Impairment of osteophyte formation in hyperglycemic patients with type II diabetes mellitus and knee osteoarthritis

The association between diabetes mellitus and functionality in knee osteoarthritis: a cross-sectional study

Objective: The aim of this study was to determine the roles of diabetes mellitus (DM) on quality of life, function of knee, and muscle strength in patients with knee osteoarthritis (OA). Material and Method: This single-center, case-control study prospectively enrolled outpatients with knee OA visiting a physical therapy and rehabilitation clinic. The patients were grouped according to the presence of DM diagnosis. Demographic data, disease duration, and medical treatments of patients were recorded. Clinical parameters, radiographic grading (Kellgren-Lawrence grades), functional scales of the knee and quality of life were evaluated. Results: The study included 82 participants [age: 61.3±6.7 years; female: 76.8%]. The mean Western Ontario and McMaster Universities Osteoarthritis Index of OA patients with (n=37) and without DM (n=45) were 45.79±18.04 vs. 65.94±16.23, respectively (p=0.003). The Hb A1c levels showed a negative correlation with Knee Injury and Osteoarthritis Outcome Score components (pain, quality of life, sports, daily activities, symptom duration) (p

Interactions between diabetes mellitus and osteoarthritis; from animal studies to clinical data

Diabetes mellitus (DM) and osteoarthritis (OA) are commonly known metabolic diseases that affect a large segment of the world population. These two conditions share several risk factors such as obesity and aging; however, there is still no consensus regarding the direct role of DM on OA development and progression. Interestingly, both animal and human studies have yielded conflicting results, with some showing a significant role for DM in promoting OA, while others found no significant interactions between these conditions. In this review, we will discuss preclinical and clinical data that assessed the interaction between DM and OA. We will also discuss possible mechanisms associated with the effect of high glucose on the articular cartilage and chondrocytes. An emerging theme dominates the breath of published work in this area: most of the studies discussed in this review do not take into consideration the role of other factors such as the type of diabetes, age, biological sex, type of animal model, body mass index, and the use of pain medications when analyzing and interpreting data. Therefore, future studies should be more rigorous when designing experiments looking at DM and its effects on OA and should carefully account for these confounding factors, so that better approaches can be developed for monitoring and treating patients at risk of OA and DM. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Diabetes mellitus is not a risk factor for osteoarthritis

BACKGROUND

Association between diabetes mellitus (DM) and risk of osteoarthritis (OA) can be confounded by body mass index (BMI), a strong risk factor for both conditions. We evaluate the association between DM or hyperglycaemia with OA using systematic review and meta-analysis.

METHODS

We searched PubMed and Web of Science databases in English for studies that gave information on the association between DM and OA. Two meta-analysis models were conducted to address: (1) risk of DM comparing subjects with and without OA and (2) risk of OA comparing subjects with and without DM. As far as available, risk estimates that adjusted for BMI were used.

RESULTS

31 studies with a pooled population size of 295 100 subjects were reviewed. 16 and 15 studies reported positive associations and null/ negative associations between DM and OA. 68.8% of positive studies had adjusted for BMI, compared with 93.3% of null/negative studies. In meta-analysis model 1, there was an increase prevalence of DM in subjects with OA compared with those without (OR 1.56, 95% CI 1.28 to 1.89). In meta-analysis model 2, there was no increased risk of OA (OR 1.14, 95% CI 0.98 to 1.33) in subjects with DM compared with those without, regardless of gender and OA sites. Comparing subjects with DM to those without, an increased risk of OA was noted in cross-sectional studies, but not in case-control and prospective cohort studies.

CONCLUSIONS

This meta-analysis does not support DM as an independent risk factor for OA. BMI was probably the most important confounding factor.

Association of Diabetes Mellitus and Biomarkers of Abnormal Glucose Metabolism With Incident Radiographic Knee Osteoarthritis

OBJECTIVE

The association of diabetes mellitus (DM) with increased risk of knee osteoarthritis (OA) is uncertain. We evaluated associations of DM and biomarkers of abnormal glucose metabolism with incident radiographic knee OA, controlling for body mass index (BMI).

