Relationship of Bone Mineral Density and Knee Osteoarthritis (Kellgren-Lawrence Grade): Fifth Korea National Health and Nutrition Examination Survey

Total knee arthroplasty and periprosthetic distal femoral fracture: looking beyond the osteoporosis to previous osteoporotic fracture

Osteoporosis increases the risk of periprosthetic distal femoral fractures after TKA, especially in patients with a history of osteoporotic fractures. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized by the patients following primary TKA.

PURPOSE

Osteoporosis is a risk factor for fractures, including those of the hip, vertebrae, and distal radius; however, the association between osteoporosis and periprosthetic fractures after total knee arthroplasty (TKA) has not been much investigated. Therefore, we aimed to investigate the association of the presence of systemic osteoporosis with periprosthetic fractures after TKA.

METHODS

This study included 34 patients with periprosthetic fractures following primary TKA and 106 controls matched for age and sex. Bone mineral density was evaluated at the femoral neck, total hip, and lumbar spine using dual X-ray absorptiometry. Medical records were reviewed for age; sex; body mass index; smoking; rheumatoid arthritis, endocrine diseases, and cardiovascular diseases; history of glucocorticoid use; medication for osteoporosis; and history of previous osteoporotic fracture. In addition, anterior femoral notching after TKA was evaluated. Univariable and multivariable logistic regression analysis were used to determine factors associated with periprosthetic fracture.

RESULTS

The prevalence of osteoporosis in the fracture group was higher than that in the control group (61.8% vs. 40.6%, p=0.045). The rate of medication for osteoporosis was significantly low in the fracture group (47.6 % vs 76.7%, p=0.026). History of previous osteoporotic fracture (odds ratio [OR], 9.1; p=0.015) and osteoporosis (OR, 3.6; p=0.013) were significant risk factors for periprosthetic fractures after TKA. Medication for osteoporosis could decrease the risk of periprosthetic fracture (OR 0.3; p=0.020).

CONCLUSION

Osteoporosis is a major risk factor for periprosthetic distal femoral fractures after TKA. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized to the patients following primary TKA, especially in patients with a history of osteoporotic fracture.

LEVEL OF EVIDENCE

Prognostic study, level III.

Relationship between DXA measured systemic bone mineral density and subchondral bone cysts in postmenopausal female patients with knee osteoarthritis: a cross-sectional study : Osteoarthritis cysts and bone mineral density

BACKGROUND

Individuals with high systemic bone mineral density (BMD) may have an increased risk of incident knee osteoarthritis (OA). Besides that, radiographic osteophytes are strongly associated with BMD. Because of these reasons, the aim of the study was to investigate the possible association between radiological subchondral bone cyst (SBC) grade and systemic BMD and vitamin D status in the postmenopausal female patients with knee OA in a crosss-sectional study.

METHODS

This study included of 48 osteoporosis treatment-free postmenopausal patients diagnosed with symptomatic medial compartment knee OA. BMD analysis was performed using dual-energy X-ray absorptiometry (DXA) and serum vitamin D levels were measured after recording patients' findings. Each knee was scanned using computed tomography (CT), and categorical SBC scores were graded for the medial and lateral tibiofemoral (TF) and patellofemoral (PF) compartments and further calculated as compartmental total, total TF and grand total of both TF compartments. SBC scores were analysed with correlation analysis.

RESULTS

The patient population was characterized by radiographic joint space narrowing, obesity and low vitamin D status. Median medial total and grand total TF SBC scores were significantly different between the patient groups according to the Kellgren-Lawrence (KL) radiographic grading (p = 0.006 and p = 0.007, respectively). There were no correlations between femoral BMD values and SBC scores. However, positive correlations were detected significantly between L1 - 4 DXA values and TF SBC scores, but not with PF SBC scores (p = 0.005 for the correlation between L1 - 4 BMD and medial compartments total TF SBC score, p = 0.021 for the correlation between L1 - 4 BMD and grand total TF SBC score). No significant correlations were found with Vitamin D levels.

