Knee pain, knee osteoarthritis, and the risk of fracture

Arden, N K; Crozier, Sarah; Smith, Helen; Anderson, Fiona; Edwards, Christopher J; Raphael, H; Cooper, Cyrus

doi:10.1002/art.22088

Cited by 168 publications

(171 citation statements)

References 28 publications

(57 reference statements)

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“…Nonetheless, not only did cohort studies fail to demonstrate a reduced fracture risk among such patients, but some have even shown an increase in the rates of OP fracture (9)(10)(11). A possible explanation for this paradox might be the increased number and severity of falls sustained by subjects with lower-limb OA, as has been observed by some investigators (26,27).…”

Section: Discussionmentioning

confidence: 98%

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Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Prieto-Alhambra¹,

Javaid²,

Judge³

et al. 2011

Arthritis & Rheumatism

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Objective. The association between osteoarthritis (OA) and fractures remains unclear. OA patients have increased bone mass, but no corresponding decrease in fracture rate. This study was undertaken to determine the fracture rates in patients with hip OA undergoing a total hip replacement (THR), as compared with diseasefree controls, and to assess the association between bisphosphonate use and postsurgery fracture risk.Methods. We conducted a population-based parallel-cohorts study. All patients in the UK General Practice Research Database undergoing a THR for hip OA between 1986 and 2006 constituted the exposed cohort (n ‫؍‬ 14,133). Five disease-free controls were matched with each patient by age, sex, and practice site. Subjects were followed up for 5 years before and after surgery. Fracture rates and rate ratios (RRs) were estimated using Poisson regression. In addition, bisphosphonate use was identified among patients undergoing THR, and the data, stratified by the presence or absence of a previous fracture and by treatment propensity score, were assessed using fitted Cox models to study the effect of bisphosphonate use on the risk of fracture postsurgery.Results. Patients undergoing a THR had a similar fracture risk as that in controls in the 5 years before THR, but had higher rates postsurgery, which peaked at years 2. Conclusion. This study identified a 25% increase in fracture risk at 2.5-5 years postsurgery among patients undergoing a THR. Bisphosphonate use reduced the post-THR risk of fracture when administered both as primary prevention and as secondary prevention, by 44% and 52%, respectively. This must be further confirmed in randomized controlled trials.

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Section: Discussionmentioning

confidence: 98%

“…Although, in the first studies, increased bone mass was observed in patients with OA (7,8), findings from more recent cohort studies have suggested that there is not only no corresponding decrease in fracture risk, but even an increased risk of fracture among patients with OA (9)(10)(11).…”

mentioning

confidence: 99%

Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Prieto-Alhambra¹,

Javaid²,

Judge³

et al. 2011

Arthritis & Rheumatism

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“…Patients with a clinical diagnosis of knee OA and with knee pain have an increased risk of nonvertebral and hip fracture; also, radiographic knee OA is associated with an increased risk of incident vertebral and nonvertebral fractures as well. Knee pain and OA should be regarded as independent risk factors for fracture (46,47).…”

Section: Impactmentioning

confidence: 99%

Osteoarthritis: etiology, epidemiology, impact on the individual and society and the main principles of management

Sakalauskienė

Jauniškienė²

2010

Medicina

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“…(1,25) This condition is known to be associated with an increase risk of fracture. (26) Another potential reason for an increased fracture risk of unaffected bone in PDB would be deformity with resulting postural instability. This would be in keeping with the trend for patients with SQSTM1 mutations to have worse bone deformities than those without mutations.…”

Section: Discussionmentioning

confidence: 99%

Mutations of SQSTM1 are associated with severity and clinical outcome in paget disease of bone

Visconti

Langston

Alonso

et al. 2010

Journal of Bone and Mineral Research

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Paget disease of bone (PDB) is a common disorder characterized by increased bone turnover at one of more sites throughout the skeleton. Genetic factors play an important role in the pathogenesis of PDB, and the most important predisposing gene is SQSTM1, which is mutated in about 10% of patients. Here we investigated the relationship between SQSTM1 mutation status, disease severity, and clinical outcome in 737 patients who took part in a randomized study of two different management strategies for the disease. Mutations of SQSTM1 were detected in 80 of 737 (10.9%) patients. Mutation carriers had an earlier age at diagnosis (59.4 AE11.5 versus 65.0 AE 10.4 years, p < .0001) and a greater number of affected bones (3.2 AE 1.2 versus 2.1 AE 1.2, p < .001) and more commonly required orthopedic surgery (26.2% versus 16.1%, p ¼ .024) and bisphosphonate therapy (86.3% versus 75.2%, p ¼ .01) than those without mutations. Quality of life, as assessed by the short-form-36 (SF36) physical summary score, was significantly reduced in carriers (34.0 AE 11.3 versus 37.1 AE 11.4, p ¼ .036). During the study, fractures were more common in carriers (12.5% versus 5.3%, p ¼ .011), although most of these occurred in unaffected bone. This study demonstrates that SQSTM1 mutations are strongly associated with disease severity and complications of PDB. Genetic testing for SQSTM1 mutations may be of value in identifying individuals at risk of developing severe disease, but further studies will be required to determine if a program of genetic testing and early intervention in these individuals would be cost-effective or be of benefit in preventing these complications. ß

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Knee pain, knee osteoarthritis, and the risk of fracture

Cited by 168 publications

References 28 publications

Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Osteoarthritis: etiology, epidemiology, impact on the individual and society and the main principles of management

Mutations of SQSTM1 are associated with severity and clinical outcome in paget disease of bone

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