METHODS

Participants (mean ± SD age 60.6 ± 7.8 years; mean ± SD body mass index [BMI] 29.1 ± 4.9 kg/m2 ) were from the Multicenter Osteoarthritis Study and did not have radiographic knee OA at baseline (Kellgren/Lawrence [K/L] grade <2 bilaterally). A random sample (n = 987) was selected and stratified by BMI. Baseline serum fasting glucose and homeostasis model assessment-estimated insulin resistance (HOMA-IR) were measured. Participants were categorized as having DM based on self-report, use of medication, or fasting glucose ≥126 mg/dl. Incident radiographic knee OA (K/L grade ≥2 or knee replacement) was assessed at 3 follow-up visits (30, 60, and 84 months). Knee-level pooled logistic regression analysis was performed to obtain odds ratios (ORs) (95% confidence interval [95% CI]) for associations of DM status and biomarkers of abnormal glucose metabolism with incident radiographic knee OA.

RESULTS

After adjustment for BMI, the odds of incident radiographic knee OA were not associated with baseline DM status nor with levels of fasting glucose and HOMA-IR, overall and in men. In women, HOMA-IR was inversely associated with odds of incident radiographic knee OA (adjusted OR 0.80 [95% CI 0.69-0.94], P = 0.005).

CONCLUSION

DM and higher levels of biomarkers of abnormal glucose metabolism were not associated with increased odds of incident radiographic knee OA after adjusting for BMI in this cohort overall. A possible protective association of higher HOMA-IR with incident radiographic knee OA in women warrants further investigation.

Diabetes mellitus and the risk of total knee replacement among Chinese in Singapore, the Singapore Chinese Health Study

Association between diabetes mellitus (diabetes) and risk of knee osteoarthritis (KOA) is confounded by high body mass index (BMI), a strong risk factor for both conditions. We evaluated the association between diabetes and incidence of total knee replacement (TKR) due to severe KOA in the Singapore Chinese Health Study, a prospective cohort of 63,257 Chinese men and women, aged 45-74 years at recruitment in 1993-1998, and re-interviewed in 1999-2004. Height, weight, lifestyle factors and history of diabetes were obtained through in-person interviews at recruitment and re-interview. Incident cases of TKR were identified via record linkage with nationwide hospital discharge database. Subjects with/without prevalent diabetes had comparable BMI (24.0 kg/m² versus 23.0 kg/m²). After an average of 14-years, 1,973 subjects had TKR attributable to KOA. Compared to subjects without diabetes, hazard ratio (HR) of TKR for subjects with diabetes was 0.63 [95% confidence interval (CI), 0.52-0.75] after controlling for BMI and other risk factors. An inverse association was also observed between incident diabetes at re-interview and subsequent risk of TKR (HR = 0.74; 95% CI = 0.58-0.94). The inverse diabetes-TKR risk association was similar by gender and across three categories of BMI. Our study does not support diabetes as a risk factor of KOA.

Type 2 diabetes and osteoarthritis: a systematic review and meta-analysis

BACKGROUND

Observational studies have reported an association between type 2 diabetes and osteoarthritis (OA) development and progression. However no systematic review of the literature exists assessing whether this association is consistently true. We aimed to systematically review the association between type 2 diabetes and the presence, development, and progression of OA.

METHODS

We searched MEDLINE, SCOPUS, EMBASE, the Web of Science, and Grey Literature (through August 2014) for prospective cohort, cross-sectional, and case-control studies with confidence intervals (CI) that reported an association between type 2 diabetes and impaired glucose tolerance (IGT) and the development or presence of OA of any joint.

RESULTS

Ten studies and fourteen ratios were included in the analysis. The pooled population size in our meta-regression was 16,742 patients. Type 2 diabetes was significantly associated with the development or presence of OA (OR; 1·21, 95% CI: 1·02-1·41). In the subset of 7 studies that did control for weight or BMI there was an increased odds of OA associated with type 2 diabetes was (OR: 1·25, 95% CI: 1·05-1·46) from a smaller pool of patients (n=7156).

CONCLUSIONS

Type 2 diabetes is associated with the development and presence of radiographic and symptomatic OA even when controlling for body mass index and weight.

Knee Osteoarthritis in Type 2 Diabetes Mellitus: Does Insulin Therapy Retard Osteophyte Formation?

