Is Osteoarthritis Always Associated with Low Bone Mineral Density in Elderly Patients?
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Design
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- Female sex, age 44 to 77
- -
- Postmenopausal status (no menstrual cycle for 12 months)
- -
- Presence of clinical, radiological, and laboratory OA parameters
- -
- Participants from southeast Serbia
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- Consent to participate in the research
- -
- Presence of comorbidities (metabolic diseases, hyperthyroidism, diabetes mellitus bone metastases, rheumatoid arthritis, kidney and liver insufficiency, malabsorption)
- -
- Body mass index <19 kg/m or >30 kg/m
- -
- Premenopausal and perimenopausal status
- -
- Consent for participation was not obtained
2.2. Measurements
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
OA | Osteoarthritis |
OP | Osteoporosis |
BMD | Bone mineral density |
ACR | American College of Radiology |
K&L | Kellgren and Lawrence |
DXA | Dual-energy X-ray absorptiometry |
BMI | Body mass index |
ER | Estrogen receptor |
IL 6 | Interleukin 6 |
COL1A1 | Collagen type 1α 1 |
FN | Femoral neck |
LS | Lumbar spine |
References
- Chan, M.Y.; Center, J.R.; Eisman, J.A.; Nguyen, T.V. Bone mineral density and association of osteoarthritis with fracture risk. Osteoarthr. Cartil. 2014, 22, 1251–1258. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. The Global Burden of Disease: 2004 Update; World Health Organization: Geneva, Switzerland, 2008; Available online: https://apps.who.int/iris/bitstream/handle/10665/43942/9789241563710_eng.pdf?sequence=1&isAllowed=y (accessed on 16 June 2012).
- Safiri, S.; Kolahi, A.A.; Smith, E.; Hill, C.; Bettampadi, D.; Mansournia, M.A.; Hoy, D.; Ashrafi-Asgarabad, A.; Sepidarkish, M.; Almasi-Hashiani, A.; et al. Global, regional and national burden of osteoarthritis 1990–2017: A systematic analysis of the Global Burden of Disease Study 2017. Ann. Rheum. Dis. 2020, 79, 819–828. [Google Scholar] [CrossRef] [PubMed]
- Valdes, A.M.; Stocks, J. Osteoarthritis and ageing. EMJ 2018, 3, 116–123. [Google Scholar]
- Gherghel, R.; Iordan, D.A.; Mocanu, M.D.; Onu, A.; Onu, I. Osteoarthritis is not a disease, but rather an accumulation of predisposing factors. A systematic review. Balneo PRM Res. J. 2021, 12, 218–226. [Google Scholar] [CrossRef]
- Nguyen, N.D.; Ahlborg, H.G.; Center, J.R.; Eisman, J.A.; Nguyen, T.V. Residual lifetime risk of fractures in women and men. J. Bone Miner. Res. 2007, 22, 781–788. [Google Scholar] [CrossRef] [PubMed]
- Shen, Y.; Huang, X.; Wu, J.; Lin, X.; Zhou, X.; Zhu, Z.; Pan, X.; Xu, J.; Qiao, J.; Zhang, T.; et al. The Global Burden of Osteoporosis, Low Bone Mass, and Its Related Fracture in 204 Countries and Territories, 1990–2019. Front. Endocrinol. 2022, 13, 882241. [Google Scholar] [CrossRef]
