Risk of osteoarthritis associated with long‐term weight‐bearing sports: A radiologic survey of the hips and knees in female ex‐athletes and population controls

663

396

Objective. Knee osteoarthritis (OA) is highly prevalent, especially in the elderly. Preventive strategies require a knowledge of risk factors that precede disease onset. The present study was conducted to determine the longitudinal risk factors for knee OA in an elderly population.Methods. A longitudinal study of knee OA involving members of the Framingham Study cohort was performed. Weight-bearing knee radiographs were obtained in 1983-1985 (baseline) index increased the risk of OA (OR = 1.6 per 5-unit increase, 95% CI 1.2-2.2), and weight change was directly correlated with the risk of OA (OR = 1.4 per 10-lb change in weight, 95% CI 1.1-1.8). Physical activity increased the risk of OA (for those in the highest quartile, OR = 3.3, 95% CI 1.4-7.5). Smokers had a lower risk than did nonsmokers (for those who smoked an average of 1 1 0 cigarettedday, OR = 0.4, 95% CI 0.2-0.8). Factors not associated with the risk of OA included chondrocalcinosis and a history of hand OA. Weight-related factors affected the risk of OA only in women.Conclusion. Elderly persons at high risk of developing radiographic knee OA included obese persons, nonsmokers, and those who were physically active. The direction of weight change correlated directly with the risk of developing OA.Osteoarthritis (OA) is the most common joint disease, especially in the elderly. However, partly because of the slow time course of disease development, no substantial longitudinal studies of risk factors for the disease have been performed. Knowledge of the risk factors for knee OA has been derived from crosssectional studies.Similar to many chronic diseases, the pathogenesis of OA is likely to be multifactorial. Risk factors consistently associated with the disease in cross-sectional studies include older age, female sex, and being overweight (1). In cross-sectional studies, the OA could develop first, leading a person to become sedentary and to gain weight. We have reported that higher weight in early life predisposes patients to knee OA (2), and that weight loss lowers the risk of developing symptomatic knee OA (3). Both results were based on a one-time assessment of OA occurrence (3). We (4) and others ( 5 )

Section: Discussionmentioning

confidence: 99%

Risk factors for incident radiographic knee osteoarthritis in the elderly. The framingham study

Felson

Zhang

Hannan

et al. 1997

663

396

“…The precise etiology of osteoarthritis (OA) is unknown; however, several risk factors have been identified, including age (1,2), female sex (3), and both occupational (4,5) and sports-related joint stress (6)(7)(8)(9). The most important modifiable risk factor for the development and progression of OA is obesity (1,(10)(11)(12)(13)(14)(15)(16)(17).…”

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confidence: 99%

Weight loss reduces knee‐joint loads in overweight and obese older adults with knee osteoarthritis

