Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study

OBJECTIVE

To assess the contribution of radiological osteoarthritis of the hips and knees to disabilities in the activities of daily living related to lower limb function.

METHODS

During a home interview 1156 men and 1739 women, randomly chosen from the source population of all independently living residents aged 55 years and over living in a district of Rotterdam (the Rotterdam Study) were asked about locomotor disability by six questions of the Health Assessment Questionnaire (HAQ) and about pain in the hips and knees in the past month. Radiographs of hips and knees were scored according to the Kellgren grading system for osteoarthritis.

RESULTS

The prevalence of locomotor disability, defined as at least some difficulty with three or more out of six lower limb functions, was 20.2% for men and 31.9% for women; hip pain was present in 8.3% of the men and 16.6% of the women; knee pain in 12.6% of the men and 22.3% of the women. The prevalence of radiological osteoarthritis grade 2+ of the hip was 14.1% for men and 15.9% for women, and of the knee 16.3% and 29.1% respectively. The odds ratio (OR) (95% confidence intervals) of hip radiological osteoarthritis for locomotor disability adjusted for age and all other variables was for men: 1.4 (0.9, 2.1) and for women: 2.2 (1.6, 2.9). The ORs of knee radiological osteoarthritis adjusted for age and all other variables were 1.1 (0.9, 2.1) and 1.4 (1.1, 1.8) respectively. Severe radiological osteoarthritis (grade 3+) was stronger associated. The ORs of pain in the hips or knees and morning stiffness were much higher (between 2.7 and 5.5 for men and between 2.1 and 5.1 for women).

CONCLUSIONS

Radiological osteoarthritis of the hip and knee are only weak independent predictors of locomotor disability in women, and not at all independently associated with locomotor disability in men. Age, pain of the hips and knees, and morning stiffness seem to be the most important independent determinants of locomotor disability.

The association of abnormalities on physical examination of the hip and knee with locomotor disability in the Rotterdam Study

To assess the influence of abnormalities found on physical examination of the hips and knees on disability 1156 men and 1739 women aged > or = 55 yr (the Rotterdam Study) were asked about locomotor disability (LD) using six questions of the Health Assessment Questionnaire (HAQ). The prevalence of LD was 20.2% for men and 31.9% for women. Moderately restricted range of motion of the hips and knees occurred in 34.5% of the men and 38.6% of the women. The prevalence of instability of the knees was 12.5% for men and 16.8% for women. Varus deformity in men (10.1%) and valgus deformity in women (15.0%) were the most common deformities of the knees. Restricted flexion of the hips was the strongest determinant of LD. Age-adjusted odds ratios for restricted hip flexion of LD were 4.7% (95% CI: 3.2-6.8) for men and 3.5 (2.7-4.5) for women. Valgus deformity, knee instability and obliquity were risk factors only in women. Adjustment of these odds ratios for morning stiffness and joint pain did not alter the estimates.

Combined treatment of growth hormone and the bisphosphonate pamidronate, versus treatment with GH alone, in GH-deficient adults: the effects on renal phosphate handling, bone turnover and bone mineral mass

OBJECTIVE

A potential drawback of GH replacement therapy in GH deficient (GHD) patients is the initial decrease in bone mass. The present study investigates the effects of the addition of pamidronate to GH replacement therapy in adult GHD subjects, on serum PTH and 1,25-dihydroxyvitamin D3 (1.25-(OH)2D3) levels, renal phosphate handling, bone turnover and bone mineral content (BMC).

DESIGN

Six GHD adult patients were studied for two periods of 6 months with a wash-out period of 3 years. In the first period they were treated with conventional replacement therapy and GH. In the second study period GH treatment was identical, while after 2 weeks 150 mg pamidronate per day was added.

RESULTS

In the first study period (GH only) there was a significant increase of phosphate reabsorption, without a change in serum PTH and 1.25-(OH)2D3 levels. This suggests a specific effect of GH or IGF-I on renal phosphate handling. This was supported by the close correlation between serum IGF-I levels and TmP/GFR (r = 0.75, P < 0.0001). When GH was administered together with pamidronate, this correlation was less, but remained significant (r = 0.44, P < 0.001). The increase in bone turnover and decrease in BMC, as initially observed during GH replacement therapy alone, were attenuated by simultaneous pamidronate administration. The decline in lumbar spine BMC (measured with dual-photon absorptiometry) at 6 months was -3.1 +/- 1.5% during GH replacement therapy alone vs an increase of +3.8 +/- 2.0% during the administration of the combination of GH and pamidronate (measured with dual-energy X-ray absorptiometry). At the distal and proximal forearm the changes amounted to -0.5 +/- 3.4% vs +4.5 +/- 1.8% and -1 +/- 1.2% vs +1.2 +/- 1.1% respectively.

CONCLUSIONS

This study shows that the addition of a bisphosphonate to GH replacement therapy in GHD adults counteracts the GH (or IGF-I) induced increase in renal phosphate reabsorption. Furthermore, it reduces GH induced bone turnover and prevents the initial decrease in bone mineral content seen during GH treatment alone, resulting in a beneficial effect on bone mineral mass. Pamidronate might therefore be an important adjunct to GH replacement therapy in adults with GHD and severe osteopenia during the early phase of GH induced stimulation of bone turnover.

Association of locomotor complaints and disability in the Rotterdam study

OBJECTIVE

To determine the association between joint complaints and locomotor disability.

METHODS

During a home interview survey 1901 men and 3135 women aged 55 years and over (the Rotterdam Study) were asked about joint pain and morning stiffness in the past month, and locomotor disability was assessed by six questions from the Health Assessment Questionnaire (HAQ).

RESULTS

The prevalence of locomotor disability was 24.5% for men and 40.5% for women. The prevalence of joint pain in men was 0.7% for pain in the hips, knees, and feet simultaneously, 3.7% for pain at two joint sites, 16.0% for pain at one joint site, and 20.4% for pain in the hips and/or knees and/or feet (any joint site); the corresponding estimates for women were 1.9%, 9.0%, 23.7%, and 34.5%, respectively. The prevalence of generalised morning stiffness was 4.9% for men and 10.4% for women. The age adjusted odds ratios for locomotor disability in men ranged from 2.4 of pain at one joint site to 8.8 of pain at all three joint sites; for women these odds ratios varied between 2.5 and 5.7, respectively. The age adjusted odds ratios of generalised morning stiffness were 8.0 for men and 7.3 for women.

CONCLUSION

There is a strong and independent association between locomotor disability and age, joint pain, and generalised morning stiffness in people aged 55 years and over. The odds for locomotor disability increase onefold for every year increase in age, while the presence of generalised morning stiffness is of greater influence than the presence of joint pain.

Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam Study

OBJECTIVE

To investigate the relation between non-insulin-dependent diabetes mellitus and bone mineral density at the lumbar spine and hip.

DESIGN

Population-based study with a cross-sectional survey.

SETTING

A district of Rotterdam, the Netherlands.

PARTICIPANTS

5931 residents (2481 men, 3450 women) of the district aged 55 years or more.

MEASUREMENTS

Participants were classified as having non-insulin-dependent diabetes mellitus if they were receiving antidiabetic medication or if they had a serum glucose level of 11.1 mmol/L or more after a nonfasting oral glucose tolerance test. Bone mineral density, measured at the lumbar spine and proximal femur using dual-energy x-ray absorptiometry and the frequency of nonvertebral fractures during the preceding 5 years were compared between persons with and without non-insulin-dependent diabetes mellitus.

RESULTS

243 men and 335 women had non-insulin-dependent diabetes mellitus. Both men and women with this condition had substantially higher mean bone mineral density values at all four sites measured than those with normal glucose tolerance. The increase could not be explained by age; obesity; use of estrogens, thiazides, or loop diuretics; impairment in abilities of daily living; smoking; or osteoarthritis. Women with non-insulin-dependent diabetes mellitus reported having had fewer fractures in the 5 preceding years than women without this condition (adjusted odds ratio, 0.63; 95% CI, 0.44 to 0.90). The frequency of fractures in men was similar for those with and without non-insulin-dependent diabetes mellitus (adjusted odds ratio, 0.96; CI, 0.60 to 1.52).

CONCLUSIONS

Men and women with non-insulin-dependent diabetes mellitus have increased bone mineral density. Non-insulin-dependent diabetes mellitus in women is associated with a lower frequency of nonvertebral fractures.

Primary open-angle glaucoma, intraocular pressure, and systemic blood pressure in the general elderly population. The Rotterdam Study

PURPOSE

The purpose of this study is to investigate the association of primary open-angle glaucoma (POAG), intraocular pressure (IOP), and systemic blood pressure.

METHODS

Subjects participating in the Rotterdam Study (n = 4187, 55 years of age and older) were examined according to standard protocols, including a medical history interview, IOP measurement, perimetry, funduscopy, and blood pressure measurement. Primary open-angle glaucoma was defined by the presence of a glaucomatous visual field defect. Additionally, the distinction was made between high-tension glaucoma, defined as POAG with an IOP of more than 21 mmHg, and normal-tension glaucoma, defined as POAG with an IOP of 21 mmHg or less. The relation between blood pressure and hypertension with IOP, POAG, high-tension glaucoma, and normal-tension glaucoma was studied by means of regression analysis.

RESULTS

A systolic blood pressure or diastolic blood pressure that was 10 mmHg higher was associated with an IOP that was, on average, 0.23 mmHg (95% confidence interval [CI], 0.19-0.27) or 0.24 mmHg (95% CI, 0.16-0.32) higher, respectively. The presence of hypertension was associated with a higher mean IOP of 0.66 mmHg (95% CI, 0.39-0.93). A higher systolic blood pressure of 10 mmHg was associated with an odds ratio of 1.22 (95% CI, 1.03-1.46) for high-tension glaucoma and 0.90 (95% CI, 0.72-1.12) for normal-tension glaucoma. Hypertension was associated with an odds ratio of 2.33 (95% CI, 0.99-5.47) for high-tension glaucoma and 0.77 (95% CI, 0.22-2.72) for normal-tension glaucoma.

CONCLUSION

Systemic blood pressure and hypertension are associated with IOP and high-tension glaucoma. No association was found between blood pressure or hypertension and normal-tension glaucoma.

Age-associated changes in ultrasound measurements of the calcaneus in men and women: the Rotterdam Study

Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the os calcis were measured in a sample of 1405 persons (628 men), aged 55-93 years, from the cohort of the Rotterdam Study, a population-based study of diseases in the elderly. We studied the effect of age, body mass index, age at menopause, current use of thiazides, loop diuretics, and estrogens, smoking, and disability on SOS and BUA. Comparisons were made between ultrasound measurements and bone mineral density (BMD) measurements of the lumbar spine and proximal femur using DXA. We found a significant decline with age in SOS and BUA in men (-0.4 and -0.1 %/year, respectively) and women (-1.3 and -0.4%/year, respectively), which persisted after adjustment for body mass index. Age at menopause was not associated with SOS or BUA. Pack-years of smoking was negatively related to SOS in both sexes and to BUA in men. Severe disability was associated with lower SOS and BUA in men, but not in women. Despite the small number of exposed persons, current corticosteroid use was associated with lower BUA in men. The other risk factors examined did not affect the ultrasound measurements. We observed modest correlations between SOS or BUA, on the one hand, and BMD of the lumbar spine, on the other hand (r = 0.32-0.42). Similar correlations were found between ultrasound measurements and BMD measurements of the proximal femur. We conclude that in persons 55 years or over (1) there is a significant age-related decline of BUA and SOS, which is about three times higher in women compared with men, and (2) ultrasound measurements are not able to predict low BMD in hip or spine.

Bone mineral density in healthy Dutch women: spine and hip measurements using dual-energy X-ray absorptiometry

OBJECTIVE

To investigate in healthy normal Dutch women the age-associated changes in bone mineral density (BMD) and the effect on bone mass of the menopause and potential risk factors.

METHODS

In 260 healthy Dutch women BMD was measured in the lumbar spine and three regions of the proximal femur (Ward's triangle, femoral neck and trochanter), using dual energy X-ray absorptiometry (DXA). The subjects were interviewed using a structured questionnaire on age, reproductive history and gynaecological status, height, weight and consumption of tobacco and alcohol.

RESULTS

In 125 premenopausal women a small age-related bone loss was observed at both the lumbar spine and proximal femur, while in postmenopausal women (n = 135) a 2-3 times higher age-related loss was observed. Expressed in years since the menopause this postmenopausal loss was found to be exponential (p < 0.001). After adjustment for age there appears to be a relationship between actual age of menopause and BMD at the lumbar spine and femoral neck. After adjustment for age and actual age of menopause we observed a small negative effect of breastfeeding, whereas parity, current alcohol use and smoking showed no additional effect on BMD in this cohort. For all women (n = 260) a highly significant correlation between BMD and body mass index was found.

CONCLUSIONS

In healthy Dutch women we observed a small premenopausal and an accelerated postmenopausal bone loss in both the lumbar spine and proximal femur. Except for breastfeeding, no other risk factors could be identified.

The association between age and bone mineral density in men and women aged 55 years and over: the Rotterdam Study

In this cross-sectional study, bone mineral density (BMD) measurements were performed in 1762 ambulatory subjects (678 men and 1084 women) aged 55 years and over from the Rotterdam Study, a population based study of diseases in the elderly. BMD measurements of the proximal femur and lumbar spine were performed using dual energy X-ray absorptiometry. No age-related decline in BMD could be observed in the lumbar spine. Yearly percentage BMD reduction in women and men was -0.6% and -0.3% in the femoral neck, -0.8% and -0.5% in the Ward's triangle, and -0.4% and -0.3% in the trochanter, respectively. Late menopause was associated with high BMD in Ward's triangle and lumbar spine. We conclude that: (1) accurate assessment of age-related bone reduction in the spine is impossible from cross-sectional studies since BMD measurements in the elderly may be influenced by spinal osteoarthritis; and (2) the rate of age-related bone reduction in the femoral neck appears to be approximately two times higher in women than in men.