CONCLUSIONS

Development of TF OA high-grade SBCs may be linked to systemic bone mass as represented by trabecular bone-rich lumbar vertebrae. The relationship might point to the importance of bone stiffness as an acting factor in knee OA possibly with mechanical energy transfer to the joint.

Osteoporosis treatment and pain relief: A scoping review

BACKGROUND AND OBJECTIVE

Anti-osteoporosis (OP) drugs have been suggested to contribute to pain reduction during OP management. This scoping review aimed at mapping the literature on pain relief with anti-OP drugs in OP treatment.

DATABASES AND DATA TREATMENT

Medline, Pubmed and Cochrane databases were searched by two reviewers with keywords combinations. Randomized controlled and real-life English studies, pain as an endpoint, antiosteoporosis drugs were inclusion criteria. Case reports, surveys, comment letters, conference abstracts, animal studies and grey literature were excluded. Predetermined data were extracted by two reviewers and disagreement solved through discussion.

RESULTS

A total of 130 articles were identified, 31 publications were included, 12 randomized clinical trials and 19 observational studies. Pain reduction was assessed by different tools: Visual Analogue Scale, Verbal Rating Scale, Facial Scale or as a domain of quality of life questionnaires including Short form 8, 36, mini-OP, Japanese OP, Qualeffo, Roland Morris Disability questionnaires. Collective data show that anti-OP drugs may display an analgesic effect that may be linked to the local mode of action of drugs on bone and consecutive modulation of pain sensitization. The methodology of the studies showed a heterogeneity of endpoints, comparators, statistical approaches and follow-up duration.

CONCLUSION

Considering the limitations of the literature, there is a need for more rigorous trials and larger real-life studies taking into account the recommendations published for research in rheumatology and in pain medicine. The identification of responders, patient subtypes, and of analgesic-effect doses would allow optimization and individualization for pain relief in patients with OP.

SIGNIFICANCE STATEMENT

This scoping review shows that anti-OP drugs may improve pain and quality of life of patients with OP. The heterogeneity in design, choice of endpoints, methodology, comparators and follow-up duration of included randomized clinical trials and real-life studies does not allow so far to identify a predominant antiosteoporosis drug or an optimal dosage for pain relief. These gaps need to be addressed and warrant further research in the future for optimizing pain improvement in the course of OP drug treatment.

Association between patellofemoral osteoarthritis with demographic features and anatomical variants of the knee in non-traumatic patients

BACKGROUND

Patellofemoral osteoarthritis (PFOA) is a common cause of knee discomfort and impairment, particularly among athletes. The development of PFOA has been associated with anatomical knee variations, such as trochlear dysplasia and patella alta. However, the relationship between these anatomical variants and the development of PFOA remains poorly understood. This study aimed to investigate the association between PFOA and knee anatomical variants in a cohort of patients.

METHODS

The study included 200 patients with PFOA and 200 healthy controls. In this study, we investigate the relationship of osteoarthritis with both anatomical variants and demographic characteristics. The participants underwent Magnetic resonance imaging (MRI) evaluation of the knee, and anatomical variants including trochlear dysplasia and patella alta were assessed. The severity of PFOA was also graded based on cartilage area and depth, as well as the bone marrow involvement and presence of osteophytes.

RESULTS

Statistically significant differences were observed between the two groups in terms of Tibial tuberosity-trochlear groove (TT-TG) distance, patella position, trochlear dysplasia, and Insall-Salvati ratio. The mean TT-TG distance, prevalence of alta patella position, and Insall-Salvati ratio were significantly higher in cases (P<0.001 for all), and cases had a higher incidence of trochlear dysplasia (P<0.001). There were no significant differences between cases and controls regarding patella baja.

CONCLUSION

Anatomical knee variants, including the TT-TG distance, trochlear dysplasia, and Insall-Salvati ratio, are significant risk factors for PFOA progression. The results also indicate that higher BMI and older age are significantly associated with more measures of MRI Osteoarthritis Knee Score (MOAKS) than demographic information. Among anatomical variants, a higher TT-TG distance and an increased grade of trochlear dysplasia show a significant relationship with more measures of MOAKS. Understanding the relationship between these factors has important clinical and research implications and can help inform the development of new treatments.

Assessing bone mineral density in non-weight bearing regions of the body: a texture analysis approach using abdomen and pelvis computed tomography Hounsfield units-a cross-sectional study

Background

Highlighting a gap in comprehending bone microarchitecture's intricacies using dual-energy X-ray absorptiometry (DXA), this study aims to bridge this chasm by analyzing texture in non-weight bearing regions on axial computed tomography (CT) scans. Our goal is to enrich osteoporosis patient management by enhancing bone quality and microarchitecture insights.

Methods

Conducted at Busan Medical Center from March 1, 2013, to August 30, 2022, 1,320 cases (782 patients) were screened. After applying exclusion criteria, 458 samples (296 patients) underwent bone mineral density (BMD) assessment with both CT and DXA. Regions of interest (ROIs) included spine pedicle's maximum trabecular area, sacrum Zone 1, superior/inferior pubic ramus, and femur's greater/lesser trochanters. Texture features (n=45) were extracted from ROIs using gray-level co-occurrence matrices. A regression model predicted BMD, spotlighting the top five influential texture features.

Results

Correlation coefficients ranged from 0.709 (lowest for total femur BMD) to 0.804 (highest for femur intertrochanter BMD). Mean squared error (MSE) values were also provided for lumbar and femur BMD/bone mineral content (BMC) metrics. The most influential texture features included contrast_32, correlation_32_v, and three other metrics.

Conclusions

By melding traditional DXA and CT texture analysis, our approach presents a comprehensive bone health perspective, potentially revolutionizing osteoporosis diagnostics.

Construction of predictive model for osteoporosis related factors among postmenopausal women on the basis of logistic regression and Bayesian network

Osteoporosis is a prevalent chronic disease that often goes unnoticed in postmenopausal women. Early identification of risk factors for osteoporosis in postmenopausal women is essential. This study aimed to develop predictive models for osteoporosis-related factors among postmenopausal women in the U.S. and explore the influencing factors. In this cross-sectional study, we included 4417 postmenopausal women from the NHANES (2009-2010, 2013-2014, and 2017-2020). Through multiple regression analysis, we found that age, minutes of sedentary activity, prednisone or cortisone usage, arthritis, bone loss around teeth, and trouble sleeping were risk factors for osteoporosis after menopause. Conversely, height, BMI, and age at the last menstrual period were identified as protective factors. The findings from the Bayesian network analysis indicated that several factors influenced osteoporosis, including age, BMI, bone loss around teeth, prednisone or cortisone usage, arthritis, and age at the last menstrual period. On the other hand, minutes of sedentary activity and height might have indirect effects, while trouble sleeping may not have a significant impact. Both logistic regression and Bayesian network models demonstrated good predictive capabilities in predicting osteoporosis among postmenopausal women. In addition, Bayesian networks offer a more intuitive depiction of the intricate network risk mechanism between diseases and factors.

Assessing Bone Mineral Density in Weight-Bearing Regions of the Body through Texture Analysis of Abdomen and Pelvis CT Hounsfield Unit

Objective: This study aimed to develop a novel method for opportunistically screening osteoporosis by measuring bone mineral density (BMD) from CT images. We addressed the limitations of commercially available software and introduced texture analysis using Hounsfield units (HU) as an alternative approach. Methods: A total of 458 samples (296 patients) were selected from a dataset of 1320 cases (782 patients) between 1 March 2013, and 30 August 2022. BMD measurements were obtained from the ilium, femoral neck, intertrochanteric region of both femurs, and L1-L5 and sacrum spine body. The region of interest (ROI) for each patient's CT scan was defined as the maximum trabecular area of the spine body, ilium, femoral neck, and femur intertrochanter. Using gray-level co-occurrence matrices, we extracted 45 texture features from each ROI. Linear regression analysis was employed to predict BMD, and the top five influential texture features were identified. Results: The linear regression (LR) model yielded correlation coefficients (R-squared values) for total lumbar BMD, total lumbar BMC, total femur BMD, total femur BMC, femur neck BMD, femur neck BMC, femur intertrochanter BMD, and femur intertrochanter BMC as follows: 0.643, 0.667, 0.63, 0.635, 0.631, 0.636, 0.68, and 0.68, respectively. Among the 45 texture features considered, the top five influential factors for BMD prediction were Entropy, autocorrelate_32, autocorrelate_32_volume, autocorrelate_64, and autocorrelate_64_volume.

Impact of Osteoporosis in Postmenopausal Women With Primary Knee Osteoarthritis

BACKGROUND

Although knee osteoarthritis (OA) and osteoporosis (OP) are common age-related bone disorders, the association between the two conditions remains indefinable. The aim of the present study is to investigate a possible relationship between the two conditions in post-menopausal women.

METHODOLOGY

A cross-sectional study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia, after obtaining IRB approval. The study included all post-menopausal female patients above 50 years of age, who underwent dual-energy X-ray absorptiometry (DXA) scans between January 2019 and July 2021 and have clear radiological data regarding knee OA. For our study, 487 ladies satisfied our inclusion criteria with an age range of 50-94 years (mean 64.67 ±8.4). The severity of knee OA was determined according to the Kellgren and Lawrence (KL) grading system.

RESULTS

The mean age and weight of all patients showed a significant association with knee OA. There was no significant association between bone quality and all parameters of bone mineral density (BMD) and T-score with the presence of knee OA. The mean age, height, weight, and BMI have a significant relationship with OP. Grade 3 of the KL classification system for knee OA is the only grade that showed a significant relationship with the presence of OP. The status of bone quality, BMD, and T-score parameters have no significant relationship with the severity subgrouping of knee OA. The BMD and the T-score of the right femoral neck have a significant correlation with BMI, which is linked to the presence of knee OA.

CONCLUSION

We didn't find a clear relationship between OP or BMD and the presence of knee OA. However, our findings demonstrated that BMD, T-score of the right femoral neck, and BMI can all be utilized as predictors for the development and progression of knee OA. We recommend considering the many potential confounding variations when describing a relationship between OP and OA.

Is There a Role for Ordering a DEXA (Dual Energy X-Ray Absorptiometry) Scan for Patients with Symptomatic Advanced Knee Osteoarthritis?

Background

Osteoarthritis of the knee (OA) and osteoporosis are two conditions that have a significant impact on society, have a great impact on quality of life, and can lead to functional impairment. However, the relationship between knee OA and osteoporosis is unclear.

Objective

The aim of this study was to examine if there is a link between symptomatic advanced knee osteoarthritis and low bone mineral density.

Methods

A total of 430 patients with symptomatic and advanced radiographic knee OA served as participants in this study. Plain radiographs were used to screen participants for osteoarthritis, and a Dual Energy X-ray Absorptiometry (DEXA) scan was used to determine each participant's bone mineral density (BMD).

Results

The lumbar spine, whole femur, and femoral neck BMD levels were statistically higher in the early OA (Kelldren-Lawrence (KL) I and II) group compared with the advanced (III and IV) OA group. Higher BMD at the whole femur and femoral neck but not at the lumbar spine was observed when comparing patients with grades I, II, and III with patients with grade IV after adjustment for body mass index.

Conclusion

The findings of this study indicate that the degree of knee OA is correlated with a decline in BMD. These findings lend credence to the theory that the two conditions may be linked to one another. Our study concluded that patients with advanced knee osteoarthritis are at risk of developing osteoporosis. As a result, orthopedic doctors are required to screen for osteoporosis in patients with advanced knee osteoarthritis to both prevent and treat osteoporosis at an earlier stage.

