Clin Orthop Surg.  2014 Dec;6(4):420-425. 10.4055/cios.2014.6.4.420.

The Relationship between Osteoarthritis of the Knee and Bone Mineral Density of Proximal Femur: A Cross-Sectional Study from a Korean Population in Women

• Im GI
• Kwon OJ
• Kim CH

• KMID: 1794730
• DOI: http://doi.org/10.4055/cios.2014.6.4.420

Abstract

BACKGROUND
The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women.
METHODS
One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship.
RESULTS
There was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade.
CONCLUSIONS
The radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward's triangle).

Keyword

Knee osteoarthritis; Osteoporosis; Proximal femur; Bone density; Relationship

MeSH Terms

Absorptiometry, Photon
Adult
Aged
Aged, 80 and over
*Bone Density
Cross-Sectional Studies
Female
Femur/physiopathology/*radiography
Humans
Knee Joint/physiopathology/radiography
Middle Aged
Osteoarthritis, Knee/physiopathology/*radiography
Osteoporosis/physiopathology/*radiography
Republic of Korea

Reference

1. Foss MV, Byers PD. Bone density, osteoarthrosis of the hip, and fracture of the upper end of the femur. Ann Rheum Dis. 1972; 31(4):259–264.

2. Burger H, van Daele PL, Odding E, et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum. 1996; 39(1):81–86.

3. Hannan MT, Anderson JJ, Zhang Y, Levy D, Felson DT. Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study. Arthritis Rheum. 1993; 36(12):1671–1680.

4. Hart DJ, Mootoosamy I, Doyle DV, Spector TD. The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study. Ann Rheum Dis. 1994; 53(3):158–162.

5. Lethbridge-Cejku M, Tobin JD, Scott WW Jr, et al. Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: data from the Baltimore Longitudinal Study of Aging. J Rheumatol. 1996; 23(11):1943–1947.

6. Nevitt MC, Lane NE, Scott JC, et al. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995; 38(7):907–916.

7. Sowers M, Lachance L, Jamadar D, et al. The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women. Arthritis Rheum. 1999; 42(3):483–489.

8. Bergink AP, van der Klift M, Hofman A, et al. Osteoarthritis of the knee is associated with vertebral and nonvertebral fractures in the elderly: the Rotterdam Study. Arthritis Rheum. 2003; 49(5):648–657.

9. Hochberg MC, Lethbridge-Cejku M, Tobin JD. Bone mineral density and osteoarthritis: data from the Baltimore Longitudinal Study of Aging. Osteoarthritis Cartilage. 2004; 12:Suppl A. S45–S48.

10. Hart DJ, Cronin C, Daniels M, Worthy T, Doyle DV, Spector TD. The relationship of bone density and fracture to incident and progressive radiographic osteoarthritis of the knee: the Chingford Study. Arthritis Rheum. 2002; 46(1):92–99.

11. Zhang Y, Hannan MT, Chaisson CE, et al. Bone mineral density and risk of incident and progressive radiographic knee osteoarthritis in women: the Framingham Study. J Rheumatol. 2000; 27(4):1032–1037.

12. Cooper C, Snow S, McAlindon TE, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000; 43(5):995–1000.

13. Felson DT, Nevitt MC. Epidemiologic studies for osteoarthritis: new versus conventional study design approaches. Rheum Dis Clin North Am. 2004; 30(4):783–797.

14. Kelsey JL, Hochberg MC. Epidemiology of chronic musculoskeletal disorders. Annu Rev Public Health. 1988; 9:379–401.

15. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ. 1993; 307(6914):1248–1250.

16. Radin EL, Paul IL, Rose RM. Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet. 1972; 1(7749):519–522.

17. Radin EL, Rose RM. Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res. 1986; (213):34–40.

18. Bellido M, Lugo L, Roman-Blas JA, et al. Subchondral bone microstructural damage by increased remodelling aggravates experimental osteoarthritis preceded by osteoporosis. Arthritis Res Ther. 2010; 12(4):R152.

19. Altman R, Asch E, Bloch D, et al. Diagnostic and therapeutic 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):1039–1049.

20. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA. 2001; 286(2):188–195.

21. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957; 16(4):494–502.

22. Carlson CS, Loeser RF, Purser CB, Gardin JF, Jerome CP. Osteoarthritis in cynomolgus macaques. III: Effects of age, gender, and subchondral bone thickness on the severity of disease. J Bone Miner Res. 1996; 11(9):1209–1217.

23. Goldring MB, Goldring SR. Articular cartilage and subchondral bone in the pathogenesis of osteoarthritis. Ann N Y Acad Sci. 2010; 1192:230–237.

24. Funck-Brentano T, Cohen-Solal M. Crosstalk between cartilage and bone: when bone cytokines matter. Cytokine Growth Factor Rev. 2011; 22(2):91–97.

25. Buckland-Wright JC, Lynch JA, Macfarlane DG. Fractal signature analysis measures cancellous bone organisation in macroradiographs of patients with knee osteoarthritis. Ann Rheum Dis. 1996; 55(10):749–755.