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Hand-arm vibration dose and work-related requirements for occupational disease no. 2103 – An epidemiological case-control study Background: An epidemiological case-control study of dose-effect relationships between hand-arm vibration exposure and musculoskeletal disorders of occupational disease no. 2103 (BK 2103) was carried out in order to provide evidence-based recommendations for the recognition of BK 2103. Methods: Male cases and controls were recruited and standardised personal interviews were conducted between 1 January 2010 and 30 November 2021. In addition to leisure activities and comorbidities, work histories regarding the use of hand-operated and hand-held technical tools that can induce hand-arm vibrations were recorded in detail. To quantify the individual vibration exposure, a database of industrial hygiene measurements of vibration values of over 700 technical power tools was established (vibration register). The vibration measurements recorded in the database allows quantification of the daily dose and lifetime dose of the vibration exposure. The dose-effect relationships between hand-arm vibration exposure and musculoskeletal disorders as defined by BK 2103 were quantified for the various dose models using conditional logistic regression analyses. Results: In total, 209 cases and 614 controls were recruited. Compared to controls, cases suffered more frequently from gout, arm fractures, hip osteoarthritis, knee osteoarthritis, spinal osteoarthritis and trauma injuries or inflammatory conditions of the finger, elbow and shoulder joints. After adjusting for relevant confounders, the study analyses demonstrate consistent and statistically significant dose-effect relationships between hand-arm vibration exposure and musculoskeletal disorders as defined by BK 2103. A vibration dose of Dhv = 142.331 m2/s4 x day or Dhw = 38.724 m2/s4 x day is associated with a doubling of the risk of musculoskeletal disorders of the upper extremities as defined by BK 2103. Conclusions: These dose values serve as a guide and could also be applied in an assessment of the work-related requirements for the recognition of BK 2103. Sensitivity analyses indicate that an exposure duration with a defined threshold daily dose is not suitable for guiding the recognition of BK 2103. Keywords: hand-arm vibration – musculoskeletal disorders – dose-effect relationship – epidemiology – risk-doubling dose