The effect of postmenopausal osteoporosis on subchondral bone pathology in a rat model of knee osteoarthritis

This study aimed to investigate the additional effect of ovariectomy-induced osteoporosis (OP) on the pathology of knee osteoarthritis (OA) in a rat meniscectomized model, particularly focusing on subchondral bone changes and pain behaviour. Rats were divided into four groups, sham, OP, OA, OP plus OA, and assessed for histology, osteoclast activity, subchondral bone microstructure, and pain-related behaviour. Rats with OP plus OA had significantly increased calcified cartilage and subchondral bone damage scores, increased densities of subchondral osteoclasts in the weight-bearing area, and more porous subchondral trabecular bone compared with rats with OA. Loss of tidemark integrity was observed most frequently in rats with OP plus OA. The density of subchondral osteoclasts correlated with the calcified cartilage and subchondral bone damage score in rats with OA (OA and OP plus OA). No significant differences in the receptor activator of nuclear factor-kappa B ligand (RANKL)/osteoprotegerin (OPG) expression ratio in subchondral bone and pain-related behavioural tests were observed between rats with OA and rats with OP plus OA. In rats with OA, coexisting OP potentially aggravated OA pathology mainly in calcified cartilage and subchondral trabecular bone by increasing subchondral osteoclast activity.

Correlation Analysis between Fat Fraction and Bone Mineral Density Using the DIXON Method for Fat Dominant Tissue in Knee Joint MRI: A Preliminary Study

Purpose

This study aimed to investigate the correlation between the fat signal fraction (FF) of the fat-dominant bone tissue of the knee joint, measured using the MRI Dixon method (DIXON) technique, and bone mineral density (BMD).

Materials and Methods

Among the patients who underwent knee DIXON imaging at our institute, we retrospectively analyzed 93 patients who also underwent dual energy X-ray absorptiometry within 1 year. The FFs of the distal femur metaphyseal (Fm) and proximal tibia metaphyseal (Tm) were calculated from the DIXON images, and the correlation between FF and BMD was analyzed. Patients were grouped based on BMD of lumbar spine (L), femoral neck (FN), and common femur (FT) respectively, and the Kruskal-Wallis H test was performed for FF.

Results

We identified a significant negative correlation between TmFF and FN-BMD in the entire patient group (r = -0.26, p < 0.05). In female patients, TmFF showed a negative correlation with FN-BMD, FT-BMD, and L-BMD (r = -0.38, 0.28 and -0.27, p < 0.05). In male patients, FmFF was negatively correlated with only FN-BMD and FT-BMD (r = -0.58 and -0.42, p < 0.05). There was a significant difference in the TmFF between female patients grouped by BMD (p < 0.05). In male patients, there was a significant difference in FmFF (p < 0.05).

Conclusion

Overall, we found that FF and BMD around the knee joints showed a negative correlation. This suggests the potential of FF measurement using DIXON for BMD screening.

High-resolution knee plain radiography image synthesis using style generative adversarial network adaptive discriminator augmentation

In this retrospective study, 10,000 anteroposterior (AP) radiography of the knee from a single institution was used to create medical data set that are more balanced and cheaper to create. Two types of convolutional networks were used, deep convolutional GAN (DCGAN) and Style GAN Adaptive Discriminator Augmentation (StyleGAN2-ADA). To verify the quality of generated images from StyleGAN2-ADA compared to real ones, the Visual Turing test was conducted by two computer vision experts, two orthopedic surgeons, and a musculoskeletal radiologist. For quantitative analysis, the Fréchet inception distance (FID), and principal component analysis (PCA) were used. Generated images reproduced the features of osteophytes, joint space narrowing, and sclerosis. Classification accuracy of the experts was 34%, 43%, 44%, 57%, and 50%. FID between the generated images and real ones was 2.96, which is significantly smaller than another medical data set (BreCaHAD = 15.1). PCA showed that no significant difference existed between the PCs of the real and generated images (p > 0.05). At least 2000 images were required to make reliable images optimally. By performing PCA in latent space, we were able to control the desired PC that show a progression of arthritis. Using a GAN, we were able to generate knee X-ray images that accurately reflected the characteristics of the arthritis progression stage, which neither human experts nor artificial intelligence could discern apart from the real images. In summary, our research opens up the potential to adopt a generative model to synthesize realistic anonymous images that can also solve data scarcity and class inequalities.

