High bone mass is associated with an increased prevalence of joint replacement: a case-control study.
OBJECTIVE
Epidemiological studies have shown an association between OA and increased BMD. To explore the nature of this relationship, we examined whether the risk of OA is increased in individuals with high bone mass (HBM), in whom BMD is assumed to be elevated due to a primary genetic cause.


METHODS
A total of 335,115 DXA scans were screened to identify HBM index cases (defined by DXA scan as an L1 Z-score of ≥+3.2 and total hip Z-score ≥+1.2, or total hip Z-score ≥+3.2 and L1 Z-score ≥+1.2). In relatives, the definition of HBM was L1 Z-score plus total hip Z-score ≥+3.2. Controls comprised unaffected relatives and spouses. Clinical indicators of OA were determined by structured assessment. Analyses used logistic regression adjusting for age, gender, BMI and social deprivation.


RESULTS
A total of 353 HBM cases (mean age 61.7 years, 77% female) and 197 controls (mean age 54.1 years, 47% female) were included. Adjusted NSAID use was more prevalent in HBM cases versus controls [odds ratio (OR) 2.17 (95% CI 1.10, 4.28); P = 0.03]. The prevalence of joint replacement was higher in HBM cases (13.0%) than controls (4.1%), with an adjusted OR of 2.42 (95% CI 1.06, 5.56); P = 0.04. Adjusted prevalence of joint pain and knee crepitus did not differ between cases and controls.


CONCLUSIONS
HBM is associated with increased prevalence of joint replacement surgery and NSAID use compared with unaffected controls.
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK. sarah.hardcastle@bristol.ac.uk
Sarah A
SA
Hardcastle
Celia L
CL
Gregson
Kevin C
KC
Deere
George
G
Davey Smith
Paul
P
Dieppe
Jon H
JH
Tobias
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D015992:Body Mass Index; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D015995:Prevalence; D011859:Radiography
DXA; bone mineral density; high bone mass; joint replacement; osteoarthritis