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Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis.

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Hartley, A 
Hardcastle, SA 
Paternoster, L 
McCloskey, E 
Poole, KES 


OBJECTIVE: High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant. DESIGN: A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering. RESULTS: 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 []), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [] and 0.15 [], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 []), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation. CONCLUSIONS: HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.



BMD, Health-related quality of life, High bone mass, Osteoarthritis, Progression, WOMAC, Absorptiometry, Photon, Activities of Daily Living, Adipose Tissue, Aged, Arthralgia, Body Weight, Bone Density, Cohort Studies, Disease Progression, Female, Follow-Up Studies, Humans, Linear Models, Male, Middle Aged, Osteoarthritis, Knee, Osteophyte, Radiography

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Osteoarthritis Cartilage

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Elsevier BV
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
The HBM study was supported by The Wellcome Trust (080280/Z/06/Z), the National Institute for Health Research Clinical Research Network (portfolio no. 5163) and Versus Arthritis (ref 20000). AH is funded by the Wellcome Trust (grant ref 20378/Z/16/Z). Follow-up imaging at the Hull site was funded by OSPREY (OSteoPorosis Research in East Yorkshire). AH, LP, JHT and CLG work in, or are affiliated with, a University of Bristol and MRC funded unit (MC_UU_00011/1).