Systemic evaluation of the relationship between asthma and osteoarthritis: Evidence from a meta-analysis and Mendelian randomization study

Objective

Osteoarthritis (OA) and asthma are two common chronic diseases with increasing incidence and prevalence, whereas there has been rare evidence to suggest the relationship between OA and asthma. This study aimed to analyze the causal relationship between OA and asthma.

Methods

Existing studies of the relationship between asthma and OA published till July 18, 2023, were identified from PubMed and Web of Science databases for meta-analysis. Subsequently, the causal relationship of all and site-specific OA with asthma was explored through a bidirectional two-sample Mendelian randomization (MR) analysis.

Results

A total of four eligible studies were included in the meta-analysis. In these studies, 80,550 participants were recruited, of whom 13,781 patients had OA. The asthma group had a significantly higher prevalence of OA than the control group (odds ratio (OR) = 2.08; 95% confidence intervals (CI): 1.42-3.03). However, MR analysis did not support a causal relationship between asthma and all OA and site-specific OA: knee and hip OA (OR = 1.03; 95% CI: 0.98-1.09), knee OA (OR = 1.02; 95% CI:0.96-1.08), and hip OA (OR = 1.04; 95% CI: 0.97-1.12). No causal relationship between OA and asthma was found through reverse MR analysis.

Conclusions

This meta-analysis suggests that patients with asthma are likely to have a greater prevalence of OA. However, the result of MR analysis reveals that asthma does not have a causal relationship to all OA or site-specific OA.

OA-Pain-Sense: Machine Learning Prediction of Hip and Knee Osteoarthritis Pain from IMU Data

Joint pain is a prominent symptom of Hip and Knee Osteoarthritis (OA), impairing patients’ movements and affecting the joint mechanics of walking. Self-report questionnaires are currently the gold standard for Hip OA and Knee OA pain assessment, presenting several problems, including the fact that older individuals often fail to provide accurate self-pain reports. Passive methods to assess pain are desirable. This study aims to explore the feasibility of OA-Pain-Sense, a passive, automatic Machine Learning-based approach that predicts patients’ self-reported pain levels using SpatioTemporal Gait features extracted from the accelerometer signal gathered from an anterior-posterior wearable sensor. To mitigate inter-subject variability, we investigated two types of data rescaling: subject-level and dataset-level. We explored six different binary machine learning classification models for discriminating pain in patients with Hip OA or Knee OA from healthy controls. In rigorous evaluation, OA-Pain-Sense achieved an average accuracy of 86.79% using the Decision Tree and 83.57% using Support Vector Machine classifiers for distinguishing Hip OA and Knee OA patients from healthy subjects, respectively. Our results demonstrate that OA-Pain-Sense is feasible, paving the way for the development of a pain assessment algorithm that can support clinical decision-making and be used on any wearable device, such as smartphones.

Analysis of correlation between the consumption of beverages and the risk of radiographic knee osteoarthritis in Korean people: A cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1, 2)

The purposes were to analyze correlations between the frequency of beverage drinking (coffee, green tea, milk, and soft drinks) and the presence of radiographic knee osteoarthritis (OA) in relation to sex. We performed this study using the Korea National Health and Nutrition Examination Survey (KHANES V-1, 2). We examined data from 5503 subjects after exclusion. We utilized the food frequency questionnaires from KHANES, and reorganized them into 2 or 3 groups according to the frequency of beverage consumption. We analyzed the relationship between radiographic knee OA and beverage consumption statistically after adjusting confounding factors with multivariable logistic regression analysis. Knee OA was inversely associated with coffee consumption only in women (P < .05). The odds ratio of knee OA was lower in those who drank at least a cup of coffee than in those who did not drink coffee in women (P for trend < .05). However, there was no significant linear trend of the odds ratio of each group in both sexes for drinking other beverages. As the coffee consumption increased, the radiographic knee OA group showed decreasing linear trend only in women. However, other beverages did not show a significant relation to the radiographic knee OA in both sexes.

