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Beynon RA, Saunders FR, Ebsim R, Frysz M, Faber BG, Gregory JS, Lindner C, Sarmanova A, Aspden RM, Harvey NC, Cootes T, Tobias JH. Dual-energy X-ray absorptiometry derived knee shape may provide a useful imaging biomarker for predicting total knee replacement: Findings from a study of 37,843 people in UK Biobank. Osteoarthr Cartil Open 2024; 6:100468. [PMID: 38655015 PMCID: PMC11035060 DOI: 10.1016/j.ocarto.2024.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Objective We aimed to create an imaging biomarker for knee shape using knee dual-energy x-ray absorptiometry (DXA) scans and investigate its potential association with subsequent total knee replacement (TKR), independently of radiographic features of knee osteoarthritis and established risk factors. Methods Using a 129-point statistical shape model, knee shape (expressed as a B-score) and minimum joint space width (mJSW) of the medial joint compartment (binarized as above or below the first quartile) were derived. Osteophytes were manually graded in a subset of images and an overall score was assigned. Cox proportional hazards models were used to examine the associations of B-score, mJSW and osteophyte score with TKR risk, adjusting for age, sex, height and weight. Results The analysis included 37,843 individuals (mean age 63.7 years). In adjusted models, B-score was associated with TKR: each unit increase in B-score, reflecting one standard deviation from the mean healthy shape, corresponded to a hazard ratio (HR) of 2.25 (2.08, 2.43), while a lower mJSW had a HR of 2.28 (1.88, 2.77). Among the 6719 images scored for osteophytes, mJSW was replaced by osteophyte score in the most strongly predictive model for TKR. In ROC analyses, a model combining B-score, osteophyte score, and demographics outperformed a model including demographics alone (AUC = 0.87 vs 0.73). Conclusions Using statistical shape modelling, we derived a DXA-based imaging biomarker for knee shape that was associated with kOA progression. When combined with osteophytes and demographic data, this biomarker may help identify individuals at high risk of TKR, facilitating targeted interventions.
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Affiliation(s)
- Rhona A. Beynon
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
| | - Fiona R. Saunders
- University of Aberdeen, Centre for Arthritis and Musculoskeletal Health, Aberdeen, United Kingdom
| | - Raja Ebsim
- The University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom
| | - Monika Frysz
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- University of Bristol, Medical Research Council Integrative Epidemiology Unit, Bristol, United Kingdom
| | - Benjamin G. Faber
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- University of Bristol, Medical Research Council Integrative Epidemiology Unit, Bristol, United Kingdom
| | - Jennifer S. Gregory
- University of Aberdeen, Centre for Arthritis and Musculoskeletal Health, Aberdeen, United Kingdom
| | - Claudia Lindner
- The University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom
| | - Aliya Sarmanova
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
| | - Richard M. Aspden
- University of Aberdeen, Centre for Arthritis and Musculoskeletal Health, Aberdeen, United Kingdom
| | - Nicholas C. Harvey
- University of Southampton, MRC Lifecourse Epidemiology Centre, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Timothy Cootes
- The University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom
| | - Jonathan H. Tobias
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- University of Bristol, Medical Research Council Integrative Epidemiology Unit, Bristol, United Kingdom
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Tobias JH, Nethander M, Faber BG, Heppenstall SV, Ebsim R, Cootes T, Lindner C, Saunders FR, Gregory JS, Aspden RM, Harvey NC, Kemp JP, Frysz M, Ohlsson C. Femoral neck width genetic risk score is a novel independent risk factor for hip fractures. J Bone Miner Res 2024; 39:241-251. [PMID: 38477772 DOI: 10.1093/jbmr/zjae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/02/2023] [Accepted: 11/09/2023] [Indexed: 03/14/2024]
Abstract
Femoral neck width (FNW) derived from DXA scans may provide a useful adjunct to hip fracture prediction. Therefore, we investigated whether FNW is related to hip fracture risk independently of femoral neck bone mineral density (FN-BMD), using a genetic approach. FNW was derived from points automatically placed on the proximal femur using hip DXA scans from 38 150 individuals (mean age 63.8 yr, 48.0% males) in UK Biobank (UKB). Genome-wide association study (GWAS) identified 71 independent genome-wide significant FNW SNPs, comprising genes involved in cartilage differentiation, hedgehog, skeletal development, in contrast to SNPs identified by FN-BMD GWAS which primarily comprised runx1/Wnt signaling genes (MAGMA gene set analyses). FNW and FN-BMD SNPs were used to generate genetic instruments for multivariable Mendelian randomization. Greater genetically determined FNW increased risk of all hip fractures (odds ratio [OR] 1.53; 95% CI, 1.29-1.82 per SD increase) and femoral neck fractures (OR 1.58;1.30-1.92), but not trochanteric or forearm fractures. In contrast, greater genetically determined FN-BMD decreased fracture risk at all 4 sites. FNW and FN-BMD SNPs were also used to generate genetic risk scores (GRSs), which were examined in relation to incident hip fracture in UKB (excluding the FNW GWAS population; n = 338 742, 3222 cases) using a Cox proportional hazards model. FNW GRS was associated with increased risk of all incident hip fractures (HR 1.08;1.05-1.12) and femoral neck fractures (hazard ratio [HR] 1.10;1.06-1.15), but not trochanteric fractures, whereas FN-BMD GRS was associated with reduced risk of all hip fracture types. We conclude that the underlying biology regulating FNW and FN-BMD differs, and that DXA-derived FNW is causally related to hip fractures independently of FN-BMD, adding information beyond FN-BMD for hip fracture prediction. Hence, FNW derived from DXA analyses or a FNW GRS may contribute clinically useful information beyond FN-BMD for hip fracture prediction.
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Affiliation(s)
- Jonathan H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Southmead Hospital, University of Bristol, Bristol BS10 5NB, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Maria Nethander
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
- Bioinformatics and Data Center, Sahlgrenska Academy at University of Gothenburg, 40530 Gothenburg, Sweden
| | - Benjamin G Faber
- Musculoskeletal Research Unit, Translational Health Sciences, Southmead Hospital, University of Bristol, Bristol BS10 5NB, United Kingdom
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Sophie V Heppenstall
- Musculoskeletal Research Unit, Translational Health Sciences, Southmead Hospital, University of Bristol, Bristol BS10 5NB, United Kingdom
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Tim Cootes
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester M13 9PT, United Kingdom
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
| | - Jenny S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen AB24 3FX, United Kingdom
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton SO16 6YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - John P Kemp
- Mater Research Institute, University of Queensland, Brisbane QLD, Australia 4102
| | - Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Southmead Hospital, University of Bristol, Bristol BS10 5NB, United Kingdom
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Staines KA, Saunders FR, Ireland A, Aspden RM, Gregory JS, Hardy RJ, Cooper R. Associations between life course longitudinal growth and hip shapes at ages 60-64 years: evidence from the MRC National Survey of Health and Development. RMD Open 2024; 10:e003816. [PMID: 38599656 PMCID: PMC11015210 DOI: 10.1136/rmdopen-2023-003816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE We sought to examine associations between height gain across childhood and adolescence with hip shape in individuals aged 60-64 years from the Medical Research Council National Survey of Health and Development, a nationally representative British birth cohort. METHODS Height was measured at ages 2, 4, 6, 7, 11 and 15 years, and self-reported at age 20 years. 10 modes of variation in hip shape (HM1-10), described by statistical shape models, were previously ascertained from DXA images taken at ages 60-64 years. Associations between (1) height at each age; (2) Super-Imposition by Translation And Rotation (SITAR) growth curve variables of height size, tempo and velocity; and (3) height gain during specific periods of childhood and adolescence, and HM1-10 were tested. RESULTS Faster growth velocity was associated with a wider, flatter femoral head and neck, as described by positive scores for HM6 (regression coefficient 0.014; 95% CI 0.08 to 0.019; p<0.001) and HM7 (regression coefficient 0.07; 95% CI 0.002 to 0.013; p=0.009), and negative scores for HM10 (regression coefficient -0.006; 95% CI -0.011 to 0.00, p=0.04) and HM2 (males only, regression coefficient -0.017; 95% CI -0.026 to -0.09; p<0.001). Similar associations were observed with greater height size and later height tempo. Examination of height gains during specific periods of childhood and adolescence identified those during the adolescence period as being most consistently associated. CONCLUSION Our analyses suggest that individual growth patterns, particularly in the adolescent period, are associated with modest variations in hip shape at 60-64 years, which are consistent with features seen in osteoarthritis.
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Affiliation(s)
- Katherine Ann Staines
- Centre for Lifelong Health, School of Applied Sciences, University of Brighton, Brighton, UK
| | - Fiona R Saunders
- Centre for Arthritis & Musculoskeletal Health, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
| | - Alex Ireland
- Department of Life Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Richard M Aspden
- Centre for Arthritis & Musculoskeletal Health, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
| | - Jennifer S Gregory
- Centre for Arthritis & Musculoskeletal Health, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
| | - Rebecca J Hardy
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle, UK
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Heppenstall SV, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH, Frysz M, Faber BG. Hip geometric parameters are associated with radiographic and clinical hip osteoarthritis: Findings from a cross-sectional study in UK Biobank. Osteoarthritis Cartilage 2023; 31:1627-1635. [PMID: 37704099 PMCID: PMC7615936 DOI: 10.1016/j.joca.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine the extent to which geometric parameters derived from dual-energy x-ray absorptiometry (DXA) scans in the UK Biobank study are related to hip osteoarthritis (HOA) independently of sex, age and body size. DESIGN Femoral neck width (FNW), diameter of the femoral head (DFH) and hip axis length (HAL) were derived automatically from left hip DXA scans in UK Biobank using outline points placed around the hip by a machine-learning program. Correlations were calculated between geometric parameters, age, height, and weight. Logistic regression was used to examine the relationship of geometric parameters with radiographic HOA, hospital diagnosed HOA (HESOA), and Cox proportional hazards model to evaluate the relationship with total hip replacement (THR). Analyses were adjusted for sex, age, height, weight, and geometric parameters. RESULTS The study consisted of 40,312 participants. In age and sex-adjusted analyses, FNW, HAL and DFH were related to increased risk of radiographic HOA. In a model adjusted for age, sex, height, weight and other geometric parameters, both FNW and HAL retained independent relationships with radiographic HOA [FNW: odds ratios 2.38 (2.18-2.59), HAL: 1.25 (1.15-1.36)], while DFH was now protective [0.55 (0.50-0.61)]. Only FNW was independently related to HESOA [2.20 (1.80-2.68)] and THR [hazard ratios 2.51 (1.89-3.32)]. CONCLUSION Greater FNW and HAL were independently related to an increased risk of radiographic HOA, whereas greater DFH appeared to be protective. Greater FNW was independently associated with HESOA and THR. These results suggest that DXA-derived geometric parameters, particularly FNW, could help determine HOA and THR risk.
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Affiliation(s)
| | - R Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - F R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - C Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - T Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - M Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - B G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
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Zheng J, Frysz M, Faber BG, Lin H, Ebsim R, Ge J, Yong Y, Saunders FR, Gregory JS, Aspden RM, Harvey NC, Jiang BH, Cootes T, Lindner C, Gao X, Wang S, Tobias JH. Comparison between UK Biobank and Shanghai Changfeng suggests distinct hip morphology may contribute to ethnic differences in the prevalence of hip osteoarthritis. Osteoarthritis Cartilage 2023:S1063-4584(23)00958-5. [PMID: 37935324 DOI: 10.1016/j.joca.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTS Joint morphology is a risk factor for hip osteoarthritis (HOA) and could explain ethnic differences in HOA prevalence. Therefore, we aimed to compare the prevalence of radiographic HOA (rHOA) and hip morphology between the predominantly White UK Biobank (UKB) and exclusively Chinese Shanghai Changfeng (SC) cohorts. METHODS Left hip iDXA scans were used to quantify rHOA, from a combination of osteophytes (grade ≥1) and joint space narrowing (grade ≥1), and hip morphology. Using an 85-point Statistical Shape Model (SSM) we evaluated cam (alpha angle ≥60°) and pincer (lateral centre-edge angle (LCEA) ≥45°) morphology and acetabular dysplasia (LCEA <25°). Diameter of femoral head (DFH), femoral neck width (FNW), and hip axis length (HAL) were also obtained from these points. Results were adjusted for differences in age, height, and weight and stratified by sex. RESULTS Complete data were available for 5924 SC and 39,020 White UKB participants with mean ages of 63.4 and 63.7 years old. rHOA prevalence was considerably lower in female (2.2% versus 13.1%) and male (12.0% and 25.1%) SC compared to UKB participants. Cam morphology, rarely seen in females, was less common in SC compared with UKB males (6.3% versus 16.5%). Composite SSM modes, scaled to the same overall size, revealed SC participants to have a wider femoral head compared to UKB participants. FNW and HAL were smaller in SC compared to UKB, whereas DFH/FNW ratio was higher in SC. CONCLUSIONS rHOA prevalence is lower in Chinese compared with White individuals. Several differences in hip shape were observed, including frequency of cam morphology, FNW, and DFH/FNW ratio. These characteristics have previously been identified as risk factors for HOA and may contribute to observed ethnic differences in HOA prevalence.
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Affiliation(s)
- Jiayi Zheng
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China; Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Jieyu Ge
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yanling Yong
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bing-Hua Jiang
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China; Fudan Institute for Metabolic Diseases, Shanghai, China.
| | - Sijia Wang
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
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Faber BG, Frysz M, Boer CG, Evans DS, Ebsim R, Flynn KA, Lundberg M, Southam L, Hartley A, Saunders FR, Lindner C, Gregory JS, Aspden RM, Lane NE, Harvey NC, Evans DM, Zeggini E, Davey Smith G, Cootes T, Van Meurs J, Kemp JP, Tobias JH. The identification of distinct protective and susceptibility mechanisms for hip osteoarthritis: findings from a genome-wide association study meta-analysis of minimum joint space width and Mendelian randomisation cluster analyses. EBioMedicine 2023; 95:104759. [PMID: 37619450 PMCID: PMC10470292 DOI: 10.1016/j.ebiom.2023.104759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Hip minimum joint space width (mJSW) provides a proxy for cartilage thickness. This study aimed to conduct a genome-wide association study (GWAS) of mJSW to (i) identify new genetic determinants of mJSW and (ii) identify which mJSW loci convey hip osteoarthritis (HOA) risk and would therefore be of therapeutic interest. METHODS GWAS meta-analysis of hip mJSW derived from plain X-rays and DXA was performed, stratified by sex and adjusted for age and ancestry principal components. Mendelian randomisation (MR) and cluster analyses were used to examine causal effect of mJSW on HOA. FINDINGS 50,745 individuals were included in the meta-analysis. 42 SNPs, which mapped to 39 loci, were identified. Mendelian randomisation (MR) revealed little evidence of a causal effect of mJSW on HOA (ORIVW 0.98 [95% CI 0.82-1.18]). However, MR-Clust analysis suggested the null MR estimates reflected the net effect of two distinct causal mechanisms cancelling each other out, one of which was protective, whereas the other increased HOA susceptibility. For the latter mechanism, all loci were positively associated with height, suggesting mechanisms leading to greater height and mJSW increase the risk of HOA in later life. INTERPRETATIONS One group of mJSW loci reduce HOA risk via increased mJSW, suggesting possible utility as targets for chondroprotective therapies. The second group of mJSW loci increased HOA risk, despite increasing mJSW, but were also positively related to height, suggesting they contribute to HOA risk via a growth-related mechanism. FUNDING Primarily funded by the Medical Research Council and Wellcome Trust.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK.
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Cindy G Boer
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, USA
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - Kaitlyn A Flynn
- Mater Research Institute, The University of Queensland, Woolloongabba, Australia; Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Mischa Lundberg
- UQ Frazer Institute, The University of Queensland, Woolloongabba, Australia
| | - Lorraine Southam
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Centre for Environmental Health, Neuherberg, Germany
| | - April Hartley
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California Davis, Sacramento, USA
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - David M Evans
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK; Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia; UQ Frazer Institute, The University of Queensland, Woolloongabba, Australia
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Centre for Environmental Health, Neuherberg, Germany; Technical University of Munich and Klinikum Rechts der Isar, TUM School of Medicine, Germany
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - Joyce Van Meurs
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - John P Kemp
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK; Mater Research Institute, The University of Queensland, Woolloongabba, Australia; Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
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7
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Faber BG, Frysz M, Hartley AE, Ebsim R, Boer CG, Saunders FR, Gregory JS, Aspden RM, Harvey NC, Southam L, Giles W, Le Maitre CL, Wilkinson JM, van Meurs JBJ, Zeggini E, Cootes T, Lindner C, Kemp JP, Davey Smith G, Tobias JH. A Genome-Wide Association Study Meta-Analysis of Alpha Angle Suggests Cam-Type Morphology May Be a Specific Feature of Hip Osteoarthritis in Older Adults. Arthritis Rheumatol 2023; 75:900-909. [PMID: 36662418 PMCID: PMC10374163 DOI: 10.1002/art.42451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine the genetic architecture of cam morphology using alpha angle (AA) as a proxy measure and conduct an AA genome-wide association study (GWAS) followed by Mendelian randomization (MR) to evaluate its causal relationship with hip osteoarthritis (OA). METHODS Observational analyses examined associations between AA measurements derived from hip dual x-ray absorptiometry (DXA) scans from the UK Biobank study and radiographic hip OA outcomes and subsequent total hip replacement. Following these analyses, an AA GWAS meta-analysis was performed (N = 44,214) using AA measurements previously derived in the Rotterdam Study. Linkage disequilibrium score regression assessed the genetic correlation between AA and hip OA. Genetic associations considered significant (P < 5 × 10-8 ) were used as AA genetic instrument for 2-sample MR analysis. RESULTS DXA-derived AA showed expected associations between AA and radiographic hip OA (adjusted odds ratio [OR] 1.63 [95% confidence interval (95% CI) 1.58, 1.67]) and between AA and total hip replacement (adjusted hazard ratio 1.45 [95% CI 1.33, 1.59]) in the UK Biobank study cohort. The heritability of AA was 10%, and AA had a moderate genetic correlation with hip OA (rg = 0.26 [95% CI 0.10, 0.43]). Eight independent genetic signals were associated with AA. Two-sample MR provided weak evidence of causal effects of AA on hip OA risk (inverse variance weighted OR 1.84 [95% CI 1.14, 2.96], P = 0.01). In contrast, genetic predisposition for hip OA had stronger evidence of a causal effect on increased AA (inverse variance weighted β = 0.09 [95% CI 0.04, 0.13], P = 4.58 × 10-5 ). CONCLUSION Expected observational associations between AA and related clinical outcomes provided face validity for the DXA-derived AA measurements. Evidence of bidirectional associations between AA and hip OA, particularly for risk of hip OA on AA, suggests that hip shape modeling secondary to a genetic predisposition to hip OA contributes to the well-established relationship between hip OA and cam morphology in older adults.
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Affiliation(s)
- Benjamin G. Faber
- Musculoskeletal Research Unit, Translational Health Sciences, and Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, and Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - April E. Hartley
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data ScienceThe University of ManchesterUK
| | - Cindy G. Boer
- Department of Internal Medicine, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Fiona R. Saunders
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenUK
| | | | - Richard M. Aspden
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenUK
| | - Nicholas C. Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK, and NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustUK
| | - Lorraine Southam
- Institute of Translational Genomics, Helmholtz Zentrum München–German Research Center for Environmental HealthNeuherbergGermany
| | - William Giles
- Department of Oncology and MetabolismThe University of SheffieldUK
| | | | | | - Joyce B. J. van Meurs
- Department of Internal Medicine and Department of Orthopaedics & Sports Medicine, Erasmus MCRotterdamThe Netherlands
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany, and TUM School of MedicineTechnical University of Munich and Klinikum Rechts der IsarGermany
| | - Timothy Cootes
- Division of Informatics, Imaging and Data ScienceThe University of ManchesterUK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data ScienceThe University of ManchesterUK
| | - John P. Kemp
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, UK, and The University of Queensland Diamantina Institute and Institute for Molecular Bioscience, The University of QueenslandQueenslandAustralia
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Jonathan H. Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, and Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
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8
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Nguyen USDT, Saunders FR, Martin KR. Sex Difference in OA: Should We Blame Estrogen? Eur J Rheumatol 2023. [PMID: 36688799 DOI: 10.5152/eurjrheum.2023.20193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability, not only in the United States but also worldwide. The burden of OA is higher in women than in men. Estrogen as a possible explanation for observed sex differences in OA has not been definitively established. The purpose of this review was to summarize the results from studies of estrogen, estrogen depletion and treatment, and their impact on knee, hip, hand, and spine OA. We conducted a targeted review of the literature using PubMed. Although several studies show that hormone replacement therapy has the potential to be protective of OA for some joints, there are studies that showed no protective effect or even adverse effect. Taken together, the evidence for the protective effect of estrogen therapy depends on OA joint, OA outcome, and study design. Although this area has been studied for decades, more exclusively since the 1990s, there is a lack of high-quality experimental research in this topic. The lack of definitive conclusion on whether estrogen can play a role in the development in OA of either the knee, hip, spine, or hand is often in part due to the noncomparability of studies existing within the literature. Differences in diagnostic criteria, imaging modalities, populations studied, study designs, and outcome measures, as well as random error, have all contributed to inconclusive evidence. Future research on the role of estrogen in OA is needed, particularly as global demographic shifts in increasing overweight/obesity prevalence and ageing populations may contribute to widening OA-related health inequalities.
