Associations Between Systemic Bone Mineral Density and Early Knee Cartilage Changes in Middle-aged Adults Without Clinical Knee Disease: a Prospective Cohort Study

Overview

Journal Arthritis Res Ther

Publisher Biomed Central

Specialty Rheumatology

Date 2017 May 20

PMID 28521839

Citations 12

Authors

Andrew J Teichtahl

Yuanyuan Wang

Anita E Wluka

Boyd J Strauss

Joseph Proietto

John B Dixon

Graeme Jones

Flavia M Cicuttini

Affiliations

Soon will be listed here.

Abstract

Background: Osteoarthritis has a high prevalence in people with high bone mineral density (BMD). Nevertheless, whether high systemic BMD predates early structural features of knee osteoarthritis is unclear. This study examined the association between systemic BMD and knee cartilage defect progression and cartilage volume loss in middle-aged people without clinical knee disease.

Methods: Adults (n = 153) aged 25-60 years had total body, lumbar spine, and total hip BMD assessed by dual-energy X-ray absorptiometry at baseline (2005-2008), and tibial cartilage volume and tibiofemoral cartilage defects assessed by magnetic resonance imaging at baseline and follow up (2008-2010).

Results: Higher spine BMD was associated with increased risk for progression of medial (OR = 1.45, 95% CI 1.10, 1.91) and lateral (OR = 1.30, 95% CI 1.00, 1.67) tibiofemoral cartilage defects. Total hip BMD was also positively associated with the progression of medial (OR = 1.63, 95% CI 1.10, 2.41) and lateral (OR = 1.53, 95% CI 1.08, 2.18) tibiofemoral cartilage defects. Greater total body, spine, and total hip BMD were associated with increased rate of lateral tibial cartilage volume loss (for every 1 g/10 cm increase in total body BMD: B = 0.44%, 95% CI 0.17%, 0.71%; spine BMD: 0.17%, 95% CI 0.04%, 0.30%; total hip BMD: 0.29%, 95% CI 0.13%, 0.45%), with no significant associations for medial tibial cartilage volume loss.

Conclusion: In middle-aged people without clinical knee disease, higher systemic BMD was associated with increased early knee cartilage damage. Further work is needed to clarify the effect of systemic BMD at different stages of the pathway from health through to disease in knee osteoarthritis, as new therapies targeting bone are developed for the management of knee osteoarthritis.

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References

Berry P, Wluka A, Davies-Tuck M, Wang Y, Strauss B, Dixon J . Sex differences in the relationship between bone mineral density and tibial cartilage volume. Rheumatology (Oxford). 2010; 50(3):563-8. DOI: 10.1093/rheumatology/keq341. View

Drinka P, DeSmet A, Bauwens S, Rogot A . The effect of overlying calcification on lumbar bone densitometry. Calcif Tissue Int. 1992; 50(6):507-10. DOI: 10.1007/BF00582163. View

Dequeker J, Aerssens J, Luyten F . Osteoarthritis and osteoporosis: clinical and research evidence of inverse relationship. Aging Clin Exp Res. 2004; 15(5):426-39. DOI: 10.1007/BF03327364. View

Wildi L, Martel-Pelletier J, Abram F, Moser T, Raynauld J, Pelletier J . Assessment of cartilage changes over time in knee osteoarthritis disease-modifying osteoarthritis drug trials using semiquantitative and quantitative methods: pros and cons. Arthritis Care Res (Hoboken). 2012; 65(5):686-94. DOI: 10.1002/acr.21890. View

Radin E, Rose R . Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res. 1986; (213):34-40. View

Ding C, Garnero P, Cicuttini F, Scott F, Cooley H, Jones G . Knee cartilage defects: association with early radiographic osteoarthritis, decreased cartilage volume, increased joint surface area and type II collagen breakdown. Osteoarthritis Cartilage. 2005; 13(3):198-205. DOI: 10.1016/j.joca.2004.11.007. View

Felson D, Lawrence R, Dieppe P, Hirsch R, Helmick C, Jordan J . Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000; 133(8):635-46. DOI: 10.7326/0003-4819-133-8-200010170-00016. View

Valdes A, Loughlin J, Oene M, Chapman K, Surdulescu G, Doherty M . Sex and ethnic differences in the association of ASPN, CALM1, COL2A1, COMP, and FRZB with genetic susceptibility to osteoarthritis of the knee. Arthritis Rheum. 2006; 56(1):137-46. DOI: 10.1002/art.22301. View

Dequeker J . Inverse relationship of interface between osteoporosis and osteoarthritis. J Rheumatol. 1997; 24(4):795-8. View

10.

Stewart A, Black A . Bone mineral density in osteoarthritis. Curr Opin Rheumatol. 2000; 12(5):464-7. DOI: 10.1097/00002281-200009000-00021. View

11.

Crema M, Hunter D, Burstein D, Roemer F, Li L, Eckstein F . Association of changes in delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) with changes in cartilage thickness in the medial tibiofemoral compartment of the knee: a 2 year follow-up study using 3.0 T MRI. Ann Rheum Dis. 2013; 73(11):1935-41. DOI: 10.1136/annrheumdis-2012-203083. View

12.

Wluka A, Ding C, Jones G, Cicuttini F . The clinical correlates of articular cartilage defects in symptomatic knee osteoarthritis: a prospective study. Rheumatology (Oxford). 2005; 44(10):1311-6. DOI: 10.1093/rheumatology/kei018. View

13.

Teichtahl A, Wluka A, Tanamas S, Wang Y, Strauss B, Proietto J . Weight change and change in tibial cartilage volume and symptoms in obese adults. Ann Rheum Dis. 2014; 74(6):1024-9. DOI: 10.1136/annrheumdis-2013-204488. View

14.

Pelletier J, Roubille C, Raynauld J, Abram F, Dorais M, Delorme P . 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. 2013; 74(2):422-9. DOI: 10.1136/annrheumdis-2013-203989. View

15.

Ding M, Odgaard A, Hvid I . Changes in the three-dimensional microstructure of human tibial cancellous bone in early osteoarthritis. J Bone Joint Surg Br. 2003; 85(6):906-12. View

16.

Cao Y, Stannus O, Aitken D, Cicuttini F, Antony B, Jones G . Cross-sectional and longitudinal associations between systemic, subchondral bone mineral density and knee cartilage thickness in older adults with or without radiographic osteoarthritis. Ann Rheum Dis. 2013; 73(11):2003-9. DOI: 10.1136/annrheumdis-2013-203691. View

17.

Zhai G, Blizzard L, Srikanth V, Ding C, Cooley H, Cicuttini F . Correlates of knee pain in older adults: Tasmanian Older Adult Cohort Study. Arthritis Rheum. 2006; 55(2):264-71. DOI: 10.1002/art.21835. View

18.

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K . Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986; 29(8):1039-49. DOI: 10.1002/art.1780290816. View

19.

Andriacchi T . Dynamics of knee malalignment. Orthop Clin North Am. 1994; 25(3):395-403. View

20.

Cicuttini F, Jones G, Forbes A, Wluka A . Rate of cartilage loss at two years predicts subsequent total knee arthroplasty: a prospective study. Ann Rheum Dis. 2004; 63(9):1124-7. PMC: 1755122. DOI: 10.1136/ard.2004.021253. View