J Korean Med Sci.  2014 Oct;29(10):1425-1431. 10.3346/jkms.2014.29.10.1425.

Prevalence of Osteoporosis in Female Patients with Advanced Knee Osteoarthritis Undergoing Total Knee Arthroplasty

Affiliations
  • 1Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea. ossbkang@gmail.com
  • 2Department of Orthopedic Surgery SMG-SNU Boramae Medical Center, Seoul, Korea.
  • 3Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.

Keyword

Bone Density; Osteoporosis; Female Knee Osteoarthritis Patient; Arthroplasty; Knee

MeSH Terms

Aged
Aged, 80 and over
*Arthroplasty, Replacement, Knee
Body Mass Index
Bone Density
Female
Humans
Knee Joint/pathology/surgery
Osteoarthritis, Knee/*epidemiology/*surgery
Osteoporosis/*epidemiology

Figure

  • Fig. 1 Study subjects enrollment flowchart. OA, osteoarthritis; TKA, total knee arthroplasty; K/L, Kellgren-Lawrence; BMI, body mass index.


Reference

1. Corti MC, Rigon C. Epidemiology of osteoarthritis: prevalence, risk factors and functional impact. Aging Clin Exp Res. 2003; 15:359–363.
2. Dixon T, Shaw M, Ebrahim S, Dieppe P. Trends in hip and knee joint replacement: socioeconomic inequalities and projections of need. Ann Rheum Dis. 2004; 63:825–830.
3. Wells VM, Hearn TC, McCaul KA, Anderton SM, Wigg AE, Graves SE. Changing incidence of primary total hip arthroplasty and total knee arthroplasty for primary osteoarthritis. J Arthroplasty. 2002; 17:267–273.
4. Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman BN, Aliabadi P, Levy D. The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1995; 38:1500–1505.
5. Zhang Y, Xu L, Nevitt MC, Aliabadi P, Yu W, Qin M, Lui LY, Felson DT. Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. Arthritis Rheum. 2001; 44:2065–2071.
6. Atik OS, Gunal I, Korkusuz F. Burden of osteoporosis. Clin Orthop Relat Res. 2006; 443:19–24.
7. Payer J, Killinger Z, Sulková I, Celec P. Preferences of patients receiving bisphosphonates: how to influence the therapeutic adherence. Biomed Pharmacother. 2008; 62:122–124.
8. Hahn MH, Won YY. Bone mineral density changes after total knee replacement in women over the age of 65. J Bone Metab. 2013; 20:105–109.
9. Labuda A, Papaioannou A, Pritchard J, Kennedy C, DeBeer J, Adachi JD. Prevalence of osteoporosis in osteoarthritic patients undergoing total hip or total knee arthroplasty. Arch Phys Med Rehabil. 2008; 89:2373–2374.
10. Simonelli C, Killeen K, Mehle S, Swanson L. Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc. 2002; 77:334–338.
11. Sowers M, Lachance L, Jamadar D, Hochberg MC, Hollis B, Crutchfield M, Jannausch ML. The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women. Arthritis Rheum. 1999; 42:483–489.
12. Lethbridge-Cejku M, Tobin JD, Scott WW Jr, Reichle R, Roy TA, Plato CC, Hochberg MC. Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: data from the Baltimore Longitudinal Study of Aging. J Rheumatol. 1996; 23:1943–1947.
13. Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, Cummings SR. The Study of Osteoporotic Fractures Research Group. Radiographic osteoarthritis of the hip and bone mineral density. Arthritis Rheum. 1995; 38:907–916.
14. Hart DJ, Mootoosamy I, Doyle DV, Spector TD. The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study. Ann Rheum Dis. 1994; 53:158–162.
15. Franklin J, Ingvarsson T, Englund M, Lohmander LS. Sex differences in the association between body mass index and total hip or knee joint replacement resulting from osteoarthritis. Ann Rheum Dis. 2009; 68:536–540.
16. Reijman M, Pols HA, Bergink AP, Hazes JM, Belo JN, Lievense AM, Bierma-Zeinstra SM. Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study. Ann Rheum Dis. 2007; 66:158–162.
17. Barrera G, Bunout D, Gattas V, de la Maza MP, Leiva L, Hirsch S. A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects. Nutrition. 2004; 20:769–771.
18. Albala C, Yanez M, Devoto E, Sostin C, Zeballos L, Santos JL. Obesity as a protective factor for postmenopausal osteoporosis. Int J Obes Relat Metab Disord. 1996; 20:1027–1032.
19. Petrella RJ, Jones TJ. Do patients receive recommended treatment of osteoporosis following hip fracture in primary care? BMC Fam Pract. 2006; 7:31.
20. de Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BC. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int. 2009; 20:2111–2125.
21. Lim S, Yoon JW, Choi SH, Park YJ, Lee JJ, Park JH, Lee SB, Kim KW, Lim JY, Kim YB, et al. Combined impact of adiponectin and retinol-binding protein 4 on metabolic syndrome in elderly people: the Korean Longitudinal Study on Health and Aging. Obesity (Silver Spring). 2010; 18:826–832.
22. Austin PC. A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med. 2008; 27:2037–2049.
23. Stürmer T, Joshi M, Glynn RJ, Avorn J, Rothman KJ, Schneeweiss S. A review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariable methods. J Clin Epidemiol. 2006; 59:437–447.
24. Cui LH, Choi JS, Shin MH, Kweon SS, Park KS, Lee YH, Nam HS, Jeong SK, Im JS. Prevalence of osteoporosis and reference data for lumbar spine and hip bone mineral density in a Korean population. J Bone Miner Metab. 2008; 26:609–617.
25. Writing Group for the ISCD Position Development Conference. Position statement: introduction, methods, and participants. The Writing Group for the International Society for Clinical Densitometry (ISCD) Position Development Conference. J Clin Densitom. 2004; 7:13–16.
26. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989; 248:13–14.
27. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15:1833–1840.
28. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30:473–483.
29. Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, Cooper C. Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum. 2006; 55:610–615.
30. Bergink AP, van der Klift M, Hofman A, Verhaar JA, van Leeuwen JP, Uitterlinden AG, Pols HA. Osteoarthritis of the knee is associated with vertebral and nonvertebral fractures in the elderly: the Rotterdam Study. Arthritis Rheum. 2003; 49:648–657.
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr