Prevalence of generalized joint hypermobility, hypermobility spectrum disorders and Ehlers-Danlos syndrome: systematic review and meta-analysis.

Abstract

Generalized joint hypermobility, GJH is common. Hypermobility can have various negative consequences and comorbidities, especially when criterion for Hypermobility Spectrum Disorder, HSD and Ehlers-Danlos syndrome, EDS are met.The prevalence of these different conditions is lacking. Therefore, the aim of this study was to assess the prevalence of these hypermobility disorders. A systematic search was conducted January 25, 2024 and updated May 28, 2025. It included the databases Ovid MEDLINE, Ovid Embase, CINAHL, and PEDro and followed a predefined search strategy adapted for each database (PROSPERO CRD42024505862) and included the MESH terms 'Ehlers Danlos Syndrome','Prevalence', 'Epidemiology' and keywords 'Hypermobility Spectrum Disorder';'Generalized joint hypermobility' and 'Systematic review'. 3633 unique records were screened, and 17 studies were included. From the meta-analysis the pooled prevalence across included studies of GJH in females were 9.5% (95% CI: 5.5; 15.8) with an I² of 95.5 % and 5.2% (95% CI: 3.0; 9.0) in males with an I² of 94.8). The evidence base for the age group 51 and older was insufficient for a robust estimate. Only one single study assessed HSD and hypermobile Ehlers-Danlos syndrome, hEDS in individuals aged 18-50 years and reported a prevalence of HSD of 38% in females and 39% in males, and the prevalence of hEDS as 2% in females and 0% in males. Hence, the available evidence did not allow for robust conclusions regarding the population-level prevalence of HSD/hEDS. This study shows that GJH is common, but with considerable heterogeneity and broad prediction intervals, which makes it crucial to interpret the pooled prevalence with caution. Moreover, a significant knowledge gap in the prevalence of GJH but particularly for HSD and EDS was identified. Our findings highlight the difficulties yet the need for more prevalence data on these conditions to understand the impact on the individual patient, health care services, and society.