The association of anthropometric measures and osteoarthritis knee in non-obese subjects: a cross sectional study

Causal associations of anthropometric measurements with osteoarthritis: A Mendelian randomization study

OBJECTIVE

We believe that there is a causal relationship between waist circumference and knee osteoarthritis. To confirm the hypothesis, we have conducted this study.

METHODS

Genetic variants associated with the five anthropometric variables were obtained from previous large-scale genomewide association studies. Summary-level data on osteoarthritis were obtained from the UK Biobank. The univariable and multivariable MR framework were used to evaluate the associations. The two-sided p value was considered to be statistically significant at 0.01 (where p = 0.05/5) after Bonferroni correction for the five exposure variables.

RESULTS

In the univariable MR, there was evidence of a detrimental effect of height, weight, BMI, waist circumference, and hip circumference on osteoarthritis risk in the main IVW analyses (height: OR 1.115, 95% CI 1.054-1.180; weight: OR 1.765, 95% CI 1.650-1.889; BMI: OR 1.952, 95%CI 1.841-2.068; waist circumference: OR 2.140, 95% CI 1.994-2.296; hip circumference: OR 1.719, 95% CI 1.600-1.846). And the analyses on knee osteoarthritis and hip osteoarthritis yielded similar results. However, the multivariable MR showed that only waist circumference was causally associated with osteoarthritis, after adjusting for the confounding exposure effects (waist circumference: OR 1.877, 95% CI 1.286-2.739). Such association was also repeated in the analyses on knee osteoarthritis but not hip osteoarthritis.

CONCLUSION

Our study highlighted the causal associations between waist circumference and knee osteoarthritis risk.

Gender Differences in Osteoarthritis of Knee: An Indian Perspective

INTRODUCTION

The global burden of knee osteoarthritis (KOA) is on the rise with advancing age, as life expectancy is improving worldwide. The literature shows a higher prevalence and incidence of KOA in women. The gender differences are seen not only in the developing world but also in the developed world. KOA at advanced stage can be quite disabling affecting the individuals' functioning capacity. The available treatment modalities can improve the quality of life significantly. The aim of this review is to study the gender differences in epidemiological and clinical aspects of KOA in Indian population.

METHODS

The keywords "knee osteoarthritis, Gender, India," "knee osteoarthritis, Sex, India," and "knee osteoarthritis, Prevalence, India" are used for data search for retrieving data from Indian studies in MEDLINE and Google Scholar. The broad inclusion criteria were clinical and radiological diagnosis of KOA, inclusive of both men and women and excluded articles with rheumatoid arthritis, inflammatory arthritis, and secondary causes of arthritis.

RESULTS

A total of 18 articles were found to fulfill the broad inclusive criteria. Majority of the articles were cross-sectional prevalence studies either done in a community setup or in tertiary care hospitals. The overall prevalence of KOA in these studies ranges from 27.1% to 66.1%, depending on the lower age limit of the study population. Postmenopausal women are affected more than premenopausal women. High body mass index, hypertension, diabetes mellitus, and osteoporosis were the common comorbid conditions.

DISCUSSION & CONCLUSION

The gender difference in the incidence and prevalence is seen in several cross-sectional studies and case series in the Indian literature. However, there is a paucity of data on clinical presentation, progression of the diseases, disability scoring at various stages of the KOA, and management.

The Association of an Increasing Waist Circumference and Risk of Incident Low Physical Function in Adults with Knee Osteoarthritis

OBJECTIVE

To investigate an 8-year change in waist circumference (WC) with the risk of incident low physical function over 1 year in adults with, or at risk of, knee osteoarthritis (OA).

METHODS

Data from the Osteoarthritis Initiative were used. Change in WC was measured from study enrollment (0 month) to the 96-month visit and classified as Increase (≥ 5cm gain) or Maintain (< 5cm gain). We identified World Health Organization (WHO) risk category based on WC at study enrollment as Large WC (males ≥ 102 cm, females ≥ 88 cm) or Small WC (males < 102 cm, females < 88 cm). The outcome was incident low physical function (≥ 28 Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at the 108-month visit. To investigate the association of the 8-year change in WC with the risk of low physical function, we calculated risk ratios (95% CI) and adjusted for potential confounders. We repeated the analyses stratified by the WHO disease risk category.

