The most frequent site of osteoarthritis (OA) is the hands, but the pattern of hand OA development remains controversial. Understanding these patterns may assist in evaluating biological aging, determining etiology, and proposing ways of preventing hand OA. We investigated the pattern distribution of OA in hands and the influences of age, sex, and handedness on its development. The study population was comprised of Chuvashians (660 males age 18–89 years and 585 females age 18–90 years). OA development was evaluated for 15 joints of each hand according to the Kellgren and Lawrence grading scheme. Statistical analyses included Pearson correlation, cluster analysis, MANCOVA, and linear and polynomial regression. OA changes first appeared in subjects <30 years of age. Metacarpophalangeal (MP) joints underwent the first OA changes until the sixth decade, when the row of distal interphalangeal (DIP) joints became most affected. Cluster analysis showed that symmetry was the most common pattern of interrelationship between rows of joints. The best-fitting and most parsimonious model of age-related pattern of hand OA was the polynomial two-interval linear model. It showed a higher rate of OA development during the relatively young ages, 32–34 years than later on. We found statistically significant differences between sexes only for the DIP (P = 0.019) and PIP (P = 0.011) rows of joints. Handedness had no influence on hand OA development. Am. J. Hum. Biol. 16:125–134, 2004. © 2004 Wiley-Liss, Inc.