Obesity and Bone Mineral Density in Patients with Large Joint Osteoarthritis

Along with the global aging of population, the number of people with somatic diseases is increasing, including such interrelated pathologies as obesity, osteoarthritis (OA) and osteoporosis (OP). The objective of the study is to examine the connection between body mass index (BMI), OA and bone mineral density (BMD) of lumbar spine, femoral neck and trabecular bone score (TBS) in postmenopausal women with OA. We have observed 359 postmenopausal women (50-89 years old) and divided them into four groups by age: 50-59 yrs, 60-69 yrs, 70-79 yrs and over 80 years old. In addition, according to the American College of Rheumatology (ACR) Clinical classification criteria for knee and hip OA, we divided them into 2 groups: group I – 117 females with symptomatic OA (including 89 patients with knee OA, 28 patients with hip OA) and group II –242 women with a normal functional activity of large joints. Analysis of data was performed taking into account their BMI, classified by World Health Organization (WHO). Diagnosis of obesity was established when BMI was above 30 kg/m2. In woman with obesity, a symptomatic OA was detected in 44 postmenopausal women (41.1%), a normal functional activity of large joints - in 63 women (58.9%). However, in women with normal BMI – 73 women, who account for 29.0% of cases, a symptomatic OA was detected. According to a chi-squared (χ2) test, a significantly higher level of BMI was detected in postmenopausal women with OA (χ2 = 5.05, p = 0.02). Women with a symptomatic OA had a significantly higher BMD of lumbar spine compared with women who had a normal functional activity of large joints. No significant differences of BMD of femoral necks or TBS were detected in either the group with OA or with a normal functional activity of large joints.

[1] World Health Organization. Obesity and overweight. 16 February 2018. WHO. URL: https://www.who.int/news-room/fact-sheets/detail/ obesity-and-overweight.
[2] M. Blüher, “Obesity: global epidemiology and pathogenesis,” Nature Reviews Endocrinology, 2019, vol.15, pp. 288–298.
[3] M. R. Salamat, A. H. Salamat, M. Janghorbani, “Association between Obesity and Bone Mineral Density by Gender and Menopausal Status,” Endocrinol Metab (Seoul), 2016, 31(4), pp. 547–558. doi: 10.3803/EnM.2016.31.4.547.
[4] A. McKee, J. E. Morley, “Obesity in the Elderly”. Feingold K.R., Anawalt B., Boyce A., et al., editors. South Dartmouth (MA): MDText.com, Inc., 2018, URL: https://www.ncbi.nlm.nih. gov/books/NBK532533/.
[5] E. Biver, “Obesity, fat and bones: friends or foes?” Rev Med Suisse, 2017, vol. 13(559), pp. 851–854.
[6] S. A. Shapses, L. C. Pop, Y. Wang, “Obesity is a concern for bone health with aging,” Nutr Res, 2017, 39, pp. 1–13. Published online 2017 Jan 18. doi: 10.1016/j.nutres.2016.12.010.
[7] HSS. Hospital for Special Surgery URL: https://www.hss.edu/ osteoarthritis-research.asp.
[8] E. Nüesch, P. Dieppe, S. Reichenbach, et al, “All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study,” BMJ, 2011, 342, d1165. doi: 10.1136/bmj.d1165.
[9] OARSI Osteoarthritis: A Serious Disease, Submitted to the U.S. Food and Drug Administration December 1, 2016 URL: https://www.oarsi.org/sites/default/files/docs/2016/oarsi_white_paper_oa_serious_disease_121416_1.pdf.
[10] I. Salehi-Abari, “2016 ACR Revised Criteria for Early Diagnosis of Knee Osteoarthritis,” Autoimmune Diseases and Therapeutic Approaches, 2016, 3:1.
[11] Y. H. Kim, J. S. Lee, J. H. Park “Association between bone mineral density and knee osteoarthritis in Koreans: the Fourth and Fifth Korea National Health and Nutrition Examination Surveys,” Osteoarthritis Cartilage, 2018, 26(11), pp. 1511–1517. doi: 10.1016/j.joca.2018.07.008. Epub 2018 Jul 26.
[12] G. Bonaccorsi, F. P. Cafarelli, C. Cervellati, F. De Guio, P. Greco, M. Giganti, G. Guglielmi, “A new corrective model to evaluate TBS in obese post-menopausal women: a cross-sectional study,” Aging Clin Exp Res, 2019 Aug 30. doi: 10.1007/s40520-019-01317-0.
[13] C. Messina, C. Buonomenna, G. Menon, S. Magnani, D. Albano, S. Gitto, F. M. Ulivieri, L. M. Sconfienza, “Fat Mass Does Not Increase the Precision Error of Trabecular Bone Score Measurements,” J Clin Densitom, 2019, 22(3), pp. 359-366. doi: 10.1016/j.jocd.2019.01.001. Epub 2019 Jan 5.
[14] S. A. Hardcastle, P. Dieppe, C. L. Gregson, G. Davey Smith, and J. H. Tobias,“Osteoarthritis and bone mineral density: are strong bones bad for joints?” Bonekey Rep, 2015, 4, pp. 624. Published online 2015 Jan 21. doi: 10.1038/bonekey.2014.119.
[15] M. C. Nevitt, N. E. Lane, J. C. Scott, M. C. Hochberg, A. R. Pressman, H. K. Genant, S. R. Cummings, “Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group,” Arthritis Rheum, 1995, 38(7), pp. 907–16.
[16] Z. Yin, W. Wang, J. Han, K. Chen, and J. Ma, “Decreased trabecular bone deterioration of proximal tibiae and lumbar vertebrae in postmenopausal women with osteoarthritis,” Exp Ther Med, 2017, 13(6), pp. 3355–3359. Published online 2017 May 8. doi: 10.3892/etm.2017.4439.
[17] V. Povoroznyuk, N. Grigorieva, “Osteoartrosis in postmenopausal women: risk factors and relationship with bone tissue,” Reproductive endocrinology, 2012, 6(8).
[18] D. Schiphof, J. Runhaar, E.J. Waarsing, E.W. van Spil, M. van Middelkoop, S.M. Bierma-Zeinstra, “The 10-year course of the clinical American college of rheumatology (acr) criteria for hip and knee osteoarthritis in an early symptomatic cohort, data from check,” Osteoarthritis and cartilage, 2018, 26(1), pp.347–348. doi: https://doi.org/10.1016/j.joca.2018.02.691
[19] A. Palermo, D. Tuccinardi, G. Defeudis, M. Watanabe, L. D’Onofrio, A. L. Pantano, N. Napoli, P. Pozzilli, S. Manfrini “BMI and BMD: The Potential Interplay between Obesity and Bone Fragility” Int. J. Environ. Res. Public Health, 2016, 13(6), p.544; https://doi.org/10.3390/ ijerph13060544
[20] H Bliddal, A R Leeds, and R Christensen “Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review” Obesity reviews, 2014, 15(7), pp. 578–586;doi: 10.1111/obr.12173