RESULTS

The Increase WC group had 1.43 (95% CI 1.04-1.96) times the risk of incident low physical function compared to adults in the Maintain WC group. Adults with a Large WC at baseline who increased WC had 1.55 (95% CI 1.00-2.37) times the risk of incident low physical function compared to those who maintained WC. Adults with a Small WC at baseline who increased WC had 1.97 (95% CI 0.84-4.63) times the risk compared to those who maintained WC.

CONCLUSION

Increasing WC increases the risk of incident low physical function in the following year. Maintaining WC may mitigate developing low physical function.

Visualization of Cartilage from Knee Joint Magnetic Resonance Images and Quantitative Assessment to Study the Effect of Age, Gender and Body Mass Index (BMI) in Progressive Osteoarthritis (OA)

Background:

Osteoarthritis (OA) is a degenerative disease of joint cartilage affecting the elderly people around the world. Visualization and quantification of cartilage is very much essential for the assessment of OA and rehabilitation of the affected people. Magnetic Resonance Imaging (MRI) is the most widely used imaging modality in the treatment of knee joint diseases. But there are many challenges in proper visualization and quantification of articular cartilage using MRI. Volume rendering and 3D visualization can provide an overview of anatomy and disease condition of knee joint. In this work, cartilage is segmented from knee joint MRI, visualized in 3D using Volume of Interest (VOI) approach.

Methods:

Visualization of cartilage helps in the assessment of cartilage degradation in diseased knee joints. Cartilage thickness and volume were quantified using image processing techniques in OA affected knee joints. Statistical analysis is carried out on processed data set consisting of 110 of knee joints which include male (56) and female (54) of normal (22) and different stages of OA (88). The differences in thickness and volume of cartilage were observed in cartilage in groups based on age, gender and BMI in normal and progressive OA knee joints.

Results:

The results show that size and volume of cartilage are found to be significantly low in OA as compared to normal knee joints. The cartilage thickness and volume is significantly low for people with age 50 years and above and Body Mass Index (BMI) equal and greater than 25. Cartilage volume correlates with the progression of the disease and can be used for the evaluation of the response to therapies.

Conclusion:

The developed methods can be used as helping tool in the assessment of cartilage degradation in OA affected knee joint patients and treatment planning.

Association of Metabolic Markers with self-reported osteoarthritis among middle-aged BMI-defined non-obese individuals: a cross-sectional study

BACKGROUND

Osteoarthritis (OA) is a chronic degenerative joint disease. While it is well-established that obesity affects OA through increased axial loading on the joint cartilage, the indirect effect of obesity through metabolic processes among the body mass index (BMI)-defined non-obese population, i.e., BMI < 30 kg/m2, is less known. Our goal was to evaluate the association of metabolic markers including body fat percentage (BF%), waist circumference, maximum weight gain during adulthood and serum creatinine with self-reported OA to establish if such measures offer additional information over BMI among the non-obese population between 40 and 65 years of age.

METHODS

Cross-sectional data from two cycles of the Canadian Health Measures Survey (CHMS) in 2007-2009 and 2009-2011 were analyzed. Sex-specific logistic regression models were developed to evaluate the association of self-reported OA with metabolic markers. Models were separately adjusted for age, BMI categories and serum creatinine, and a stratified analysis across BM categories was performed. In a secondary analysis, we evaluated the association of self-reported OA, cardiovascular diseases and hypertension across BF% categories.

RESULTS

Of 2462 individuals, 217 (8.8%) self-reported OA. After adjusting for age and BMI, those within BF%-defined overweight/obese category had 2.67 (95% CI: 1.32-3.51) and 2.11(95% CI: 1.38-3.21) times higher odds of reporting self-reported OA compared to those within BF%-defined athletic/acceptable category for females and males, respectively. BF% was also significantly associated with self-reported OA after adjusting for age and serum creatinine only among females (OR: 1.47, 95%CI: 1.12-1.84). Furthermore, among the BMI-defined overweight group, the age-adjusted odds of self-reported OA was significantly higher for overweight/obese BF% compared to athletic/acceptable BF% in both females and males. In a secondary analysis, we showed that the association of self-reported OA and hypertension/cardiovascular diseases is significantly higher among BF% overweight/obese (OR: 1.37, 95%CI: 1.19-3.09) compared to BF% athletic/acceptable (OR: 1.13, 95%CI: 0.87-2.82).