OBJECTIVE

The aim of this study was to investigate whether or not radiographic changes observed in knee osteoarthritis (OA) in type 2 diabetes mellitus (T2DM) patients on insulin therapy differed from those not on insulin.

MATERIAL AND METHODS

A cross-sectional study was performed in 311 subjects: 211 T2DM patients and 100 without diabetes (controls) in Mubarak Hospital, Kuwait. Patients were categorized into 3 groups: T2DM patients not on insulin (G1, n = 99), T2DM patients on insulin (G2, n = 112) and a nondiabetic control group (G3, n = 100). Plain X-ray of both knees was used to assess the changes of knee OA and graded using the Kellegren-Lawrence scale (0-4) and the Osteoarthritis Research Society International Atlas grading scale (0-3). A total of 622 knee X-rays were evaluated. SPSS version 21.0 was used for data analysis.

RESULTS

A highly significant association (p < 0.0001) was observed for joint space narrowing (JSN) as well as for osteophyte formation between the three groups. Comparing G2 and G3, a highly significant association (p < 0.0001) was retained for JSN [201 (89.7%) vs. 199 (99.5%)] and for osteophyte formation [26 (11.7%) vs. 72 (36.0%)]. Comparing G1 and G2, significantly less osteophyte formation was noted in G2 patients compared to G1 patients [26 (11.7%) vs. 39 (19.7%), p = 0.02]. Multivariate logistic regression analysis showed that the G2 group had less chance of osteophyte formation than either the G1 group or G3 control group (OR = 0.294, p = 0.008 and OR = 0.098, p < 0.001, respectively).

CONCLUSION

Our findings show that T2DM patients with OA knees on insulin therapy have less radiographic osteophytes compared to T2DM patients not on insulin.

Is osteoarthritis a metabolic disorder?

BACKGROUND

Obesity is associated with an increased risk of developing osteoarthritis (OA), even in non-weight bearing joints. High levels of adipose tissue-associated inflammation may explain this association.

SOURCES OF DATA AND AREAS OF DEBATE

Published evidence looking at the associations between components of Metabolic Syndrome (MetS) and knee, hip or hand OA and the higher mortality described with knee OA.

EMERGING POINTS

Development of MetS and OA shares a relationship with adipose tissue-associated inflammation. This review supports this inflammatory pathway being part of the shared mechanism behind obesity as a risk factor for OA and the recently described OA-associated increased mortality.

TIMELY AREAS FOR DEVELOPMENT

In an era of an obesity epidemic, this review identifies a need for well-designed cohort studies assessing early metabolic changes in populations at high risk of OA and MetS, and to identify risk factors for increased mortality in patients with OA.

Association between diabetes mellitus and osteoarthritis: systematic literature review and meta-analysis

Objectives

To investigate the prevalence of osteoarthritis (OA) in patients with diabetes mellitus (DM) and prevalence of DM in patients with OA and whether OA and DM are associated.

Design

A systematic literature review and meta-analysis. We included cohort, case–control and cross-sectional studies assessing the number of patients with DM and/or OA. The mean prevalence of OA among patients with DM and DM among patients with OA was calculated. Data from trials assessing an association of diabetes and OA were pooled and results are presented as unadjusted OR and 95% CI.

Results

From the 299 publications, we included 49 studies in the analysis, including 28 cross-sectional studies, 11 cohort studies and 10 case–control studies. In all, 21, 5 and 23 articles involved patients with OA exclusively, patients with DM and the general population, respectively. For 5788 patients with DM, the mean OA prevalence was 29.5±1.2%. For 645 089 patients with OA, the prevalence of DM was 14.4±0.1%. The risk of OA was greater in the DM than non-DM population (OR=1.46 (1.08 to 1.96), p=0.01), as was DM in the OA than non-OA population (OR=1.41 (1.21 to 1.65), p<0.00 001). Among the 12 studies reporting an OR adjusted on at least the body mass index, 5 showed no association of DM and OA and 7 identified DM as an independent risk factor.

Conclusions

This meta-analysis highlights a high frequency of OA in patients with DM and an association between both diseases, representing a further step towards the individualisation of DM-related OA within a metabolic OA phenotype.

Links between osteoarthritis and diabetes: implications for management from a physical activity perspective

Osteoarthritis (OA) and type 2 diabetes mellitus (T2DM) often coexist in older adults. Those with T2DM are more susceptible to developing arthritis, which has been traditionally attributed to common risk factors, namely, age and obesity. Alterations in lipid metabolism and hyperglycemia might directly impact cartilage health and subchondral bone, contributing to the development/progression of OA. Adequate management of older persons with both conditions benefits from a comprehensive understanding of the associated risk factors. We discuss common risk factors and emerging links between OA and T2DM, emphasizing the importance of physical activity and the implications of safe and effective physical activity.

Risk factors for early radiographic changes of tibiofemoral osteoarthritis

OBJECTIVE

To evaluate the risk factors for early radiographic changes of knee osteoarthritis.

METHODS

SUBJECTS

(n = 114) with unilateral or bilateral grade 0-1 knee osteoarthritis underwent x ray examination of the knees (semiflexed anteroposterior view) and assessment with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at baseline and 30 months later. Severity of joint space narrowing (JSN) and osteophytosis were graded in randomly ordered serial radiographs by two readers, blinded to the sequence of the films, using standard pictorial atlases.

RESULTS

The odds of an initial appearance of radiographic features of knee osteoarthritis at month 30 were more than threefold greater in African Americans than in whites (osteophytosis: odds ratio (OR) 3.30, 95% confidence interval (CI) 1.04 to 10.54; JSN: OR 3.49, 95% CI 1.16 to 10.68). In addition, the appearance of osteophytosis was positively related to baseline stiffness (OR 1.91/2.1 points on the 2-10 WOMAC scale, 95% CI 1.29 to 2.82).

CONCLUSIONS

The distinction between incident and established, but early, radiographic knee osteoarthritis is difficult because of the limits to which all possible evidence of the disease can be ruled out in a conventional baseline knee radiograph. Nonetheless, our finding that African Americans were at greater risk of early osteophytosis and JSN than other subjects differs from the results of our previous analysis of risk factors for progressive knee osteoarthritis in the same subjects. The development of osteophytes also was associated with joint stiffness. Future investigations should focus on the systemic and local influences that these ostensible risk factors represent.

Rheumatologic manifestations of diabetes mellitus

Diabetes mellitus has been linked to disorders of bones and joints, including neuroarthropathy, limited joint mobility, and hyperostosis. Some of the relations have known pathogenic mechanisms, but most are based on epidemiologic findings. This article reviews the associations between diabetes mellitus and its putative rheumatologic manifestations, and proposes a classification composed of four categories: consequences of diabetic complications, consequences of metabolic derangements inherent to diabetes, syndromes that may share etiologic mechanisms with microvascular disease, and probable associations. This approach may facilitate a clearer understanding of the musculoskeletal conditions that are prevalent in patients with diabetes mellitus.

Non-insulin dependent diabetes mellitus (NIDDM) and patterns of osteoarthritis. The Ulm osteoarthritis study

OBJECTIVES

Despite recent advances regarding the role of diabetes with respect to cartilage metabolism, epidemiologic data to quantify the role of diabetes in the development of osteoarthritis (OA) are sparse.

METHODS

OA patterns were studied in 809 patients with knee or hip joint replacement due to OA. NIDDM was defined by a history of physician diagnosed diabetes or use of antihyperglycemics.

RESULTS

Patients with NIDDM had more often bilateral OA (adjusted odds ratio (OR)=2.2; 95% confidence interval (CI): 0.8-6.4). No association between NIDDM and generalized OA (adjusted OR= 1.0; 95%CI: 0.5-1.9) was observed.

CONCLUSIONS

Our results are consistent with the hypothesis that NIDDM might be a potentially important systemic risk factor for knee and hip OA, but chance cannot be ruled out as an alternative explanation.

Central osteophytes in the knee: prevalence and association with cartilage defects on MR imaging

OBJECTIVE

The objective of this study was to determine the prevalence and location of central osteophytes in patients referred for MR imaging of the knee and the relationship of central osteophytes to articular cartilage defects, marginal osteophytes, meniscal tears, and anterior cruciate ligament tears as seen on MR imaging.

