A Hartley1, S A Hardcastle2, L Paternoster3, E McCloskey4, K E S Poole5, M K Javaid6, M Aye7, K Moss8, R Granell3, J Gregory9, M Williams10, J H Tobias11, C L Gregson12. 1. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. Electronic address: ah14433@bristol.ac.uk. 2. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK. 3. MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. 4. Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK; Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK; Centre for Integrated Research Into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK. 5. Cambridge NIHR Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, Cambridge. 6. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. 7. Department of Diabetes, Endocrinology and Metabolism, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK. 8. Centre for Rheumatology, St George's Hospital, St George's Healthcare NHS Trust, London, UK. 9. Institute of Medical Science, School of Medicine, University of Aberdeen, Aberdeen, UK. 10. Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol UK. 11. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. 12. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Abstract
OBJECTIVE: High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant. DESIGN: A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering. RESULTS: 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation. CONCLUSIONS: HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.
OBJECTIVE: High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant. DESIGN: A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering. RESULTS: 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation. CONCLUSIONS: HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.
Authors: April Hartley; Eleanor Sanderson; Raquel Granell; Lavinia Paternoster; Jie Zheng; George Davey Smith; Lorraine Southam; Konstantinos Hatzikotoulas; Cindy G Boer; Joyce van Meurs; Eleftheria Zeggini; Celia L Gregson; Jon H Tobias Journal: Int J Epidemiol Date: 2022-08-10 Impact factor: 9.685
Authors: B G Faber; R Ebsim; F R Saunders; M Frysz; J S Gregory; R M Aspden; N C Harvey; G Davey Smith; T Cootes; C Lindner; J H Tobias Journal: Osteoarthritis Cartilage Date: 2021-08-20 Impact factor: 6.576
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Authors: Benjamin G Faber; Raja Ebsim; Fiona R Saunders; Monika Frysz; Claudia Lindner; Jennifer S Gregory; Richard M Aspden; Nicholas C Harvey; George Davey Smith; Timothy Cootes; Jonathan H Tobias Journal: Bone Date: 2021-08-11 Impact factor: 4.398