- Borgström, F.; Karlsson, L.; Ortsäter, G.; Norton, N.; Halbout, P.; Cooper, C.; Lorentzon, M.; McCloskey, E.V.; Harvey, N.C.; Javaid, M.K.; et al. Fragility fractures in Europe: Burden, management and opportunities. Arch. Osteoporos. 2020, 15, 59. [Google Scholar] [CrossRef]
- Durdin, R.; Parsons, C.M.; Dennison, E.; Harvey, N.C.; Cooper, C.; Ward, K. Ethnic Differences in Bone Microarchitecture. Curr. Osteoporos. Rep. 2020, 18, 803–810. [Google Scholar] [CrossRef]
- Felson, D.T. The prevalence of knee osteoarthritis in the elderly: The Framingham Osteoarthritis Study. Semin. Arthritis. Rheumatism. 1990, 20, 42–50. [Google Scholar] [CrossRef]
- Foss, M.V.; Byers, P.D. Bone density, osteoarthrosis of the hip and fracture of the upper end of the femur. Ann. Rheum. Dis. 1972, 31, 259–264. [Google Scholar] [CrossRef]
- Wolf, O.; Strom, H.; Milbrink, J.; Larsson, S.; Mallmin, H. Differences in hip bone mineral density may explain the hip fracture pattern in osteoarthritic hips. Acta Orthop. 2009, 3, 308–313. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Roux, C.; Fechtenbaum, J.; Briot, K.; Cropet, C.; Liu-Leage, S.; Marcelli, C. Inverse relationship between vertebral fractures and spine osteoarthritis in postmenopausal women with osteoporosis. Ann. Rheum. Dis. 2008, 67, 224–228. [Google Scholar] [CrossRef] [PubMed]
- Bertoldi, I.; Frediani, B. Osteoarthritis and Osteoporosis: Correlations Between Two Clinical Entities. Reumatismo 2013, 65, 51–54. [Google Scholar] [CrossRef]
- Kellgren, J.H.; Lawrence, J.S. Radiological assessment of osteo-arthrosis. Ann. Rheum. Dis. 1957, 16, 494–502. [Google Scholar] [CrossRef]
- Burger, H.; van Daele, P.L.; Odding, E.; Valkenburg, H.A.; Hofman, A.; Grobbee, D.E.; Schütte, H.E.; Birkenhäger, J.C.; Pols, H.A. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age: The Rotterdam Study. Arthritis Rheum. 1996, 39, 81–86. [Google Scholar] [CrossRef] [PubMed]
- Dequeker, J.; Boonen, S.; Aerssens, J.; Westhovens, R. Inverse relationship osteoarthritis-osteoporosis: What is the evidence? What are the consequence? Br. J. Rheumatol. 1996, 35, 813–818. [Google Scholar] [CrossRef]
- Anand, V.; Gupta, A.; Sethi, S.; Kumar, S. Study of Relationship between Bone Mineral Density in Ipsilateral Proximal Femur and Severity of Osteoarthritis of Knee. J. Family Med. Prim. Care 2022, 11, 599–602. [Google Scholar] [CrossRef]
- Hart, D.J.; Mootoosamy, I.; Doyle, D.V.; Spector, T.D. The relationship between osteoarthritis and osteoporosis in the general population: The Chingford Study. Ann. Rheum. Dis. 1994, 53, 158–162. [Google Scholar] [CrossRef]
- Nevitt, M.C.; Lane, N.E.; Scott, J.C.; Hochberg, M.C.; Pressman, A.R.; Genant, H.K.; Cummings, S.R. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995, 38, 907–916. [Google Scholar] [CrossRef]
- Arden, N.K.; Nevitt, M.C.; Lane, N.E.; Gore, L.R.; Hochberg, M.C.; Scott, J.C.; Pressman, A.R.; Cummings, S.R. Osteoarthritis and risk of falls, rates of bone loss and osteoporotic fractures. Study of Osteoporotic Fractures research group. Arthritis Rheum. 1999, 42, 1378–1385. [Google Scholar] [CrossRef]