MATERIALS AND METHODS

Two hundred consecutive patients referred for MR imaging of the knee were evaluated for central osteophytes, articular cartilage defects, marginal osteophytes, meniscal tears, and anterior cruciate ligament tears. A 1.5-T scanner was used, and assessments were made by consensus of two experienced musculoskeletal radiologists. Seven patients were excluded, leaving 193 patients in the study population.

RESULTS

The prevalence of central osteophytes in the knee was 15% (35 central osteophytes in 29 patients). Patients with central osteophytes were older (mean age, 52 years versus 38 years), weighed more (mean weight, 204 lb [92 kg] versus 174 lb [78 kg]), had more articular cartilage defects (mean, 4.3 versus 1.3), and had more marginal osteophytes (mean, 3.9 versus 1.1) than patients without central osteophytes (p < 0.0001, Student's t test). Patients with central osteophytes were more likely to have a meniscal tear (p = 0.004, chi-square test), but they were not more likely to have an anterior cruciate ligament tear. All central osteophytes were associated with articular cartilage defects at the same location, which were full or near-full thickness on MR imaging for 32 of 35 central osteophytes.

CONCLUSION

Central osteophytes are common in patients referred for MR imaging of the knee. When central osteophytes are seen in the knee there is a high likelihood of an associated full thickness or near-full thickness articular cartilage defect.

The relation between cartilage damage and osteophyte size in a murine model for osteoarthritis in the knee

The aim of this study was to investigate the relationship between location and size of osteophytes and cartilage loss in an instability-induced experimental model for osteoarthritis. Osteoarthritis was induced in murine knee joints by injection of highly purified bacterial collagenase, causing joint instability. The size of the osteophytes and the cartilage loss were measured at different locations in the joint using image analysis on histological sections of total kees. Cartilage damage did not occur without osteophytes. Osteophytes were located on both medial and lateral sides, independent of the location of cartilage damage, but the size of the osteophytes was related to the amount of cartilage damage on the corresponding side. Cartilage loss on the lateral tibial plateau correlated well with the size of lateral osteophytes, in particular with the osteophyte at the margin of the lateral tibial plateau. Cartilage loss on the medial tibial plateau appeared to have a good correlation with the size of medial osteophytes, which was most pronounced for the osteophyte on the medial margin of the tibial plateau. This side-specific correlation between cartilage damage and osteophyte formation suggests compartmentalization of the osteoarthritic process.

Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study

OBJECTIVE

To examine the possible inverse relationship between osteoporosis and osteoarthritis (OA) by evaluating the association between bone mineral density (BMD) and knee OA in the Framingham Study cohort.

METHODS

Of the 1,154 Framingham Study cohort subjects in whom BMD measurements were obtained at biennial examination 20, 932 (81%) had had knee OA assessed during the Framingham Knee OA Study 4 years earlier. BMD of the proximal femur and radius was measured by densitometry. Knee OA was assessed from a weight-bearing anteroposterior radiography and graded on a scale of 0 (no OA) to 4 (severe OA). Osteophytes and joint space narrowing were also evaluated separately. Linear regression was used to test the association of BMD with knee OA, with osteophytes, and with joint space narrowing, after adjustment for age, body mass index, and mean number of cigarettes smoked per day.

RESULTS

The subjects included 572 women and 360 men with an age range of 63-91 years (mean 71 years). Of these, 351 had no OA, 269 had grade 1 OA, 170 had grade 2 OA, 93 had grade 3 OA, and 49 had grade 4 OA. Mean femoral BMD at the 3 proximal femur sites was 5-9% higher in men and women with either grade 1, grade 2, or grade 3 knee OA, compared with those with no knee OA (P < 0.0001). Mean femoral BMD in those with grade 4 OA was not higher than in those with no OA. Radius BMD was not associated with knee OA in subjects of either sex. Women with osteophytes had higher BMD compared with women with no osteophytes. Mean BMD did not differ across levels of joint space narrowing.

CONCLUSION

We conclude that, among women, femoral BMD is higher in those with osteophytosis of the knee, and BMD is not necessarily associated with joint space narrowing.