Is Osteoarthritis Always Associated with Low Bone Mineral Density in Elderly Patients?

Abstract

Background and Objectives: The relationship between osteoarthritis (OA) and osteoporosis (OP) has been analysed for over four decades. However, this relationship has remained controversial. Numerous observational and longitudinal studies have shown an inverse association between the two diseases and a protective effect of one against the other. On the other hand, some studies show that patients with OA have impaired bone strength and are more prone to fractures. The study’s main objective was to determine the bone mineral density (BMD) of the spine and hip (femoral neck) of postmenopausal women of different ages, with radiologically determined OA of the hip and knee, as well as to determine the correlation between BMD values and age in the experimental group. Materials and Methods: The retrospective cohort study included 7018 patients with osteoarthritis of peripheral joints and the spine, examined by a rheumatologist in an outpatient rheumatology clinic at the Institute for Treatment and Rehabilitation, Niška Banja from July 2019 to March 2021. A nested anamnestic study was conducted within the cohort study of patients, and it included two groups: an experimental group composed of 60 postmenopausal women, and a control group composed of the same number of women. Out of 120 patients, 24 did not meet the criteria for the continuation of the study (due to technical errors—radiographic and/or densitometry artefacts). Fifty-six postmenopausal women (aged 45–77 years) with hip and knee radiological OA were examined as an experimental group. The participants were divided into two subgroups according to age (45–60 years and over 61 years). The control group included 40 healthy postmenopausal women of the same age range, without radiological OA, with normal BMD of the hip and spine. All patients with OA met the American College of Radiology (ACR) criteria. OA of the hip and knee was determined radiologically according to Kellgren and Lawrence (K&L) classification, and patients were included in the study if a K&L grade of at least ≥ 2 was present. Hip and spine BMD was measured by dual-energy X-ray absorptiometry (DXA). Results: Compared to the control group, we found statistically significantly lower BMD and T-scores of the spine in older postmenopausal women: BMD (g/cm2), p = 0.014; T-score, p = 0.007, as well as of the hip: BMD (g/cm2), p = 0.024; T-score p < 0.001. The values of BMD and T-score of the spine and hip are lower in more severe forms of OA (X-ray stage 3 and 4, according to K&L), p < 0.001. We found negative correlation between BMD and T-score and age only for the hip: BMD (g/cm2), ρ = 0.378, p = 0.005; T-score ρ = −0.349, p = 0.010. Conclusions: Older postmenopausal women with radiographic hip and knee OA had significantly lower BMD of the hip and spine as compared to the control group without OA, pointing to the need for the prevention and treatment of OA, as well as early diagnosis, monitoring, and treatment of low bone mineral density.

Correlation between Bone Mineral Density and Progression of Hip Osteoarthritis in Adult Men and Women in Bulgaria—Results from a 7-Year Study

“…The age restrictions were introduced in order to exclude mild hip dysplasia (clinical presentation before 55 years of age) [ 28 ], the effect of hormonal changes in the early menopause (50–55 years) over SB [ 34 ], and the high rate of HOA in people over 60 years of age [ 18 , 22 ], as well as due to data regarding life duration (decreasing the chance of successfully finishing the 7-year follow-up period). The restriction in BMI and severe deviations in the weight-bearing axis were introduced in order to eliminate the effect of these variables on the RP of HOA [ 26 , 27 ].…”

“…Over the past 40 years, researchers have tried to determine the relationship between BMD and the progression of clinical and morphological changes in HOA [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. However, most studies have reported somewhat contradictory data, such as an association between HOA and increased or decreased BMD, both on a local level (PF-BMD) [ 10 , 11 , 15 , 18 , 22 ] and in the whole body (TB-BMD) [ 12 , 13 , 14 , 16 , 17 , 18 ], including patients with advanced HOA waiting for THR [ 19 , 20 , 21 ]. In the cited studies [ 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], the effect of several important factors was not taken into account.…”

“…However, most studies have reported somewhat contradictory data, such as an association between HOA and increased or decreased BMD, both on a local level (PF-BMD) [ 10 , 11 , 15 , 18 , 22 ] and in the whole body (TB-BMD) [ 12 , 13 , 14 , 16 , 17 , 18 ], including patients with advanced HOA waiting for THR [ 19 , 20 , 21 ]. In the cited studies [ 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], the effect of several important factors was not taken into account. Despite the fact that CP, RP, and LP have been linked to the type of radiographic model (RM) (‘A’ vs. ‘I’ vs. ‘H’), this relationship was not factored into the research designs [ 10 , 23 , 24 , 25 , 26 , 27 ].…”

Osteoporosis, Osteoarthritis, and Subchondral Insufficiency Fracture: Recent Insights

“…Lower-extremity OA, especially in postmenopausal women, is complicated by OP. Stamenkovic et al demonstrated that in postmenopausal women, the BMD grade and T-score of the spine and femoral neck are low in more severe forms of OA [23]. Postural changes identified in postmenopausal women have been associated with bone loss and joint degeneration [114].…”

“…High bone mineral density (BMD) has been implicated in OA pathophysiology [18][19][20], and OA and OP were initially considered incompatible and contrary pathologies. Conversely, osteoporotic fractures in patients with lower-extremity OA (HOA and KOA) and the development of OA progression in patients with OP are being reported increasingly [21][22][23]. Subchondral insufficiency fracture (SIF), which is based on bone fragility and often causes irreversible deformity and significant ADL loss, has gradually been clarified.…”