Abstract
BackgroundTo examine the association between circulating 25(OH)D concentrations and incidence of total hip replacement for osteoarthritis in a prospective cohort study.MethodsThis study examined a random sample of 2651 participants in the Melbourne Collaborative Cohort Study who had 25(OH)D concentrations measured from dried blood spots collected in 1990-1994. Participants who underwent total hip replacement for osteoarthritis between January 2001 and December 2018 were identified by linking the cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of total hip replacement for osteoarthritis in relation to 25(OH)D concentrations, adjusted for confounders.ResultsEighty-six men and eighty-seven women had a total hip replacement for osteoarthritis. Compared with men in the lowest (1st) quartile of 25(OH)D concentration, the HR for total hip replacement was 2.32 (95% CI 1.05, 5.13) for those in the 2nd quartile, 2.77 (95% CI 1.28, 6.00) for those in the 3rd quartile, and 1.73 (95% CI 0.75, 4.02) for those in the highest quartile of 25(OH)D concentrations (p for trend 0.02). There was little evidence of an association in women.ConclusionsHigher circulating 25(OH)D concentrations were associated with an increased risk of total hip replacement for osteoarthritis in men but not in women. Although the underlying mechanism warrants further investigation, our findings highlight the need to determine the optimal levels of circulating 25(OH)D to reduce the risk of hip osteoarthritis.
Highlights
To examine the association between circulating 25(OH)D concentrations and incidence of total hip replacement for osteoarthritis in a prospective cohort study
We used a robust definition of hip OA, i.e. hip replacement for OA, which in the context of the Australian healthcare system is a valid measure of severe hip OA, as all Australian citizens and permanent residents have access to quality health care services under Australia’s publicly funded universal health insurance system (Medicare)
Participants of the current study were younger (53.7 ± 8.7 vs. 55.1 ± 8.6 years), more likely to be men (54.6% vs 39.1%), to be born in Australia and UK (84.7% vs 75.3%), to participate in vigorous physical activity (25.9% vs 21.1%), to be former/current smokers (54.0% vs 41.5%), to be in the upper two quintiles of Socio-Economic Indexes For Areas (SEIFA) (53.6% vs 45.6%), and less likely to have hypertension (17.7% vs 21.5%) and diabetes (2.5% vs. 3.5%), compared with Melbourne Collaborative Cohort Study (MCCS) participants who were not included in the analysis
Summary
To examine the association between circulating 25(OH)D concentrations and incidence of total hip replacement for osteoarthritis in a prospective cohort study. Previous studies have examined whether circulating 25(OH) D concentrations are associated with hip OA in populations at risk of osteoporosis [6, 7] or community-based populations [8,9,10]. Two studies reported that low serum levels of 25(OH)D were associated with increased prevalence and incidence of radiographic hip OA among men and women aged ≥65 years (mean age 73.5 years, standard deviation 5.8 years) [6, 7]. In an Australian study of 9135 participants, we found that higher concentrations of circulating 25(OH)D were associated with increased risk of hip replacement for severe OA in men but not in women [8]. Our study had a large number of joint replacements, increasing the power to show potential associations [8]
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