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Affiliation(s)
- Uyen-Sa D T Nguyen
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, United States
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Kathryn R Martin
- Academic Primary Care, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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Frysz M, Faber BG, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH. Machine Learning-Derived Acetabular Dysplasia and Cam Morphology Are Features of Severe Hip Osteoarthritis: Findings From UK Biobank. J Bone Miner Res 2022; 37:1720-1732. [PMID: 35811326 PMCID: PMC9545366 DOI: 10.1002/jbmr.4649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modeling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip dual-energy X-ray absorptiometry (DXA) scans. Statistical shape modeling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) to severe (grade ≥3) rHOA, hospital-diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top 10 hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral center-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology, respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital-diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital-diagnosed HOA, and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Benjamin G Faber
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospitals Southampton NHS Foundation TrustSouthamptonUK
| | - Tim Cootes
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Jon H Tobias
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
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10
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Faber BG, Ebsim R, Saunders FR, Frysz M, Lindner C, Gregory JS, Aspden RM, Harvey NC, Davey Smith G, Cootes T, Tobias JH. A novel semi-automated classifier of hip osteoarthritis on DXA images shows expected relationships with clinical outcomes in UK Biobank. Rheumatology (Oxford) 2022; 61:3586-3595. [PMID: 34919677 PMCID: PMC9434243 DOI: 10.1093/rheumatology/keab927] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Conventional scoring methods for radiographic hip OA (rHOA) are subjective and show inconsistent relationships with clinical outcomes. To provide a more objective rHOA scoring method, we aimed to develop a semi-automated classifier based on DXA images and confirm its relationships with clinical outcomes. METHODS Hip DXAs in UK Biobank (UKB) were marked up for osteophyte area from which acetabular, superior and inferior femoral head osteophyte grades were derived. Joint space narrowing (JSN) grade was obtained automatically from minimum joint space width (mJSW) measures. Clinical outcomes related to rHOA comprised hip pain, hospital diagnosed OA (HES OA) and total hip replacement. Logistic regression and Cox proportional hazard modelling were used to examine associations between overall rHOA grade (0-4; derived from combining osteophyte and JSN grades) and the clinical outcomes. RESULTS A toal of 40 340 individuals were included in the study (mean age 63.7), of whom 81.2% had no evidence of rHOA, while 18.8% had grade ≥1 rHOA. Grade ≥1 osteophytes at each location and JSN were associated with hip pain, HES OA and total hip replacement. Associations with all three clinical outcomes increased progressively according to rHOA grade, with grade 4 rHOA and total hip replacement showing the strongest association [57.70 (38.08-87.44)]. CONCLUSIONS Our novel semi-automated tool provides a useful means for classifying rHOA on hip DXAs, given its strong and progressive relationships with clinical outcomes. These findings suggest DXA scanning can be used to classify rHOA in large DXA-based cohort studies supporting further research, with the future potential for population-based screening.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen
| | - Monika Frysz
- Musculoskeletal Research Unit
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester
| | - Jonathan H Tobias
- Musculoskeletal Research Unit
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
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Faber BG, Ebsim R, Saunders FR, Frysz M, Lindner C, Gregory JS, Aspden RM, Harvey NC, Smith GD, Cootes T, Tobias JH. OA20 Radiographic hip osteoarthritis classified semi-automatically on dual-energy x-ray absorptiometry scans is strongly predictive of total hip replacement: findings from UK Biobank. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac132.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Aims
Radiographic hip osteoarthritis (rHOA) is traditionally defined on hip x-rays, using subjective methods such as Kellgren-Lawrence scoring. Associations between subjective rHOA measures and symptoms are inconsistent. Applying digital tools to high-resolution dual-energy X-ray absorptiometry (DXA) scans, we aimed to develop a novel semi-automated classifier for rHOA and evaluate the face validity of the classifier based on relationships with hip pain, hospital diagnosed OA (HES OA), and risk of total hip replacement (THR).
Methods
Using hip DXAs in UK Biobank, osteophyte grades 0-3 were assigned based on manually measured osteophyte area. Minimum joint space width (mJSW) was automatically measured using outline points placed by a machine learning-based algorithm and then used to categorise individuals into joint space narrowing (JSN) grades 0-3. Osteophyte and JSN grades were combined, using a novel system giving greater to weight to osteophytes, to categorise individuals into rHOA grades 0-4. Logistic regression giving odds ratios (OR) was used to examine associations between rHOA grade and hip pain, and HES OA. Cox proportional hazard models giving hazard ratios (HR) were used to examine associations between rHOA grade and subsequent THR. Our adjusted model included age, sex, height and weight as covariates.
Results
40,340 individuals were included in the study (mean age 63.7 [range 44-82], 19294/21046 male/female). 32758 (81.2%) had rHOA grade 0, 4565 (11.3%) grade 1, 2317 (5.7%) grade 2, 543 (1.3%) grade 3, 157 (0.4%) grade 4, with all features of rHOA being more common in males than females. rHOA grades ≥2 were associated with all three clinical outcomes in both unadjusted and adjusted models, a clear dose-response relationship was seen with each increase in grade showing a large rise in OR/HRs (Table 1). Grade 4 rHOA was strongly predictive of THR (HR 57.70 [95%CI 38.08-87.44]).
Conclusion
We successfully applied a novel semi-automated classifier to over 40,000 individuals from UKB. The validity of our classifier was supported by the strong and progressive relationships observed between rHOA and hip pain, and HES OA and risk of THR. We conclude that hip DXAs provide a promising means of defining rHOA, with potential screening applications in the clinic.
