Bone Mineral Density and the Risk of Knee Osteoarthritis: The Johnston County Osteoarthritis Project

Kamil E. Barbour¹, Jennifer M. Hootman², Charles G. Helmick³, Louise Murphy⁴, Jordan B. Renner⁵ and Joanne M. Jordan⁶, ¹Centers for Disease Control and Prevention, Atlanta, GA, ²Division of Population Health, Centers for Disease Control and Prevention, Kennesaw, GA, ³National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, ⁴Division of Population Health, CDC, Atlanta, GA, ⁵University of North Carolina Department of Radiology, Chapel Hill, NC, ⁶Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: bone density and risk, OA

Session Information

Title: Osteoarthritis - Clinical Aspects I: Risk Factors for and Sequelae of Osteoarthritis.

Session Type: Abstract Submissions (ACR)

Background/Purpose: There is credible evidence that high bone mineral density (BMD) is associated with an increased risk of incident radiographic osteoarthritis (ROA) of the knee. However, less is known about the relationship of BMD and the outcome with greater clinical and public health relevance, incident symptomatic ROA (sROA).

Methods: Using data (N=951) from the Johnston County Osteoarthritis Project’s first (1999-2004) and second follow-up (2005-2010), we examined the association between BMD and both incident knee ROA and sROA among participants aged ≥45 years. Total hip BMD at baseline was measured using dual-energy X-ray absorptiometry. Participants were grouped into sex-specific BMD quartiles because of large sex-specific differences in BMD. Incident knee ROA was defined as development of a Kellgren-Lawrence grade of ≥2 in a knee at second follow-up. Incident knee sROA was defined as onset of both ROA and symptoms in at least one knee at second follow-up. Weibull regression modeling, which accounted for interval censored data, was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CIs). Multivariate models adjusted for age, BMI, sex, race, education, smoking, physical activity, and history of knee injury.

Results: Median follow-up time was 6.8 (range=4.0-10.2) years. Compared with participants in the lowest BMD quartile, the multivariable adjusted HRs (95% CIs) of sROA for participants in the second, third, and highest quartiles of total hip BMD were 1.4 (0.9 to 2.4), 1.7 (1.1 to 2.7), and 1.6 (1.02 to 2.5), respectively, p trend = 0.03. Risk of sROA risk did not vary by total hip BMD quartiles, nor was the test of trend significant across BMD quartiles (p trend=0.23).

Conclusion: Although high levels of BMD may significantly increase one’s risk of knee ROA, we found no evidence of an association between BMD and the more clinically relevant outcome of knee sROA. These findings suggest that adults can achieve and maintain a healthy BMD without the tradeoff of increasing their risk of the painful and potentially debilitating outcome of sROA.

Disclosure:

K. E. Barbour,
None;

J. M. Hootman,
None;

C. G. Helmick,
None;

L. Murphy,
None;

J. B. Renner,
None;

J. M. Jordan,

Trinity Partners, Inc. ,

Osteoarthritis Research Society International,

Chronic Osteoarthritis Management Initiative of US Bone and Joint Initiative,

Samumed,

Interleukin Genetics, Inc. ,

Algynomics, Inc. ,

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