Clinical Efficacy of Glucosamine plus Sodium Hyaluronate for Osteoporosis Complicated by Knee Osteoarthritis and Its Influence on Joint Function and Bone Metabolic Markers

Background. Osteoporosis (OP) associated with knee osteoarthritis (KOA) is common in older men and postmenopausal women, and it is important to find reliable and effective treatments for this disease to improve joint function and bone metabolism in this population. Objective. To clarify the clinical efficacy of glucosamine (GlcN) plus sodium hyaluronate (SH) for OP complicated by KOA (OP + KOA) and its influence on joint function and bone metabolic markers (BMMs). Methods. Admitted from July 2019 to July 2021, 126 patients with OP + KOA were selected, including 76 cases (observation group) treated with GlcN plus SH and 50 cases (control group) given GlcN alone. The pain, joint function, BMMs, and clinical efficacy were evaluated and compared. Pain and joint function assessments employed the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) plus Lysholm Knee Scoring Scale, respectively. BMMs mainly measured bone gla protein (BGP), serum tartrate-resistant acid phosphatase variant (TRACP)-5b, type I collagen cross-linked C-telopeptide (CTX-1), and bone-specific alkaline phosphatase (BALP). Results. Higher posttreatment VAS scores were determined in observation group as compared to control group; observation group showed lower WOMAC scores of joint function and higher Lysholm scores than control group; in terms of BMMs, TRACP-5b and CTX-1 were lower while BGP and BALP were higher in observation group; the curative effect was also higher in observation group. All the above differences were statistically significant. Conclusions. GlcN plus SH has definite clinical efficacy in the treatment of OP + KOA, which can not only significantly improve patients’ joint function and bone metabolism but also relieve pain, with high clinical popularization value.

Exercise-induced modulation of myokine irisin in bone and cartilage tissue—Positive effects on osteoarthritis: A narrative review

Osteoarthritis is a chronic degenerative musculoskeletal disease characterized by pathological changes in joint structures along with the incidence of which increases with age. Exercise is recommended for all clinical treatment guidelines of osteoarthritis, but the exact molecular mechanisms are still unknown. Irisin is a newly discovered myokine released mainly by skeletal muscle in recent years—a biologically active protein capable of being released into the bloodstream as an endocrine factor, the synthesis and secretion of which is specifically induced by exercise-induced muscle contraction. Although the discovery of irisin is relatively recent, its role in affecting bone density and cartilage homeostasis has been reported. Here, we review the production and structural characteristics of irisin and discuss the effects of the different types of exercise involved in the current study on irisin and the role of irisin in anti-aging. In addition, the role of irisin in the regulation of bone mineral density, bone metabolism, and its role in chondrocyte homeostasis and metabolism is reviewed. A series of studies on irisin have provided new insights into the mechanisms of exercise training in improving bone density, resisting cartilage degeneration, and maintaining the overall environmental homeostasis of the joint. These studies further contribute to the understanding of the role of exercise in the fight against osteoarthritis and will provide an important reference and aid in the development of the field of osteoarthritis prevention and treatment.

Zoledronic acid does not slow spinal radiographic progression of osteoarthritis in postmenopausal women with osteoporosis and radiographic osteoarthritis

Introduction:

Post hoc analyses of osteoporosis trials have suggested that alendronate and strontium ranelate may be associated with a reduction in the progression of spinal radiographic osteoarthritis (OA). We performed an analysis on a subgroup of participants in the horizon PFT trial (a 3-year randomized controlled trial (RCT) of yearly zoledronic acid (ZA) in postmenopausal women with osteoporosis), to evaluate the effect of ZA on the structural progression of spinal osteophytes (OPh) and disk space narrowing (DN).

Methods:

Paired lateral spinal X-rays (baseline and 36 months) were selected from the horizon PFT trial records restricted to those with radiographic OA at baseline. The X-rays were analyzed by two readers blinded to the treatment allocation. OPh and DN were scored separately using the Lane atlas (0–3 for increasing severity at each vertebral level) at all evaluable levels from T4–12 and L1–5.