Disclosure
B.G. Faber: None. R. Ebsim: None. F.R. Saunders: None. M. Frysz: None. C. Lindner: None. J.S. Gregory: None. R.M. Aspden: None. N.C. Harvey: None. G. Davey Smith: None. T. Cootes: None. J.H. Tobias: None.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UNITED KINGDOM
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UNITED KINGDOM
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UNITED KINGDOM
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UNITED KINGDOM
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UNITED KINGDOM
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UNITED KINGDOM
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UNITED KINGDOM
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
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Faber BG, Ebsim R, Saunders FR, Frysz M, Lindner C, Gregory JS, Aspden RM, Harvey NC, Smith GD, Cootes T, Tobias JH. Osteophyte size and location on hip DXA scans are associated with hip pain: Findings from a cross sectional study in UK Biobank. Bone 2021; 153:116146. [PMID: 34389476 PMCID: PMC8503366 DOI: 10.1016/j.bone.2021.116146] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE It remains unclear how the different features of radiographic hip osteoarthritis (rHOA) contribute to hip pain. We examined the relationship between rHOA, including its individual components, and hip pain using a novel dual-energy x-ray absorptiometry (DXA)-based method. METHODS Hip DXAs were obtained from UK Biobank. A novel automated method obtained minimum joint space width (mJSW) from points placed around the femoral head and acetabulum. Osteophyte areas at the lateral acetabulum, superior and inferior femoral head were derived manually. Semi-quantitative measures of osteophytes and joint space narrowing (JSN) were combined to define rHOA. Logistic regression was used to examine the relationships between these variables and hip pain, obtained via questionnaires. RESULTS 6807 hip DXAs were examined. rHOA was present in 353 (5.2%) individuals and was associated with hip pain [OR 2.42 (1.78-3.29)] and hospital diagnosed OA [6.01 (2.98-12.16)]. Total osteophyte area but not mJSW was associated with hip pain in mutually adjusted models [1.31 (1.23-1.39), 0.95 (0.87-1.04) respectively]. On the other hand, JSN as a categorical variable showed weak associations between grade ≥ 1 and grade ≥ 2 JSN with hip pain [1.30 (1.06-1.60), 1.80 (1.34-2.42) respectively]. Acetabular, superior and inferior femoral osteophyte areas were all independently associated with hip pain [1.13 (1.06-1.20), 1.13 (1.05-1.24), 1.10 (1.03-1.17) respectively]. CONCLUSION In this cohort, the relationship between rHOA and prevalent hip pain was explained by 2-dimensional osteophyte area, but not by the apparent mJSW. Osteophytes at different locations showed important, potentially independent, associations with hip pain, possibly reflecting the contribution of distinct biomechanical pathways.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Science, University of Manchester, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Science, University of Manchester, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Science, University of Manchester, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
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Faber BG, Ebsim R, Saunders FR, Frysz M, Gregory JS, Aspden RM, Harvey NC, Davey Smith G, Cootes T, Lindner C, Tobias JH. Cam morphology but neither acetabular dysplasia nor pincer morphology is associated with osteophytosis throughout the hip: findings from a cross-sectional study in UK Biobank. Osteoarthritis Cartilage 2021; 29:1521-1529. [PMID: 34419604 PMCID: PMC8547486 DOI: 10.1016/j.joca.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/23/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine whether acetabular dysplasia (AD), cam and/or pincer morphology are associated with radiographic hip osteoarthritis (rHOA) and hip pain in UK Biobank (UKB) and, if so, what distribution of osteophytes is observed. DESIGN Participants from UKB with a left hip dual-energy X-ray absorptiometry (DXA) scan had alpha angle (AA), lateral centre-edge angle (LCEA) and joint space narrowing (JSN) derived automatically. Cam and pincer morphology, and AD were defined using AA and LCEA. Osteophytes were measured manually and rHOA grades were calculated from JSN and osteophyte measures. Logistic regression was used to examine the relationships between these hip morphologies and rHOA, osteophytes, JSN, and hip pain. RESULTS 6,807 individuals were selected (mean age: 62.7; 3382/3425 males/females). Cam morphology was more prevalent in males than females (15.4% and 1.8% respectively). In males, cam morphology was associated with rHOA [OR 3.20 (95% CI 2.41-4.25)], JSN [1.53 (1.24-1.88)], and acetabular [1.87 (1.48-2.36)], superior [1.94 (1.45-2.57)] and inferior [4.75 (3.44-6.57)] femoral osteophytes, and hip pain [1.48 (1.05-2.09)]. Broadly similar associations were seen in females, but with weaker statistical evidence. Neither pincer morphology nor AD showed any associations with rHOA or hip pain. CONCLUSIONS Cam morphology was predominantly seen in males in whom it was associated with rHOA and hip pain. In males and females, cam morphology was associated with inferior femoral head osteophytes more strongly than those at the superior femoral head and acetabulum. Further studies are justified to characterise the biomechanical disturbances associated with cam morphology, underlying the observed osteophyte distribution.
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Affiliation(s)
- B G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
| | - R Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - F R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - M Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - J S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | - G Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - T Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - C Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
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14
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Faber BG, Ebsim R, Saunders FR, Frysz M, Davey Smith G, Cootes T, Tobias JH, Lindner C. Deriving alpha angle from anterior-posterior dual-energy x-ray absorptiometry scans: an automated and validated approach. Wellcome Open Res 2021; 6:60. [PMID: 36072553 PMCID: PMC9426635 DOI: 10.12688/wellcomeopenres.16656.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction: Alpha angle (AA) is a widely used measure of hip shape that is commonly used to define cam morphology, a bulging of the lateral aspect of the femoral head. Cam morphology has shown strong associations with hip osteoarthritis (OA) making the AA a clinically relevant measure. In both clinical practice and research studies, AA tends to be measured manually which can be inconsistent and time-consuming. Objective: We aimed to (i) develop an automated method of deriving AA from anterior-posterior dual-energy x-ray absorptiometry (DXA) scans; and (ii) validate this method against manual measures of AA. Methods: 6,807 individuals with left hip DXAs were selected from UK Biobank. Outline points were manually placed around the femoral head on 1,930 images before training a Random Forest-based algorithm to place the points on a further 4,877 images. An automatic method for calculating AA was written in Python 3 utilising these outline points. An iterative approach was taken to developing and validating the method, testing the automated measures against independent batches of manually measured images in sequential experiments. Results: Over the course of six experimental stages the concordance correlation coefficient, when comparing the automatic AA to manual measures of AA, improved from 0.28 [95% confidence interval 0.13-0.43] for the initial version to 0.88 [0.84-0.92] for the final version. The inter-rater kappa statistic comparing automatic versus manual measures of cam morphology, defined as AA ³≥60°, improved from 0.43 [80% agreement] for the initial version to 0.86 [94% agreement] for the final version. Conclusions: We have developed and validated an automated measure of AA from DXA scans, showing high agreement with manually measuring AA. The proposed method is available to the wider research community from Zenodo.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
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15
