digits will be measured separately on both hands. Measurements will be taken with the participants' hands placed on a flat surface with the palms facing upward. Digit length will be defined as the distance from the midpoint of the proximal crease at the base of the finger to the distal tip of the finger. A digital caliper with a precision of 0.01 mm will be used, and two separate measurements will be obtained for each finger, with the mean value recorded. Based on these measurements, the 2D:4D digit ratio will be calculated for each hand by dividing the length of the second digit by that of the fourth digit. To enhance reliability, assessments will be performed independently by two different researchers, and inter-rater agreement will be evaluated. | Behavioural | Healthy Controls (without joint hypermobility), Young Adults With Joint Hypermobility |
Primary outcome
Beighton Scoring System
Time frame: 1 month
Individuals will be assessed for joint hypermobility (Beighton Scoring System) by a physical therapist. The Beighton Scoring System is widely used to distinguish individuals with generalized joint hypermobility from those without. The Beighton Scoring System consists of: * Passive dorsiflexion of the fifth metacarpophalangeal joint * Passive hyperextension of the elbow * Passive hyperextension of the knee joint * Passive placement of the thumb on the flexor side of the forearm * Forward flexion of the trunk In adults up to 50 years of age, a score of ≥5 out of 9 indicates joint hypermobility, while in adults over 50, a score of ≥4 out of 9 is considered positive for joint hypermobility.
2D:4D Digit Ratio
Time frame: 1 month
The lengths of the second (2D) and fourth (4D) digits will be measured separately on both hands. Measurements will be taken with the participants' hands placed on a flat surface with the palms facing upward. Digit length will be defined as the distance from the midpoint of the proximal crease at the base of the finger to the distal tip of the finger. A digital caliper with a precision of 0.01 mm will be used, and two separate measurements will be obtained for each finger, with the mean value recorded. Based on these measurements, the 2D:4D digit ratio will be calculated for each hand by dividing the length of the second digit by that of the fourth digit. To enhance reliability, assessments will be performed independently by two different researchers, and inter-rater agreement will be evaluated.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Dec 2025.
- Background: PubMed 16261185Fink B, Manning JT, Neave N. The 2nd-4th digit ratio (2D:4D) and neck circumference: implications for risk factors in coronary heart disease. Int J Obes (Lond). 2006 Apr;30(4):711-4. doi: 10.1038/sj.ijo.0803154.
- Results publication: PubMed 12612280Engelbert RH, Bank RA, Sakkers RJ, Helders PJ, Beemer FA, Uiterwaal CS. Pediatric generalized joint hypermobility with and without musculoskeletal complaints: a localized or systemic disorder? Pediatrics. 2003 Mar;111(3):e248-54. doi: 10.1542/peds.111.3.e248.
- Results publication: PubMed 20850761Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalized hypermobility in children. J Pediatr. 2011 Jan;158(1):119-23, 123.e1-4. doi: 10.1016/j.jpeds.2010.07.021. Epub 2010 Sep 17.
- Results publication: PubMed 39317996Yildiz R, Yildiz A, Zorlular R, Elbasan B. Relationship between sensory processing skills and motor skills in 12-month-old infants. Brain Behav. 2024 Sep;14(9):e70052. doi: 10.1002/brb3.70052.
- Derived from this study: PubMed 41693451Zorlular R, Zorlular A. Prenatal Hormonal Markers in Individuals With Joint Hypermobility: The Role of the 2D:4D Digit Ratio. Am J Hum Biol. 2026 Feb;38(2):e70217. doi: 10.1002/ajhb.70217.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Joint Hypermobility and Healty Controls, run by Nigde Omer Halisdemir University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 24 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Beighton Scoring System (time frame: 1 month). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07157930, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Dec 2025.