Individuals With High Bone Mass Have Increased Progression of Radiographic and Clinical Features of Knee Osteoarthritis

April E. Hartley*, Sarah A. Hardcastle, Lavinia Paternoster, Eugene McCloskey, Kenneth E. S. Poole, Muhammad K. Javaid, Mo Aye, Katie Moss, Raquel Granell, Jenny Gregory, Martin Williams, Jon H. Tobias, Celia L. Gregson

*Corresponding author for this work

Research output: Contribution to journalArticle

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.
Original languageEnglish
JournalOsteoarthritis and Cartilage
Early online date14 May 2020
DOIs
Publication statusE-pub ahead of print - 14 May 2020

Keywords

  • osteoarthritis
  • progression
  • high bone mass
  • BMD
  • WOMAC
  • health-related quality of life

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    Hartley, A. E., Hardcastle, S. A., Paternoster, L., McCloskey, E., Poole, K. E. S., Javaid, M. K., Aye, M., Moss, K., Granell, R., Gregory, J., Williams, M., Tobias, J. H., & Gregson, C. L. (2020). Individuals With High Bone Mass Have Increased Progression of Radiographic and Clinical Features of Knee Osteoarthritis. Osteoarthritis and Cartilage. https://doi.org/10.1016/j.joca.2020.03.020