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Faber BG, Ebsim R, Saunders FR, Frysz M, Davey Smith G, Cootes T, Tobias JH, Lindner C. Deriving alpha angle from anterior-posterior dual-energy x-ray absorptiometry scans: an automated and validated approach. Wellcome Open Res 2021; 6:60. [PMID: 36072553 PMCID: PMC9426635 DOI: 10.12688/wellcomeopenres.16656.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction: Alpha angle (AA) is a widely used imaging measure of hip shape that is commonly used to define cam morphology, a bulging of the lateral aspect of the femoral head. Cam morphology has shown strong associations with hip osteoarthritis (OA) making the AA a clinically relevant measure. In both clinical practice and research studies, AA tends to be measured manually which can be inconsistent and time-consuming. Objective: We aimed to (i) develop an automated method of deriving AA from anterior-posterior dual-energy x-ray absorptiometry (DXA) scans; and (ii) validate this method against manual measures of AA. Methods: 6,807 individuals with left hip DXAs were selected from UK Biobank. Outline points were manually placed around the femoral head on 1,930 images before training a Random Forest-based algorithm to place the points on a further 4,877 images. An automatic method for calculating AA was written in Python 3 utilising these outline points. An iterative approach was taken to developing and validating the method, testing the automated measures against independent batches of manually measured images in sequential experiments. Results: Over the course of six experimental stages the concordance correlation coefficient, when comparing the automatic AA to manual measures of AA, improved from 0.28 [95% confidence interval 0.13-0.43] for the initial version to 0.88 [0.84-0.92] for the final version. The inter-rater kappa statistic comparing automatic versus manual measures of cam morphology, defined as AA ³≥60°, improved from 0.43 [80% agreement] for the initial version to 0.86 [94% agreement] for the final version. Conclusions: We have developed and validated an automated measure of AA from DXA scans, showing high agreement with manually measuring AA. The proposed method is available to the wider research community from Zenodo.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK.,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
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16
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Saunders FR, Gregory JS, Pavlova AV, Muthuri SG, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Cooper R, Ireland A. Motor development in infancy and spine shape in early old age: Findings from a British birth cohort study. J Orthop Res 2020; 38:2740-2748. [PMID: 32162719 PMCID: PMC8641380 DOI: 10.1002/jor.24656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Spine shape changes dramatically in early life, influenced by attainment of developmental milestones such as independent walking. Whether these associations persist across life is unknown. Therefore, we investigated associations between developmental milestones and spine shape, as determined using statistical shape models (SSMs) of lumbar spine from dual-energy X-ray absorptiometry scans in 1327 individuals (688 female) at 60 to 64 years in the MRC National Survey of Health and Development. Lumbar lordosis angle (L4 inferior endplate to T12 superior endplate) was measured using the two-line Cobb method. In analyses adjusted for sex, height, lean and fat mass, socioeconomic position, and birthweight, later walking age was associated with greater lordosis described by SSM1 (regression coefficient, 0.023; 95% CI, 0.000-0.047; P = .05) and direct angle measurement. Modest associations between walking age and less variation in anterior-posterior vertebral size caudally (SSM6) were also observed (0.021; 95% CI, -0.002 to 0.044; P = .07). Sex interactions showed that later walking was associated with larger relative vertebral anterior-posterior dimensions in men (SSM3; -0.043; 95% CI, -0.075 to 0.01; P = .01) but not women (0.018; 95% CI, -0.0007 to 0.043; P = .17). Similar associations were observed between age at independent standing and SSMs but there was little evidence of association between sitting age and spine shape. Unadjusted associations between walking age and SSMs 1 and 6 remained similar after adjustment for potential confounders and mediators. This suggests that these associations may be explained by altered mechanical loading of the spine during childhood growth, although other factors could contribute. Early life motor development, particularly walking, may have a lasting effect on the features of spine morphology with clinical significance.
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Affiliation(s)
- Fiona R. Saunders
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Jennifer S. Gregory
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Anastasia V. Pavlova
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,School of Health SciencesRobert Gordon UniversityAberdeenUK
| | | | - Rebecca J. Hardy
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK,Cohort and Longitudinal Studies Enhancement Resources (CLOSER)UCL Institute of EducationLondonUK
| | - Kathryn R. Martin
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rebecca J. Barr
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,Medicines Monitoring Unit (MEMO), School of Medicine, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Judith E. Adams
- Manchester Academic Health Science Centre and Radiology, Manchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation Trust and University of ManchesterManchesterUK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Richard M. Aspden
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Alex Ireland
- Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
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17
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Ireland A, Saunders FR, Muthuri SG, Pavlova AV, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Gregory JS, Cooper R. Age at Onset of Walking in Infancy Is Associated With Hip Shape in Early Old Age. J Bone Miner Res 2019; 34:455-463. [PMID: 30496618 PMCID: PMC6446733 DOI: 10.1002/jbmr.3627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
Bones' shapes and structures adapt to the muscle and reaction forces they experience during everyday movements. Onset of independent walking, at approximately 12 months, represents the first postnatal exposure of the lower limbs to the large forces associated with bipedal movements; accordingly, earlier walking is associated with greater bone strength. However, associations between early life loading and joint shape have not been explored. We therefore examined associations between walking age and hip shape at age 60 to 64 years in 1423 individuals (740 women) from the MRC National Survey of Health and Development, a nationally representative British birth cohort. Walking age in months was obtained from maternal interview at age 2 years. Ten modes of variation in hip shape (HM1 to HM10), described by statistical shape models, were ascertained from DXA images. In sex-adjusted analyses, earlier walking age was associated with higher HM1 and HM7 scores; these associations were maintained after further adjustment for height, body composition, and socioeconomic position. Earlier walking was also associated with lower HM2 scores in women only, and lower HM4 scores in men only. Taken together, this suggests that earlier walkers have proportionately larger (HM4) and flatter (HM1, HM4) femoral heads, wider (HM1, HM4, HM7) and flatter (HM1, HM7) femoral necks, a smaller neck-shaft angle (HM1, HM4), anteversion (HM2, HM7), and early development of osteophytes (HM1). These results suggest that age at onset of walking in infancy is associated with variations in hip shape in older age. Early walkers have a larger femoral head and neck and smaller neck-shaft angle; these features are associated with reduced hip fracture risk, but also represent an osteoarthritic-like phenotype. Unlike results of previous studies of walking age and bone mass, associations in this study were not affected by adjustment for lean mass, suggesting that associations may relate directly to skeletal loading in early life when joint shape changes rapidly. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Alex Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Manchester, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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18
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Baird DA, Evans DS, Kamanu FK, Gregory JS, Saunders FR, Giuraniuc CV, Barr RJ, Aspden RM, Jenkins D, Kiel DP, Orwoll ES, Cummings SR, Lane NE, Mullin BH, Williams FMK, Richards JB, Wilson SG, Spector TD, Faber BG, Lawlor DA, Grundberg E, Ohlsson C, Pettersson‐Kymmer U, Capellini TD, Richard D, Beck TJ, Evans DM, Paternoster L, Karasik D, Tobias JH. Identification of Novel Loci Associated With Hip Shape: A Meta-Analysis of Genomewide Association Studies. J Bone Miner Res 2019; 34:241-251. [PMID: 30320955 PMCID: PMC6375741 DOI: 10.1002/jbmr.3605] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/30/2018] [Accepted: 10/06/2018] [Indexed: 02/05/2023]
Abstract
