Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis
Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis
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DOI：
10.1016/j.joca.2020.03.020
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发表时间：
2020-09-01
影响因子：
7
通讯作者：
Gregson, C. L.
中科院分区：
文献类型：
--
作者：
Hartley, A.;Hardcastle, S. A.;Gregson, C. L.
目的：高骨量(HBM)与以骨赘为特征的放射学膝关节骨性关节炎(KOA)的发病率增加有关。我们的目标是确定膝关节骨性关节炎的放射学进展及其亚型是否增加，以及观察到的变化是否与临床相关。设计：有和没有髋关节骨矿(L1和/或总髋部骨密度Z-Score>；=+3.2)的队列收集了基线和8年随访时的膝关节X线片。使用OARSI图谱对亚型进行分级。对内侧/外侧胫骨/股骨骨赘和内侧/外侧关节间隙狭窄(JSN)分级进行汇总，得出骨赘DJSN。采用WOMAC问卷对疼痛、功能和僵硬程度进行量化。对年龄、性别、身高、基线亚型分级、绝经、教育程度和全身脂肪质量(TBFM)进行调整后，采用多变量线性/泊松回归方法确定HBM状态与亚型进展之间的关系。结果：169人有重复拍片，提供330张膝关节图像；63%有膝关节肥大，73%为女性，平均年龄58(12)岁。虽然HbM与Kellgren eLawrence测量的总体进展没有明显的相关性(RR=1.55[0.56.4.32])，但HbM分别与骨赘和DJSN呈正相关(调整后的平均差异分别为0.45[0.01.0.89]和0.15[0.01.0.29])。HBM患者的WOMAC膝关节疼痛评分较高(b=7.42[1.17.13.66])，这主要是由骨赘评分调整(58%衰减)而不是JSN(30%衰减)或TBFM(16%衰减)解释的。在症状僵硬和功能受限方面也观察到了相同的模式。结论：骨赘进展与HBM有关，这似乎是报告的疼痛、僵硬和功能丧失增加的原因之一。(C)2020年国际骨性关节炎研究会。爱思唯尔有限公司出版。保留所有权利。
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 Dosteophytes, DJSN 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 subphenotype 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 eLawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Dosteophytes and DJSN 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 (b = 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. (C) 2020 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.