- Wang, S.P.; Wu, P.K.; Lee, C.H.; Shih, C.M.; Chiu, Y.C.; Hsu, C.E. Association of osteoporosis and varus inclination of the tibial plateau in postmenopausal women with advanced osteoarthritis of the knee. BMC Musculoskelet. Disord. 2021, 22, 223. [Google Scholar] [CrossRef] [PubMed]
- Nevitt, M.C.; Zhang, Y.; Javaid, M.K.; Neogi, T.; Curtis, J.R.; Niu, J.; McCulloch, C.E.; Segal, N.A.; Felson, D.T. High systemic bone mineral density increases the risk of incident knee OA and joint space narrowing, but not radiographic progression of existing knee OA: The MOST study. Ann. Rheum. Dis. 2010, 69, 163–168. [Google Scholar] [CrossRef] [PubMed]
- Arden, N.K.; Crozier, S.; Smith, H.; Anderson, F.; Edwards, C.; Raphael, H.; Cooper, C. Knee pain, knee osteoarthritis and the risk of fracture. Arthritis Rheum. 2006, 55, 610–615. [Google Scholar] [CrossRef]
- Leslie, W.D.; Lix, L.M.; Tsang, J.F.; Caetano, P.A. Single-site vs multisite bone density measurement for fracture prediction. Arch. Intern. Med. 2007, 167, 1641–1647. [Google Scholar] [CrossRef]
- El-Sherif, H.E.; Kamal, R.; Moawyah, O. Hand osteoarthritis and bone mineral density in postmenopausal women; clinical relevance to hand function, pain and disability. Osteoarthr. Cartil. 2008, 16, 12–17. [Google Scholar] [CrossRef]
- Haara, M.M.; Arokoski, J.P.; Kröger, H.; Kärkkäinen, A.; Manninen, P.; Knekt, P.; Impivaara, O.; Heliövaara, M. Association of radiological hand osteoarthritis with bone mineral mass: A population study. Rheumatology 2005, 44, 1549–1554. [Google Scholar] [CrossRef] [PubMed]
- Simon, D.; Tascilar, K.; Unbehend, S.; Bayat, S.; Berlin, A.; Liphardt, A.M.; Meinderink, T.; Rech, J.; Hueber, A.J.; Schett, G.; et al. Bone mass, bone microstructure and biomechanics in patients with hand osteoarthritis. J. Bone Miner. Res. 2020, 35, 1695–1702. [Google Scholar] [CrossRef] [PubMed]
- Zoli, A.; Lizzio, M.M.; Capuano, A.; Massafra, U.; Barini, A.; Ferraccioli, G. Osteoporosis and bone metabolism in postmenopausal women with osteoarthritis of the hand. Menopause 2006, 13, 462–466. [Google Scholar] [CrossRef]
- Sornay-Rendu, E.; Munoz, F.; Duboeuf, F.; Delmas, P.D. Disc space narrowing is associated with an increased vertebral fracture risk in postmenopausal women: The OFELY Study. J. Bone Miner. Res. 2004, 19, 1994–1999. [Google Scholar] [CrossRef]
- Yalçin, P. Osteoartrit osteoporoz Ilişkisi. In Tanidan Tedaviye Osteoartrit; Sardoğan, M., Ed.; Nobel Tip Kitabev: Istanbul, Turkey, 2007; pp. 111–115. [Google Scholar]
- Altman, R.D. Criteria for the classification of osteoarthritis of the knee and hip. Scand. J. Rheumatol. Suppl. 1987, 65, 31–39. [Google Scholar] [CrossRef]
- World Health Organization. Assessment of Fracture Risk and Its Application to Screening for Postmenopausal Osteoporosis: Report of a WHO Study Group; World Health Organization: Geneva, Switzerland, 1994; Available online: https://apps.who.int/iris/handle/10665/39142 (accessed on 16 June 2012).