CONCLUSION

Our results provide corroborating evidence for a relationship between body fat and OA in a population-based study, while no significant independent correlates were found between other metabolic markers and OA prevalence. Future investigation on the longitudinal relationship between BF and OA among this sub-population may inform targeted prevention opportunities.

Factors associated with pain and osteoarthritis at the hip and knee in Great Britain's Olympians: a cross-sectional study

BACKGROUND

Knowledge of the epidemiology and potentially modifiable factors associated with musculoskeletal disease is an important first step in injury prevention among elite athletes.

AIM

This study investigated the prevalence and factors associated with pain and osteoarthritis (OA) at the hip and knee in Great Britain's (GB) Olympians aged 40 and older.

METHODS

This is a cross-sectional study. A survey was distributed to 2742 GB Olympians living in 30 countries. Of the 714 (26.0%) who responded, 605 were eligible for analysis (ie, aged 40 and older).

RESULTS

The prevalence of hip and knee pain was 22.4% and 26.1%, and of hip and knee OA was 11.1% and 14.2%, respectively. Using a multivariable model, injury was associated with OA at the hip (adjusted OR (aOR) 10.85; 95% CI 3.80 to 30.96) and knee (aOR 4.92; 95% CI 2.58 to 9.38), and pain at the hip (aOR 5.55; 95% CI 1.83 to 16.86) and knee (aOR 2.65; 95% CI 1.57 to 4.46). Widespread pain was associated with pain at the hip (aOR 7.63; 95% CI 1.84 to 31.72) and knee (aOR 4.77; 95% CI 1.58 to 14.41). Older age, obesity, knee malalignment, comorbidities, hypermobility and weight-bearing exercise were associated with hip and knee OA and/or pain.

CONCLUSIONS

This study detected an association between several factors and hip and knee pain/OA in retired GB Olympic athletes. These associations require further substantiation in retired athletes from other National Olympic Committees, and through comparison with the general population. Longitudinal follow-up is needed to investigate the factors associated with the onset and progression of OA/pain, and to determine if modulation of such factors can reduce the prevalence of pain and OA in this population.

Thigh Muscle Strength Predicts Knee Replacement Risk Independent of Radiographic Disease and Pain in Women: Data From the Osteoarthritis Initiative

OBJECTIVE

To determine whether thigh muscle strength predicts the risk of undergoing knee replacement surgery, independent of radiographic severity of osteoarthritis and pain.

METHODS

Participants in the Osteoarthritis Initiative study who had received a knee replacement between the 12-month and 60-month follow-up visits (cases) were each matched with 1 control subject (who did not receive a knee replacement over 60 months) for age, sex, height, body mass index, baseline radiographic stage, and location of joint space narrowing. Isometric knee extensor and flexor strength was recorded biennially. The strength examination prior to knee replacement (≤2 years) was termed time 0, that 2 years prior to time 0 was termed time -2, and that 4 years prior to time 0 was termed time -4. Muscle strength in patients and controls was compared using paired t-tests and conditional logistic regression analysis adjusted for pain.

RESULTS

One hundred thirty-six participants (60% women, mean ± SD age 65 ± 9 years, body mass index 29 ± 4 kg/m(2) ) received a knee replacement during follow-up, had strength data for at least time 0, and had a matched control. Knee extensor strength at time 0 (primary outcome measure) was significantly lower in female patients compared with controls (P < 0.001, pain-adjusted odds ratio [ORadj ] 1.72, 95% confidence interval 1.16-2.56), but no significant difference was observed in men. Results were similar for knee flexor strength at time 0 and for longitudinal change in extensor and flexor strength between time -2 and time 0. Thigh muscle strength at time -2 or time -4, or change between time -4 and time -2, did not predict the risk of undergoing knee replacement surgery in men or women.

CONCLUSION

Thigh muscle strength predicted the risk of undergoing knee replacement surgery in women, but not in men. The results of this study may identify a window during which the risk of undergoing knee replacement surgery in women can be modified.

Mediating role of body mass index in knee osteoarthritis

Objective

This study explores the role of knee circumference, body mass index (BMI), and range of motion (ROM) in predicting knee osteoarthritis (KOA). The objective is to elucidate the mediating role of BMI in influencing the relationship between age, knee circumference and pain in knee osteoarthritis, as measured with the help of the knee outcome survey (KOS) questionnaire.

Methods

The design used in this study was causal comparative. The study consisted of 66 patients with symptomatic KOA and 60 matched asymptomatic individuals.