We aimed to report the first genomewide association study (GWAS) meta-analysis of dual-energy X-ray absorptiometry (DXA)-derived hip shape, which is thought to be related to the risk of both hip osteoarthritis and hip fracture. Ten hip shape modes (HSMs) were derived by statistical shape modeling using SHAPE software, from hip DXA scans in the Avon Longitudinal Study of Parents and Children (ALSPAC; adult females), TwinsUK (mixed sex), Framingham Osteoporosis Study (FOS; mixed), Osteoporotic Fractures in Men study (MrOS), and Study of Osteoporotic Fractures (SOF; females) (total N = 15,934). Associations were adjusted for age, sex, and ancestry. Five genomewide significant (p < 5 × 10-9 , adjusted for 10 independent outcomes) single-nucleotide polymorphisms (SNPs) were associated with HSM1, and three SNPs with HSM2. One SNP, in high linkage disequilibrium with rs2158915 associated with HSM1, was associated with HSM5 at genomewide significance. In a look-up of previous GWASs, three of the identified SNPs were associated with hip osteoarthritis, one with hip fracture, and five with height. Seven SNPs were within 200 kb of genes involved in endochondral bone formation, namely SOX9, PTHrP, RUNX1, NKX3-2, FGFR4, DICER1, and HHIP. The SNP adjacent to DICER1 also showed osteoblast cis-regulatory activity of GSC, in which mutations have previously been reported to cause hip dysplasia. For three of the lead SNPs, SNPs in high LD (r2 > 0.5) were identified, which intersected with open chromatin sites as detected by ATAC-seq performed on embryonic mouse proximal femora. In conclusion, we identified eight SNPs independently associated with hip shape, most of which were associated with height and/or mapped close to endochondral bone formation genes, consistent with a contribution of processes involved in limb growth to hip shape and pathological sequelae. These findings raise the possibility that genetic studies of hip shape might help in understanding potential pathways involved in hip osteoarthritis and hip fracture. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Denis A Baird
- Musculoskeletal Research UnitUniversity of BristolBristolUK
| | - Daniel S Evans
- California Pacific Medical Center Research InstituteSan FranciscoCAUSA
| | - Frederick K Kamanu
- Institute for Aging ResearchHebrew SeniorLifeDepartment of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
| | | | - Fiona R Saunders
- Arthritis and Musculoskeletal MedicineUniversity of AberdeenAberdeenUK
| | | | - Rebecca J Barr
- Arthritis and Musculoskeletal MedicineUniversity of AberdeenAberdeenUK
- MEMO ResearchUniversity of DundeeDundeeUK
| | - Richard M Aspden
- Arthritis and Musculoskeletal MedicineUniversity of AberdeenAberdeenUK
| | | | - Douglas P Kiel
- Institute for Aging ResearchHebrew SeniorLifeDepartment of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
- Broad Institute of MIT and HarvardBostonMAUSA
| | - Eric S Orwoll
- School of MedicineOregon Health and Science UniversityPortlandORUSA
| | - Steven R Cummings
- California Pacific Medical Center Research InstituteSan FranciscoCAUSA
| | - Nancy E Lane
- University of California at DavisSacramentoCAUSA
| | - Benjamin H Mullin
- Department of Endocrinology and DiabetesSir Charles Gairdner HospitalNedlandsAustralia
- School of Biomedical SciencesUniversity of Western AustraliaPerthAustralia
| | - Frances MK Williams
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
| | - J Brent Richards
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
- Departments of Medicine, Human Genetics, Epidemiology, and BiostatisticsJewish General HospitalMcGill UniversityMontrealCanada
| | - Scott G Wilson
- Department of Endocrinology and DiabetesSir Charles Gairdner HospitalNedlandsAustralia
- School of Biomedical SciencesUniversity of Western AustraliaPerthAustralia
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
| | - Tim D Spector
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
| | | | | | - Elin Grundberg
- Department of Human GeneticsMcGill UniversityMontrealCanada
| | - Claes Ohlsson
- Centre for Bone and Arthritis ResearchInstitute of MedicineUniversity of GothenburgGothenburgSweden
| | | | - Terence D Capellini
- Broad Institute of MIT and HarvardBostonMAUSA
- Human Evolutionary BiologyHarvard UniversityBostonMAUSA
| | | | | | - David M Evans
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- University of Queensland Diamantina InstituteTranslational Research InstituteBrisbaneAustralia
| | | | - David Karasik
- Institute for Aging ResearchHebrew SeniorLifeDepartment of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
- Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Jonathan H Tobias
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
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19
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Abstract
Considered for decades as a cartilage disease, recent studies of osteoarthritis (OA) take us back to the concepts discussed at the naming of the disorder as "bone-joint-inflammation". By describing the joint as an organ, can OA be called an organ disease - similar to heart disease? Is there a systemic (which system?) involvement? Would this help with diagnosis or therapy? Hyperplasia of the joint tissues is one of the most notable early features of the disease: articular cartilage thickens, chondrocytes proliferate and increase matrix biosynthesis, but not its incorporation; the subchondral bone densifies but is hypomineralised and there is an increase in bone marrow fat content. Associations between OA and hypertension, hypercholesterolaemia and blood glucose suggest systemic and metabolic components are involved. The source of pain is still unknown but here is evidence for peripheral and central sensitisation. Joint deformity is difficult to quantify, but statistical shape modelling provides a tool to use as an imaging biomarker. A genome-wide association study meta-analysis has identified novel genes associated with hip shape with many genes related to tissue growth and development. There are associations between hip shapes and age of first walking as well as with obesity through adulthood. These life-course events and a recapitulation in old age of developmental processes suggest that the cradle may affect our path to the grave. These observations suggest that tissue regeneration approaches, treating only the cartilage in OA joints, may only be of limited benefit.
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Affiliation(s)
- R M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of
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20
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Baird DA, Paternoster L, Gregory JS, Faber BG, Saunders FR, Giuraniuc CV, Barr RJ, Lawlor DA, Aspden RM, Tobias JH. Investigation of the Relationship Between Susceptibility Loci for Hip Osteoarthritis and Dual X‐Ray Absorptiometry–Derived Hip Shape in a Population‐Based Cohort of Perimenopausal Women. Arthritis Rheumatol 2018; 70:1984-1993. [DOI: 10.1002/art.40584] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/05/2018] [Indexed: 11/06/2022]
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21
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Muthuri SG, Saunders FR, Hardy RJ, Pavlova AV, Martin KR, Gregory JS, Barr RJ, Adams JE, Kuh D, Aspden RM, Cooper R. Associations between body mass index across adult life and hip shapes at age 60 to 64: Evidence from the 1946 British birth cohort. Bone 2017; 105:115-121. [PMID: 28842363 PMCID: PMC5658512 DOI: 10.1016/j.bone.2017.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/10/2017] [Accepted: 08/19/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine the associations of body mass index (BMI) across adulthood with hip shapes at age 60-64years. METHODS Up to 1633 men and women from the MRC National Survey of Health and Development with repeat measures of BMI across adulthood and posterior-anterior dual-energy X-ray absorptiometry bone mineral density images of the proximal femur recorded at age 60-64 were included in analyses. Statistical shape modelling was applied to quantify independent variations in hip mode (HM), of which the first 6 were examined in relation to: i) BMI at each age of assessment; ii) BMI gain during different phases of adulthood; iii) age first overweight. RESULTS Higher BMI at all ages (i.e. 15 to 60-64) and greater gains in BMI were associated with higher HM2 scores in both sexes (with positive HM2 values representing a shorter femoral neck and a wider and flatter femoral head). Similarly, younger age first overweight was associated with higher HM2 scores but only in men once current BMI was accounted for. In men, higher BMI at all ages was also associated with lower HM4 scores (with negative HM4 values representing a flatter femoral head, a wider neck and smaller neck shaft angle) but no associations with BMI gain or prolonged exposure to high BMI were found. Less consistent evidence of associations was found between BMI and the other four HMs. CONCLUSION These results suggest that BMI across adulthood may be associated with specific variations in hip shapes in early old age.