- Hassett, G.; Hart, D.J.; Doyle, D.V.; March, L.; Spector, T.D. The relation between progressive osteoarthritis of the knee and long term progression of osteoarthritis of the hand, hip and lumbar spine. Ann. Rheum. Dis. 2006, 65, 623–628. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nevitt, M.C.; Felson, D.T. High bone density and radiographic osteoarthritis: Questions answered and unanswered. Osteoarthr. Cartil. 2020, 28, 1151–1153. [Google Scholar] [CrossRef]
- Bergink, A.P.; Rivadeneira, F.; Bierma-Zeinstra, S.M.; Zillikens, M.C.; Ikram, M.A.; Uitterlinden, A.G.; van Meurs, J.B.J. Are bone mineral density and fractures related to the incidence and progression of radiographic osteoarthritis of the knee, hip, and hand in elderly men and women? The Rotterdam study. Arthritis Rheumatol. 2019, 71, 361–369. [Google Scholar] [CrossRef] [PubMed]
- Rustenburg, C.M.E.; Emanuel, K.S.; Peeters, M.; Lems, W.F.; Vergroesen, P.-P.A.; Smit, T.H. Osteoarthritis and intervertebral disc degeneration: Quite different, quite similar. JOR Spine 2018, 1, e1033. [Google Scholar] [CrossRef]
- Ichchou, L.; Allali, F.; Rostom, S.; Bennani, L.; Hmamouchi, I.; Abourazzak, F.Z.; Khazzani, H.; El Mansouri, L.; Abouqal, R.; Hajjaj-Hassouni, N. Relationship between spine osteoarthritis, bone mineral density and bone turn over markers in post menopausal women. BMC Womens Health 2010, 10, 25. [Google Scholar] [CrossRef]
- Ding, C.; Cicuttini, F.; Boon, C.; Boon, P.; Srikanth, V.; Cooley, H.; Jones, G. Knee and hip radiographic osteoarthritis predict total hip bone loss in older adults: A prospective study. J. Bone Miner. Res. 2010, 25, 858–865. [Google Scholar] [CrossRef]
- Teichtahl, A.J.; Wang, Y.; Wluka, A.E.; Strauss, B.J.; Proietto, J.; Dixon, J.B.; Jones, G.; Cicuttini, F.M. Associations between systemic bone mineral density and early knee cartilage changes in middle-aged adults without clinical knee disease: A prospective cohort study. Arthritis Res. Ther. 2017, 19, 98. [Google Scholar] [CrossRef]
- Spector, T.D.; Conaghan, P.G.; Buckland-Wright, J.C.; Garnero, P.; Cline, G.A.; Beary, J.F.; Valent, D.J.; Meyer, J.M. Effect of risedronate on joint structure and symptoms of knee osteoarthritis: Results of the BRISK randomised, controlled trial [ISRCTN01928173]. Arthritis Res. Ther. 2005, 7, R625–R633. [Google Scholar] [CrossRef]
- Reginster, J.Y.; Badurski, J.; Bellamy, N.; Bensen, W.; Chapurlat, R.; Chevalier, X.; Christiansen, C.; Genant, H.; Navarro, F.; Nasonov, E.; et al. Efficacy and safety of strontium ranelate in the treatment of knee osteoarthritis: Results of a double-blind, randomised placebo-controlled trial. Ann. Rheum. Dis. 2013, 72, 179–186. [Google Scholar] [CrossRef]
- Pelletier, J.P.; Roubille, C.; Raynauld, J.P.; Abram, F.; Dorais, M.; Delorme, P.; Martel-Pelletier, J. Disease-modifying effect of strontium ranelate in a subset of patients from the Phase III knee osteoarthritis study SEKOIA using quantitative MRI: Reduction in bone marrow lesions protects against cartilage loss. Ann. Rheum. Dis. 2015, 74, 422–429. [Google Scholar] [CrossRef]