Result

BMI was significantly and positively correlated with both pain and knee girth for the symptomatic KOA group. This finding signifies a relationship between KOA and other indicators, such as age and knee circumference.

Conclusions

The results of the study would indicate an important milestone in clinical rehabilitation, especially for physical therapists, enabling them to plan, modify, and design interventions to improve the health status of KOA patients.

The impact of waist circumference on function and physical activity in older adults: longitudinal observational data from the osteoarthritis initiative

Background

We previously demonstrated that BMI is associated with functional decline and reduced quality of life. While BMI in older adults is fraught with challenges, waist circumference (WC) is a marker of visceral adiposity that can also predict mortality. However, its association with function and quality of life in older adults is not well understood and hence we sought to examine the impact of WC on six-year outcomes.

Methods

We identified adults aged ≥60 years from the longitudinal Osteoarthritis Initiative and stratified the cohort into quartiles based on WC. Our primary outcome measures of function at six year follow-up included: self-reported quality of life [Short Form-12 (SF-12)], physical function [Physical Activity Scale for the Elderly (PASE)] and disability [Late-life Disability Index (LLDI)]. Linear regression analyses predicted 6-year outcomes based on WC quartile category (lowest = referent), adjusted for age, sex, race, education, knee pain, smoking status, a modified Charlson co-morbidity index and baseline scores, where available.

Results

We identified 2,182 subjects meeting our inclusion criteria and stratified the study cohort by quartiles of WC. Mean age ranged from 67.5-68.7 years, 60-71% were female and 80-86% were white. The highest WC quartile compared to 50-75th, 25-50th or lowest quartile, was associated with a greater number of medications (4.3, 4.0, 3.6 and 3.4 [p < 0.001]), lower gait speeds (1.23, 1.27, 1.32, and 1.34 m/s[p < 0.001]), higher rates of knee osteoarthritis (70.2, 62.2, 60.2, 48.6;p < 0.001), higher Charlson co-morbidity scores and greater knee pain (WOMAC scores) (all p < 0.001). At follow-up, adjusted SF-12 physical function subscale and PASE scores, were lowest in the highest WC quartile as compared to the 50-75%, 25-50%, and lowest quartiles [(SF-12 scores: 45.5, 46.7, 47.6, and 47.9), and (PASE scores: 109.6, 128.7, 126.6, and 131.0). The LLDI limitation subscale for disability demonstrated lower scores in the high WC quartile as opposed to the referent group.

Conclusions

Elevated WC is associated with lower quality of life, a decline in physical function, and a slightly higher risk of disability over time. Intervention studies are needed to prevent functional decline in this high-risk population.

Correlation of Self-Reported Questionnaire (KOOS) with Some Objective Measures in Primary OA Knee Patients

Purpose. Objective of the present study was to see the correlation of subjectively measured KOOS questionnaire with objectively measured 6-minute walk test (6-MWT), age, height, weight, and BMI. Participants. 251 subjects with OA knee based on American College of Rheumatology criteria. Methods. After passing inclusion and exclusion criteria, the following parameters were recorded: age, height, weight, and BMI. Then subjects were asked to fill KOOS questionnaire; then all subjects were asked to do self-paced walk for 6 minutes. Analysis. Spearman rank test was done to see the correlation. Significant level was set at P < 0.05. Results. 6-MWT had a weak correlation with KOOS-ADL (rho 0.461) and strong correlation with KOOS-symptom, KOOS-pain, and KOOS-sports and very strong correlation with KOOS-QOL. BMI had a strong correlation with KOOS-pain, KOOS-symptom, KOOS-ADL, and KOOS-sports and very strong correlation with KOOS-QOL. Weight had a weak correlation with KOOS-symptom, KOOS-ADL, and KOOS-sports and strong correlation with KOOS-pain and KOOS-QOL. All the above values were significant with P < 0.001. Conclusion. KOOS is strongly positively correlated with 6-MWT and negatively correlated with BMI. Its correlation strength has decreased with weight.

A survey of recently published papers on orthopedics in the Brazilian scientific press

This paper is a review of articles published in Brazilian scientific periodicals in recent years. Its main purpose is to bring to the attention of the readership of Acta Ortopedica Brasileira original contributions to the field published in non-specialized journals. We hope that this will serve as a general scientific update for readers. The review includes works published in six ISI indexed non-orthopedic journals, following a literature search conducted in fourteen such journals.