Results:

A total of 504 sets of paired radiographs were included in the analysis, 245 in the ZA group and 259 in the placebo group. Overall, the rates of change of OPh and DN scores were low, and they were not statistically different between the groups (change in the whole spine OPh ZA 1.0 ± 1.6, placebo 0.8 ± 1.3, p = 0.1; DN ZA 0.3 ± 1.0, placebo 0.3 ± 0.8, p = 0.7).

Conclusion:

Yearly ZA for 3 years was not associated with a slowing of progression of OPh or DN in the thoracolumbar spine in patients with pre-existing radiographic OA.

The role of bone mineral density and cartilage volume to predict knee cartilage degeneration

Knee Osteoarthritis (OA) is a highly prevalent condition affecting knee joint that causes loss of physical function and pain. Clinical treatments are mainly focused on pain relief and limitation of disabilities; therefore, it is crucial to find new paradigms assessing cartilage conditions for detecting and monitoring the progression of OA. The goal of this paper is to highlight the predictive power of several features, such as cartilage density, volume and surface. These features were extracted from the 3D reconstruction of knee joint of forty-seven different patients, subdivided into two categories: degenerative and non-degenerative. The most influent parameters for the degeneration of the knee cartilage were determined using two machine learning classification algorithms (logistic regression and support vector machine); later, box plots, which depicted differences between the classes by gender, were presented to analyze several of the key features’ trend. This work is part of a strategy that aims to find a new solution to assess cartilage condition based on new-investigated features.

CT- and MRI-Based 3D Reconstruction of Knee Joint to Assess Cartilage and Bone

For the observation of human joint cartilage, X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) are the main diagnostic tools to evaluate pathologies or traumas. The current work introduces a set of novel measurements and 3D features based on MRI and CT data of the knee joint, used to reconstruct bone and cartilages and to assess cartilage condition from a new perspective. Forty-seven subjects presenting a degenerative disease, a traumatic injury or no symptoms or trauma were recruited in this study and scanned using CT and MRI. Using medical imaging software, the bone and cartilage of the knee joint were segmented and 3D reconstructed. Several features such as cartilage density, volume and surface were extracted. Moreover, an investigation was carried out on the distribution of cartilage thickness and curvature analysis to identify new markers of cartilage condition. All the extracted features were used with advanced statistics tools and machine learning to test the ability of our model to predict cartilage conditions. This work is a first step towards the development of a new gold standard of cartilage assessment based on 3D measurements.

Study of relationship between bone mineral density in ipsilateral proximal femur and severity of osteoarthritis of knee

Introduction:

Osteoarthritis (OA) of the knee is the most common rheumatic disease that is characterized by degradation of articular cartilage, subchondral bone alteration, meniscal degeneration, synovial inflammatory response, and overgrowth of bone and cartilage. In severe OA, the reduced mobility caused by pain can increase bone loss and reduction of bone mineral density leading to osteoporosis.

Objective:

To examine the possible relationship between severity of osteoarthritis (OA) and bone mineral density (BMD) by evaluating the bone mineral density in ipsilateral proximal femur and radiographic grading of knee OA in the Indian population.

Methods:

In this cross-sectional observational study, 100 subjects diagnosed with OA knee using ACR criteria were enrolled. Severity of OA knee was assessed using Kellgren-Lawrence scale (1 to 4) on weight-bearing radiographs. The BMD, T-score, and Z-score of the ipsilateral proximal femur was measured by dual-energy X-ray absorptiometry. Pearson’s correlation coefficient was used to test the association of severity of OA knee with BMD.

Results:

Among 100 subjects, there were 51 females and 49 males with mean age 59.94 ± 6.67. Maximum patients were with K-L grade 2 (42%) followed by grade 3 (30%) and grade 4 (22%). There was statistically significant (p < 0.0001) association between BMD and severity of OA knee. BMD decreased as the K-L grade of OA knee increased from 1 to 4. Similar statistically significant association was observed in T-score and Z-score.

Conclusion:

The study concluded that BMD of ipsilateral proximal femur decreases with severity of OA knee. These data support the fact that the two conditions may be related to each other and primary care physicians must look for these two conditions in coexistence. Primary prevention of either of the two conditions should be advised, if the other condition coexists in the same patient.