- Roubille, C.; Pelletier, J.P.; Martel-Pelletier, J. New and emerging treatments for osteoarthritis management: Will the dream come true with personalized medicine? Expert Opin. Pharmacother. 2013, 14, 2059–2077. [Google Scholar] [CrossRef]
- Reynard, L.N.; Barter, M.J. Osteoarthritis year in review 2019; genetics, genomics and epigenetics. Osteoarthr. Cartil. 2020, 28, 275–284. [Google Scholar] [CrossRef] [PubMed]
- Li, Y.; Xie, B.; Jiang, Z.; Yuan, B. Relationship between osteoporosis and osteoarthritis based on DNA methylation. Int. J. Clin. Exp. Pathol. 2019, 12, 3399–3407. [Google Scholar] [PubMed]
- Wu, J.; Xu, J.; Wang, K.; Zhu, Q.; Cai, J.; Ren, J. Associations between circulating adipokines and bone mineral density in patients with knee osteoarthritis: A cross-sectional study. BMC Musculoskelet. Disord. 2018, 19, 16. [Google Scholar] [CrossRef] [PubMed]
- Jin, W.J.; Jiang, S.D.; Jiang, L.S.; Dai, L.Y. Differential responsiveness to 17β-estradiol of mesenchymal stem cells from postmenopausal women between osteoporosis and osteoarthritis. Osteoporos. Int. 2012, 23, 2469–2478. [Google Scholar] [CrossRef] [PubMed]
- Sample, S.J.; Behan, M.; Smith, L.; Oldenhoff, W.E.; Markel, M.D.; Kalscheur, V.L. Functional adaptation to loading of a single bone is neuronally regulated and involves multiple bones. J. Bone Miner. Res. 2008, 23, 1372–1381. [Google Scholar] [CrossRef] [PubMed]
- Ding, C.; Prameswaran, V.; Udayan, R.; Burgess, J.; Jones, G. Circulating levels of inflammatory markers predict change in bone mineral density and resorption in older adults: A longitudinal study. J. Clin. Endocrinol. Metab. 2008, 93, 1952–1958. [Google Scholar] [CrossRef] [PubMed]
- Ilesanmi-Oyelere, B.L.; Schollum, L.; Kuhn-Sherlock, B.; McConnell, M.; Mros, S.; Coad, J.; Roy, N.C.; Kruger, M.C. Inflammatory markers and bone health in postmenopausal women: A cross-sectional overview. Immun. Ageing 2019, 16, 15. [Google Scholar] [CrossRef]
- Hardcastle, S.A.; Dieppe, P.; Gregson, C.L.; Davey Smith, G.; Tobias, J.H. Osteoarthritis and bone mineral density: Are strong bones bad for joints? Bonekey Rep. 2015, 4, 624. [Google Scholar] [CrossRef]
- Cai, X.; Yuan, S.; Zeng, Y.; Wang, C.; Yu, N.; Ding, C. New Trends in Pharmacological Treatments for Osteoarthritis. Front. Pharmacol. 2021, 12, 645842. [Google Scholar] [CrossRef]
- Onu, I.; Matei, D.; Sardaru, D.-P.; Cascaval, D.; Onu, A.; Gherghel, R.; Serban, I.L.; Mocanu, G.D.; Iordan, D.A.; Murariu, G.; et al. Rehabilitation of Patients with Moderate Knee Osteoarthritis Using Hyaluronic Acid Viscosupplementation and Physiotherapy. Appl. Sci. 2022, 12, 3165. [Google Scholar] [CrossRef]
Group | |||
---|---|---|---|
Parameters | Control Group (Mean ± SD) | Experimental Group (Mean ± SD) | Comparison of the Groups p-Value |
Age | 60.300 ± 8.125 | 63.107 ± 8.300 | 0.148 |
Height (cm) | 166.218 ± 7.212 | 164.215 ± 6.280 | 0.307 |