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Affiliation(s)
- Stella G Muthuri
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK.
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Rebecca J Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK
| | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Rebecca J Barr
- Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Mailbox 2 Level 7, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK
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22
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Ahedi HG, Aspden RM, Blizzard LC, Saunders FR, Cicuttini FM, Aitken DA, Jones G, Gregory JS. Hip Shape as a Predictor of Osteoarthritis Progression in a Prospective Population Cohort. Arthritis Care Res (Hoboken) 2017; 69:1566-1573. [DOI: 10.1002/acr.23166] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/18/2016] [Accepted: 12/06/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Harbeer G. Ahedi
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Richard M. Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical Sciences, University of Aberdeen; Aberdeen UK
| | - Leigh C. Blizzard
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Fiona R. Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical Sciences, University of Aberdeen; Aberdeen UK
| | | | - Dawn A. Aitken
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Jennifer S. Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical Sciences, University of Aberdeen; Aberdeen UK
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23
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Pavlova AV, Saunders FR, Muthuri SG, Gregory JS, Barr RJ, Martin KR, Hardy RJ, Cooper R, Adams JE, Kuh D, Aspden RM. Statistical shape modelling of hip and lumbar spine morphology and their relationship in the MRC National Survey of Health and Development. J Anat 2017; 231:248-259. [PMID: 28561274 PMCID: PMC5522893 DOI: 10.1111/joa.12631] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 12/23/2022] Open
Abstract
The anatomical shape of bones and joints is important for their proper function but quantifying this, and detecting pathological variations, is difficult to do. Numerical descriptions would also enable correlations between joint shapes to be explored. Statistical shape modelling (SSM) is a method of image analysis employing pattern recognition statistics to describe and quantify such shapes from images; it uses principal components analysis to generate modes of variation describing each image in terms of a set of numerical scores after removing global size variation. We used SSM to quantify the shapes of the hip and the lumbar spine in dual-energy x-ray absorptiometry (DXA) images from 1511 individuals in the MRC National Survey of Health and Development at ages 60-64 years. We compared shapes of both joints in men and women and hypothesised that hip and spine shape would be strongly correlated. We also investigated associations with height, weight, body mass index (BMI) and local (hip or lumber spine) bone mineral density. In the hip, all except one of the first 10 modes differed between men and women. Men had a wider femoral neck, smaller neck-shaft angle, increased presence of osteophytes and a loss of the femoral head/neck curvature compared with women. Women presented with a flattening of the femoral head and greater acetabular coverage of the femoral head. Greater weight was associated with a shorter, wider femoral neck and larger greater and lesser trochanters. Taller height was accompanied by a flattening of the curve between superior head and neck and a larger lesser trochanter. Four of the first eight modes describing lumbar spine shape differed between men and women. Women tended to have a more lordotic spine than men with relatively smaller but caudally increasing anterior-posterior (a-p) vertebral diameters. Men were more likely to have a straighter spine with larger vertebral a-p diameters relative to vertebral height than women, increasing cranially. A weak correlation was found between body weight and a-p vertebral diameter. No correlations were found between shape modes and height in men, whereas in women there was a weak positive correlation between height and evenness of spinal curvature. Linear relationships between hip and spine shapes were weak and inconsistent in both sexes, thereby offering little support for our hypothesis. In conclusion, men and women entering their seventh decade have small but statistically significant differences in the shapes of their hips and their spines. Associations with height, weight, BMI and BMD are small and correspond to subtle variations whose anatomical significance is not yet clear. Correlations between hip and spine shapes are small.
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Affiliation(s)
- Anastasia V. Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - Fiona R. Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | | | - Jennifer S. Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - Rebecca J. Barr
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
- Present address:
Medicines Monitoring Unit (MEMO)Division of Molecular & Clinical MedicineSchool of Medicine Ninewells Hospital & Medical SchoolUniversity of DundeeMailbox 2, Level 7Dundee DD1 9SYUK
| | - Kathryn R. Martin
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | | | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Judith E. Adams
- Manchester Academic Health Science CentreManchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Richard M. Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
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24
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Hughes A, Saunders FR, Wallace HM. Naproxen causes cytotoxicity and induces changes in polyamine metabolism independent of cyclo-oxygenase expression. Toxicol Res (Camb) 2012. [DOI: 10.1039/c2tx20018j] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Saunders FR, Wallace HM. On the natural chemoprevention of cancer. Plant Physiol Biochem 2010; 48:621-626. [PMID: 20347597 DOI: 10.1016/j.plaphy.2010.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 02/26/2010] [Accepted: 03/02/2010] [Indexed: 05/29/2023]
Abstract
Cancer is a complex disease to treat and the treatments have not progressed significantly in the last few years. Alternative strategies such as chemoprevention are being investigated. Proof of concept of chemoprevention has been shown with the non-steroidal anti-inflammatory drugs (NSAIDs); however there is significantly more interest in plant and naturally available compounds for chemoprevention. A number of different naturally occurring chemical compounds are reviewed here for their potential benefits and the pathways which they may target, in particular the polyamine pathway.
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Affiliation(s)
- Fiona R Saunders
- Section of Translational Medicine, Division of Applied Medicine, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland AB252ZD, UK
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Saunders FR, Hughes A, Wallace HM. Investigating the effects of NSAIDs on the expression of regulatory components of the polyamine pathway. Toxicology 2008. [DOI: 10.1016/j.tox.2008.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Colorectal cancer is one of a number of cancers that may be amenable to prevention. The NSAIDs (non-steroidal anti-inflammatory drugs) have been shown to be effective chemopreventative agents in humans, but their mechanism of action is not clear. The polyamines are cellular polycations that are essential for cell growth and are overproduced in cancer cells. It is our hypothesis that inhibition of polyamine metabolism is an integral part of the mechanism of cancer prevention mediated by NSAIDs.
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Affiliation(s)
- F R Saunders
- Department of Medicine and Therapeutics, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK
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