Abstract
ObjectivesHigh Bone Mass (HBM) is associated with (a) radiographic knee osteoarthritis (OA), partly mediated by increased BMI, and (b) pelvic enthesophytes and hip osteophytes, suggestive of a bone-forming phenotype. We aimed to establish whether HBM is associated with radiographic features of OA in non-weight-bearing (hand) joints, and whether such OA demonstrates a bone-forming phenotype. MethodsHBM cases (BMD Z-scores≥+3.2) were compared with family controls. A blinded assessor graded all PA hand radiographs for: osteophytes (0–3), joint space narrowing (JSN) (0–3), subchondral sclerosis (0–1), at the index Distal Interphalangeal Joint (DIPJ) and 1st Carpometacarpal Joint (CMCJ), using an established atlas. Analyses used a random effects logistic regression model, adjusting a priori for age and gender. Mediating roles of BMI and bone turnover markers (BTMs) were explored by further adjustment. Results314 HBM cases (mean age 61.1years, 74% female) and 183 controls (54.3years, 46% female) were included. Osteophytes (grade≥1) were more common in HBM (DIPJ: 67% vs. 45%, CMCJ: 69% vs. 50%), with adjusted OR [95% CI] 1.82 [1.11, 2.97], p=0.017 and 1.89 [1.19, 3.01], p=0.007 respectively; no differences were seen in JSN. Further adjustment for BMI failed to attenuate ORs for osteophytes in HBM cases vs. controls; DIPJ 1.72 [1.05, 2.83], p=0.032, CMCJ 1.76 [1.00, 3.06], p=0.049. Adjustment for BTMs (concentrations lower amongst HBM cases) did not attenuate ORs. ConclusionsHBM is positively associated with OA in non-weight-bearing joints, independent of BMI. HBM-associated OA is characterised by osteophytes, consistent with a bone-forming phenotype, rather than JSN reflecting cartilage loss. Systemic factors (e.g. genetic architecture) which govern HBM may also increase bone-forming OA risk.
Highlights
Epidemiological studies have consistently demonstrated an association between higher bone mineral density (BMD) and both prevalent [1,2,3,4] and incident [5,6,7] radiographic osteoarthritis (OA) of large joints
We have shown an increased prevalence of radiographic features of OA in non weight-bearing joints of the hand, amongst High Bone Mass (HBM) individuals compared with family controls, similar to that we previously identified in the weight-bearing joints of the knee and hip [9, 10]
In conclusion, our findings support a positive association between HBM and osteophytosis in nonweight-bearing joints of the hand, which is independent of body mass index (BMI)
Summary
Epidemiological studies have consistently demonstrated an association between higher bone mineral density (BMD) and both prevalent [1,2,3,4] and incident [5,6,7] radiographic osteoarthritis (OA) of large joints. To gain insights into mechanisms underlying this BMD-OA relationship, we recently studied the prevalence and phenotype of OA in a unique High Bone Mass (HBM) population. We have found that HBM individuals have a higher prevalence of self-reported joint replacement and use of non-steroidal anti-inflammatory drugs (NSAIDs) compared with family controls [8]. Additional evidence of a ‘bone-forming’ tendency is supported by a greater prevalence and severity of radiographic pelvic enthesophytes (bony spurs at tendon/ligament insertions) seen in HBM individuals, compared with family controls [11]
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