The controversial relationship between osteoarthritis and osteoporosis: an update on hand subtypes

Current Epidemiology and Risk Factors for the Development of Hand Osteoarthritis

PURPOSE OF REVIEW

Hand osteoarthritis (hand OA), the most common peripheral arthritis in the world, is less studied than osteoarthritis (OA) of the knee and hip. However, it is uniquely situated to offer novel insight into OA as a disease process by removing weight-bearing as a confounder of systemic disease mechanisms. Here we review the epidemiology of hand OA and key risk factors for its development.

RECENT FINDINGS

Mounting evidence points to obesity as an important risk factor for hand OA development, with new evidence implicating a role for leptin and serum fatty acids. Disease progression in hand OA and specifically the erosive OA subtype may be associated with diabetes. New evidence supports an association between cardiovascular disease progression and symptomatic hand OA. Alcohol use may be associated with increased synovitis and erosive hand OA. Differences in ethnical distributions of hand OA have become more apparent, with a lower prevalence in Black patients compared to White patients. Novel genetic insights implicating the WNT gene pathway and IL-1β have led to novel potential targets in hand OA pathogenesis. Hand OA is a heterogeneous disease with many modifiable and non-modifiable risk factors that can determine disease severity and shed light on disease pathogenesis.

Correlation of osteoarthritis or rheumatoid arthritis with bone mineral density in adults aged 20-59 years

Background

It is reported that osteoporosis commonly occurs among patients with rheumatoid arthritis (RA), whereas the association between osteoporosis and osteoarthritis (OA) remains controversial. Our aim in this study was to investigate the association between BMD, as a marker of osteoporosis, and OA and RA among adults 20−59 years of age, using a population-based sample from the National Health and Nutrition Examination Survey (NHANES).

Methods

Our analysis was based on the NHANES data collected between 2011 and 2018. Data regarding arthritis status and the type of arthritis (OA or RA) were obtained from questionnaires. Lumbar BMD was measured by dual-energy X-ray absorptiometry. The association between OA, RA, and lumbar BMD was evaluated using logistic regression models. Subgroup analyses, stratified by gender and race, were performed. The association between duration of arthritis and lumbar BMD was also investigated.

Results

A total of 11,094 adults were included in our study. Compared to the non-arthritis group, participants with OA had a higher lumbar BMD (β = 0.023, 95% CI 0.011–0.035), with no significant association between lumbar BMD and RA (β = 0.014, 95% CI − 0.003 to 0.031). On subgroup analyses stratified by gender, males with OA had a higher lumbar BMD compared to those without OA (β = 0.047, 95% CI 0.028–0.066). In females, OA was not associated with lumbar BMD (β = 0.007, 95% CI − 0.008 to 0.021). There was no association between lumbar BMD and RA in both males (β = 0.023, 95% CI − 0.003 to 0.048) and females (β = 0.008, 95% CI − 0.015 to 0.031). Duration of arthritis was not associated with lumbar BMD for both OA (β = − 0.0001, 95% CI − 0.0017 to 0.0015) and RA (β = 0.0006, 95% CI − 0.0012 to 0.0025).

Conclusions

Lumbar BMD was associated with OA but not with RA. While a higher lumbar BMD was associated with OA in males, but not in females. Our findings may improve our understanding between OA, RA, and bone health.

Decreased trabecular bone deterioration of proximal tibiae and lumbar vertebrae in postmenopausal women with osteoarthritis

Osteoporosis and osteoarthritis (OA) are two common age-related skeletal disorders, which are associated with substantial morbidity and disability, particularly among elderly women. The present study was performed to investigate the trabecular bone deterioration of proximal tibiae and lumbar vertebrae in postmenopausal women with OA. The results demonstrated that the histomorphometric section of trabecular bone below the growth plate was markedly different between the healthy control and OA group. However, the loss of trabecular bone underneath the growth plate in the healthy control group was significantly worse than that of the OA group. Hematoxylin and eosin staining demonstrated the increased disconnection and separation of the trabecular bone network as well as the reduction of trabecular bone mass of primary and secondary spongiosa throughout the proximal metaphysis of tibia in the healthy control compared to the OA group; similar results were found when the same experiment was repeated on the lumbar vertebrae of healthy control subjects and OA patients from postmenopausal women. The biological properties of trabecular bone in the proximal tibia and lumbar vertebrae were measured in postmenopausal women with OA. Spearman's rank correlation analysis revealed that the bone volume fraction was both positively correlated with radiographic severity and Western Ontario McMaster University Osteoarthritis Index scores in in the proximal tibia and lumbar vertebrae from postmenopausal women with OA. In conclusion, the structural properties of the proximal tibia and lumbar vertebrae supported that an inverse correlation existed between postmenopausal women with OA and healthy controls. Moreover, there is an important protective mechanism of OA on trabecular microstructure in proximal tibiae and lumbar vertebrae from postmenopausal women.

Erosive osteoarthritis: A systematic analysis of definitions used in the literature

BACKGROUND

Erosive osteoarthritis (EOA) is a commonly invoked diagnosis representing an important variant of hand osteoarthritis (OA). There is increasing literature on the prevalence, risk factors, etiology, and management of EOA.

METHODS

We systematically reviewed the literature to assess variability in the diagnostic definitions used to define EOA in these studies.

RESULTS

We reviewed 336 articles and found 62 articles citing diagnostic definitions for EOA. Radiographic appearance was the most commonly used criterion, but there was little agreement on the details or extent of the radiographic changes. Overall, 56 of the 62 studies included clinical features in the diagnostic definitions, yet these features varied considerably. Exclusion criteria were mentioned in 43 of the studies.

CONCLUSION

Based on the widely disparate definitions of EOA, we urge caution in interpretation of this literature, and propose that further understanding of EOA will require consensus on its definition.