Weight (kg) | 75.380 ± 6.580 | 73.896 ± 7.498 | 0.287 |
BMI (kg/m2) | 27.767 ± 3.167 | 27.258 ± 3.428 | 0.455 |
Smoking status | (n (%)) | (n (%)) | |
10 (25.000%) | 15 (26.786%) | 0.844 * | |
Median grades of OA severity (K&L) | Median (Min-Max) | Median (Min-Max) | |
Anteroposterior radiographs of the knee | 1 (0–1) | 2 (2–4) | <0.001 |
Anteroposterior radiographs of the pelvis | 1 (0–1) | 2 (2–4) | <0.001 |
Group | |||
---|---|---|---|
Characteristics | Control Group (Mean ± SD) | Experimental Group (Mean ± SD) | Comparison of the Groups p-Value |
BMD of the spine | |||
45–60 years of age | 1.007 ± 0.088 | 0.994 ± 0.169 | 0.416 |
61 years of age and older | 1.068 ± 0.131 | 0.942 ± 0.132 | 0.014 |
Total | 1.024 ± 0.104 | 0.964 ± 0.150 | 0.011 |
BMD of the hip | |||
45–60 years of age | 0.950 ± 0.106 | 0.874 ± 0.145 | 0.063 |
61 years of age and older | 0.899 ± 0.134 | 0.790 ± 0.144 | 0.024 |
Total | 0.926 ± 0.120 | 0.826 ± 0.149 | 0.003 |
T-score of the spine | |||
45–60 years of age | −0.483 ± 0.703 | −1.110 ± 1.216 | 0.002 |
61 years of age and older | −0.227 ± 1.006 | −1.232 ± 1.070 | 0.007 |
Total | −0.413 ± 0.792 | −1.180 ± 1.126 | <0.001 |
T-score of the hip | |||
45–60 years of age | −0.055 ± 0.737 | −0.652 ± 1.089 | 0.071 |
61 years of age and older | 0.080 ± 0.758 | −1.365 ± 1.045 | <0.001 |
Total | 0.010 ± 0.731 | −1.061 ± 1.112 | <0.001 |
RTG Classification (K&L) | |||
---|---|---|---|
Characteristics | 2 (n = 31) (Mean ± SD) | 3 and 4 (n = 25) (Mean ± SD) | Comparison of the Groups p-Value |
BMD of the spine | 1.024 ± 0.140 | 0.890 ± 0.129 | <0.001 |
BMD of the hip | 0.889 ± 0.142 | 0.746 ± 0.118 | <0.001 |
T-score of the spine | −0.741 ± 0.964 | −1.724 ± 1.089 | <0.001 |
T-score of the hip | −0.527 ± 1.045 | −1.729 ± 0.797 | <0.001 |
Age | Statistics | BMD of the Spine | T-Score of the Spine | BMD of the Hip | T-Score of the Hip |
---|---|---|---|---|---|
Coefficient | −0.096 | 0.046 | −0.378 | −0.349 | |
Total | (95% CI) | (−0.350, 0.171) | (−0.220, 0.305) | (−0.583, −0.128) | (−0.561, −0.095) |
p | 0.479 | 0.738 | 0.005 | 0.010 |
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Stamenkovic, B.N.; Rancic, N.K.; Bojanovic, M.R.; Stojanovic, S.K.; Zivkovic, V.G.; Djordjevic, D.B.; Stankovic, A.M. Is Osteoarthritis Always Associated with Low Bone Mineral Density in Elderly Patients? Medicina 2022, 58, 1207. https://doi.org/10.3390/medicina58091207
Stamenkovic BN, Rancic NK, Bojanovic MR, Stojanovic SK, Zivkovic VG, Djordjevic DB, Stankovic AM. Is Osteoarthritis Always Associated with Low Bone Mineral Density in Elderly Patients? Medicina. 2022; 58(9):1207. https://doi.org/10.3390/medicina58091207
Chicago/Turabian StyleStamenkovic, Bojana N., Natasa K. Rancic, Mila R. Bojanovic, Sonja K. Stojanovic, Valentina G. Zivkovic, Dragan B. Djordjevic, and Aleksandra M. Stankovic. 2022. "Is Osteoarthritis Always Associated with Low Bone Mineral Density in Elderly Patients?" Medicina 58, no. 9: 1207. https://doi.org/10.3390/medicina58091207