Dose-response relationship between cumulative physical workload and osteoarthritis of the hip – a meta-analysis applying an external reference population for exposure assignment

Abstract

BackgroundThere is consistent evidence from observational studies of an association between occupational lifting and carrying of heavy loads and the diagnosis of hip osteoarthritis. However, due to the heterogeneity of exposure estimates considered in single studies, a dose-response relationship between cumulative physical workload and hip osteoarthritis could not be determined so far.MethodsThis study aimed to analyze the dose-response relationship between cumulative physical workload and hip osteoarthritis by replacing the exposure categories of the included studies with cumulative exposure values of an external reference population. Our meta-regression analysis was based on a recently conducted systematic review (Bergmann A, Bolm-Audorff U, Krone D, Seidler A, Liebers F, Haerting J, Freiberg A, Unverzagt S, Dtsch Arztebl Int 114:581–8, 2017). The main analysis of our meta-regression comprised six case-control studies for men and five for women. The population control subjects of a German multicentre case-control study (Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, Luttmann A, Michaelis M, Petereit-Haack G, Schumann B, Bolm-Audorff U, BMC Musculoskelet Disord 10:48, 2009) served as the reference population. Based on the sex-specific cumulative exposure percentiles of the reference population, we assigned exposure values to each category of the included studies using three different cumulative exposure parameters. To estimate the doubling dose (the amount of physical workload to double the risk of hip osteoarthritis) on the basis of all available case-control-studies, meta-regression analyses were conducted based on the linear association between exposure values of the reference population and the logarithm of reported odds ratios (ORs) from the included studies.ResultsIn men, the risk to develop hip osteoarthritis was increased by an OR of 1.98 (95% CI 1.20–3.29) per 10,000 tons of weights ≥20 kg handled, 2.08 (95% CI 1.22–3.53) per 10,000 tons handled > 10 times per day and 8.64 (95% CI 1.87–39.91) per 106 operations. These estimations result in doubling dosages of 10,100 tons of weights ≥20 kg handled, 9500 tons ≥20 kg handled > 10 times per day and 321,400 operations of weights ≥20 kg. There was no linear association between manual handling of weights at work and risk to develop hip osteoarthritis in women.ConclusionsUnder specific conditions, the application of an external reference population allows for the derivation of a dose-response relationship despite high exposure heterogeneities in the pooled studies.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2085-8) contains supplementary material, which is available to authorized users.

Occupational load as a risk factor for clinically relevant base of thumb osteoarthritis

“…These findings are similar to a previous register-based study of hip and knee OA, which showed that while men and women both had increased cumulative risk dependent on occupation, men had overall higher incidence of OA related to occupation 11. A meta-analysis of hip OA reported a similar dose–response relationship in men, but not in women, between cumulative lifting of heavy loads and the development of OA 12. Based on these studies in weightbearing joints, as well as previous biomechanical studies showing that strong grasp activities confer the highest loads to the CMC1 joint,2 it can be postulated that occupational joint loading has a deleterious impact on articular cartilage leading to OA.…”

Osteoarthrosis in the clinic of internal and occupational diseases: differential diagnostic aspects

“…Кроме плечевых, локтевых и коленных суставов к настоящему времени появилось достаточно данных по ассоциации профессиональных факторов с ОА тазобедренного сустава. Профессиональные факторы риска развития ОА тазобедренного сустава изучены в 7 систематических обзорах [13,[19][20][21][22][23][24]. В обзоре A. Bergmann и соавт.…”

“…, который включал 51 исследование (526 343 человека), установлено, что такие профессиональные факторы, как подъем тяжестей, приседание на корточках и восхождение по лестнице, могут увеличивать риск развития остеоартроза Ряд авторов указывают[16][17][18][19][20][21] на ассоциацию частых приседаний с развитием ОА коленного сустава. Установлено, что при приседании нагрузка на коленный сустав в 2,5 раза больше, чем при ходьбе…”

Work-relatedness of inguinal hernia: a systematic review including meta-analysis and GRADE

“…For prevention, a prerequisite is knowing whether work-related risk factors actually do matter in the onset or worsening of a disease [ 9 ]. In addition, if data allow, clinically relevant exposure threshold limits can be formulated, as is done for several other prevalent diseases like carpal tunnel syndrome [ 10 ], lateral epicondylitis [ 11 ], specific shoulder disorders [ 12 ], hip and knee osteoarthritis [ 13 , 14 ], and lumbosacral radiculopathy syndrome [ 15 ]. Regarding medical causation, many countries provide financial compensation when a disease is recognised as an occupational disease, like the Unites States of America, Canada and many countries in the European Union, like Italy, France, and Germany.…”