Clin Orthop Surg.  2021 Mar;13(1):60-66. 10.4055/cios20111.

Relationship of Bone Mineral Density and Knee Osteoarthritis (Kellgren-Lawrence Grade): Fifth Korea National Health and Nutrition Examination Survey

Affiliations
  • 1Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Korea
  • 2Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
  • 3Department of Orthopaedic Surgery, CM Hospital, Seoul, Korea
  • 4Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea

Abstract

Background
Osteoarthritis (OA) and osteoporosis (OP) are the 2 most common bone disorders associated with aging. We can simply assume that older patients have a higher incidence of OA and OP with more severity. Although several papers have conducted studies on the relationship between OA and OP, none of them has demonstrated a conclusive link. In this study, we used radiological knee OA and bone mineral density (BMD; T-score of the total hip and lumbar spine) to analyze the incidence of OA and OP in a large population. We aimed to determine the relationship between OA and OP and investigate the associated risk factors.
Methods
This cross-sectional study used data extracted from the 2010–2012 Korea National Health and Nutrition Examination Survey. We evaluated a total of 4,250 participants aged ≥ 50 years who underwent knee radiography and dual-energy X-ray absorptiometry and their laboratory results. The relationship between radiological knee OA and BMD was assessed. The generalized linear model was used to evaluate the relationship between BMD and Kellgren-Lawrence (KL) grade.
Results
The higher KL grade was associated with older age, higher body mass index (BMI), female sex, and lower hemoglobin level (p < 0.001). No significant association was found between OA and the following variables: white blood cell, platelet, total cholesterol, vitamin D, alkaline phosphatase, parathyroid hormone, hypertension, diabetes, asthma, dyslipidemia, smoking status, alcohol consumption, and regular exercise (p > 0.05). After adjusting for confounding factors (age, BMI, diabetes, hypertension, smoking, and alcohol consumption), the average T-scores of total hip and lumbar spine were the highest in the mild OA group with KL grade 2 (–0.22 ± 1.08 and –0.89 ± 1.46, respectively,p < 0.001). The average T-scores of the total hip and lumbar spine significantly decreased as OA progressed from moderate (KL grade 3; –0.49 ± 1.05 and –1.33 ± 1.38, respectively, p < 0.001) to severe (KL grade 4; –0.73 ± 1.13 and –1.74 ± 1.75, respectively, p < 0.001). T-scores of the moderate-to-severe OA group were significantly lower than those of the non-OA group (KL grades 0 and 1, p < 0.001).
Conclusions
Compared with the non-OA group, BMD (T-scores of the total hip and lumbar spine) was higher in the mild OA group and lower in the moderate-to-severe OA group.

Keyword

Osteoarthritis; Osteoporosis; Korea National Health and Nutrition Examination Survey; Kellgren-Lawrence grade
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