Messier¹,

Gutekunst²,

Davis³

et al. 2005

452

317

Objective. To determine the relationship between change in body mass and knee-joint moments and forces during walking in overweight and obese older adults with knee osteoarthritis (OA) following an 18-month clinical trial of diet and exercise.Methods. Data were obtained from 142 sedentary, overweight, and obese older adults with self-reported disability and radiographic evidence of knee OA who underwent 3-dimensional gait analysis. Gait kinetic outcome variables included peak knee-joint forces and peak internal knee-joint moments. Mixed regression models were created to predict followup kinetic values, using followup body mass as the primary explanatory variable. Baseline body mass was used as a covariate, and thus followup body mass was a surrogate measure for change in body mass (i.e., weight loss).Results. There was a significant direct association between followup body mass and peak followup values of compressive force (P ‫؍‬ 0.001), resultant force (P ‫؍‬ 0.002), abduction moment (P ‫؍‬ 0.03), and medial rotation moment (P ‫؍‬ 0.02). A weight reduction of 9.8N (1 kg) was associated with reductions of 40.6N and 38.7N in compressive and resultant forces, respectively. Thus, each weight-loss unit was associated with an ϳ4-unit reduction in knee-joint forces. In addition, a reduction in body weight of 9.8N (1 kg) was associated with a 1.4% reduction (0.496 Nm) in knee abduction moment. Conclusion. Our results indicate that each poundof weight lost will result in a 4-fold reduction in the load exerted on the knee per step during daily activities. Accumulated over thousands of steps per day, a reduction of this magnitude would appear to be clinically meaningful.The precise etiology of osteoarthritis (OA) is unknown; however, several risk factors have been identified, including age (1,2), female sex (3), and both occupational (4,5) and sports-related joint stress (6-9). The most important modifiable risk factor for the development and progression of OA is obesity (1,10-17). Weight loss reduces the risk of symptomatic knee OA (13), and for obese patients with knee OA, weight loss and exercise are recommended by both the American College of Rheumatology and the European League Against Rheumatism (18,19). We have shown that an average weight loss of 5% over 18 months in overweight and obese adults with knee OA results in an 18% improvement in function. When dietary changes are combined with exercise, function improves 24% and is accompanied by a significant improvement in mobility (20).Although obesity is strongly associated with knee OA, some obese but otherwise healthy adults adapt to their excessive weight and subsequently reduce kneejoint torques and possibly knee-joint forces during walking (21). In other obese adults, however, excessive biomechanical joint stress represents one possible pathway for the pathogenesis and progression of knee OA. We hypothesized a significant and direct relationship between weight loss and attenuation of knee-joint forces and moments during walking in overweight and obese older adu...

“…This may be attributable to the cumulative physical activity that they encounter during the years of service required to reach their current rank level. Several studies that have examined former recreational and professional athletes have shown a positive correlation between various sports participation and an increased prevalence of hip OA (33)(34)(35)(36)(37)(38)(39)(40)(41). A retrospective case-control study of regular high-mileage, long-distance male runners who were longitudinally followed for 15 years found radiologic evidence of OA consisting of subchondral sclerosis (59%) and osteophyte formation (29%) in their cohort (39).…”

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confidence: 99%

“…Additionally, 30% of these runners at age 42 years had symptomatic hip pain, and their long-term, high-intensity, high-mileage running was found to be statistically equivalent to age as a risk factor for the development of radiographic hip OA and symptomatic hip pain. Prolonged exposure to higher levels of recreational physical activity has been reported to have a statistically significant increase in the risk of developing radiographic symptomatic hip OA in women and men ranging from a factor of 2 to 4.5, respectively (37,40,41). In contrast, several surveys have found no increased risk for the development of hip OA secondary to running or increased physical activity levels (42)(43)(44)(45).…”

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confidence: 99%

The incidence of primary hip osteoarthritis in active duty US military servicemembers

Scher

Belmont

Mountcastle

et al. 2009

Objective. Although multiple studies have reported the prevalence of primary hip osteoarthritis (OA), little has been reported on incidence rates of hip OA. We sought to determine the incidence rate and demographic risk factors of hip OA in an ethnically diverse and physically active population of US military servicemembers. Methods. A query was performed using the US Defense Medical Epidemiology Database for the International Classification of Diseases, Ninth Revision, Clinical Modification code for hip OA (715.95). Multivariate Poisson regression analysis was used to estimate the rate of hip OA per 100,000 person-years, controlling for sex, race, age, rank, and service. Results. The overall unadjusted incidence rate of hip OA was 35 per 100,000 person-years. Women, compared with men, had a significantly increased adjusted incidence rate ratio for hip OA of 1.87 (95% confidence interval [95% CI] 1.73-2.01). The adjusted incidence rate ratio for black servicemembers when compared with white servicemembers was 1.32 (95% CI 1.23-1.41). The adjusted incidence rate ratio for the >40-year-old age group compared with the 20-year-old group was 22.21 (95% CI 17.54 -28.14). With junior officers as the referent category, junior enlisted, senior enlisted, and senior officers rank groups had a significantly increased adjusted incidence rate ratio for hip OA. With the Air Force as the referent category, each service had a significantly increased adjusted incidence rate ratio for hip OA. Conclusion. Female sex; black race; age >40 years; junior enlisted, senior enlisted, and senior officer rank groups; and military service in the Navy, Army, or Marines were all risk factors for hip OA.