Age and sex differences in hip joint space among asymptomatic subjects without structural change - Implications for epidemiologic studies
Age and sex differences in hip joint space among asymptomatic subjects without structural change - Implications for epidemiologic studies
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DOI：
10.1002/art.10886
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发表时间：
2003-04-01
影响因子：
--
通讯作者：
Doherty, M
中科院分区：
文献类型：
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作者：
Lanyon, P;Muir, K;Doherty, M
Objective.髋关节骨关节炎（OA）的患病率随着年龄的增长而显著增加。虽然尚不清楚髋关节间隙丢失是正常老化的特征还是OA过程的反映，但OA的流行病学标准仅基于狭窄。本研究的目的是确定在无髋关节OA的无症状受试者中，关节间隙宽度是否随年龄发生变化，以及是否存在性别差异。我们确定了1994年至1996年期间接受静脉尿路造影术的1,806例受试者，并向1998年存活的1,527例受试者发送了一份问卷，收到了1,031份答复（68%）。所有X线片均由一名对年龄、性别和疼痛状态不知情的观察者读取。根据标准图谱，对OA的个体影像学特征（狭窄、骨赘、硬化和囊肿）进行分级，并分配总体定性分级。最小关节间隙宽度（JSW）测量卡尺在0.1毫米内。共276名女性（平均年龄63岁）和257名男性（平均年龄64岁）被确定谁从来没有髋关节疼痛（定义为曾经有过疼痛的大多数日子至少1个月），谁没有证据表明，无论是关节间隙狭窄或骨赘（0级，无结构变化）。根据年龄将任一髋关节的最小JSW制成表格。JSW测量具有重现性，(95在所有年龄段，男性的JSW均大于女性（女性为3.85 mm，男性为4.19 mm，平均差异为0.34。mm; 95%置信区间[95% CI] 0.24，0.44）。在女性中观察到JSW随年龄的显著下降，45-54岁和75-84岁之间的平均差异为0.36 mm（95% CI 0.15，0.58; P=0.001）。在男性中观察到JSW随年龄的显著变化（平均差异0.16 mm; 95% CI-0.11，0.43）。对另外64名女性和61名男性进行分析，他们没有髋关节疼痛，并且有1-2级的总体定性变化，得出了类似的结果。实施这些结果，将女性髋关节OA的定义阈值从小于或等于2.5 mm改为小于或等于2.2 mm，使髋关节OA的患病率从10.6%降至5.6%。这些关节间隙的性别差异在髋关节OA定义中主要强调关节间隙狭窄方面具有重要意义。女性的关节间隙也随着年龄的增长而显著下降，这在男性中是没有的。这表明，在女性中，软骨损失可能是一种与年龄相关的现象，与结构变化的其他方面无关。应考虑制定髋关节OA的性别特异性定义。"
Objective. The prevalence of hip osteoarthritis (OA) increases significantly with age. Although it is not clear whether joint space loss at the hip is a feature of normal aging or a reflection of the OA process, epidemiologic criteria for OA are based on narrowing alone. The aim of this study was to determine whether changes in joint space width occur with age, and whether there are sex differences, in asymptomatic subjects without hip OA.Methods. We identified a total of 1,806 subjects who had undergone intravenous urography between 1994 and 1996 and sent a questionnaire to the 1,527 of these subjects who were alive in 1998; 1,031 replies (68%) were received. All radiographs were read by an observer blinded to age, sex, and pain status. Individual radiographic features of OA (narrowing, osteophyte, sclerosis, and cysts) were graded, and an overall qualitative grade was allocated, according to a standard atlas. Minimum joint space width (JSW) was measured by metered caliper to within 0.1 mm. A total of 276 women (mean age 63 years) and 257 men (mean age 64 years) were identified who had never had hip pain (defined as having ever had pain on most days for at least 1 month) and who had no evidence of either joint space narrowing or osteophyte (grade 0, no structural changes). The minimum JSW in either hip was tabulated according to age.Results. JSW measurement was reproducible., (95% confidence limits of agreement) to within +/-0.5 mm. At all ages, men had larger JSW than women (3.85 mm in women, 4.19 mm in men, mean difference 0.34. mm; 95% confidence interval [95% CI] 0.24, 0.44). A significant decline in JSW with age was seen in women, with a mean difference between ages 45-54 and 75-84 years of 0.36 mm (95% CI 0.15, 0.58; P=0.001). No, significant change in JSW with age was seen in men (mean difference 0.16 mm; 95% CI -0.11, 0.43). Analysis of an additional 64 women and 61 men who were without hip pain and had overall qualitative grade 1-2 changes gave similar results. Implementing these results to alter the threshold for definition of hip OA in women from less than or equal to2.5 mm to less than or equal to2.2 mm reduced the prevalence of hip OA from 10.6% to 5.6%.Conclusion. These sex differences in joint space have significant implications in terms of the major emphasis on joint space narrowing in definitions of hip OA. Women also have a significant progressive decline in joint space with age that is not seen in men. This, suggests that in women, loss of cartilage may be an age-related phenomenon that is independent of other aspects of structural change. Consideration should be given to the development of sex-specific definitions of hip "OA."