ORCID Profile
0000-0002-9814-0006
Current Organisation
University of Tasmania
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Publisher: Oxford University Press (OUP)
Date: 07-09-2010
DOI: 10.1093/RHEUMATOLOGY/KEQ286
Abstract: The presence of bone marrow lesions (BMLs) has been linked to pain and progression of knee OA. The aim of this study was to determine the relationship between BMLs and longitudinal change in tibial cartilage volume and risk of knee joint replacement in subjects with knee OA. One hundred and nine men and women with symptomatic knee OA were recruited. The same knee was imaged using MRI at baseline and ∼2 years later. Tibial cartilage volume and BMLs were measured. Knee joint replacement over 4 years was determined. The mean age of the subjects at baseline was 63.2 (s.d. 10.3) years. BMLs were present in 66% of the subjects. Cross-sectionally, BMLs were negatively associated with both medial (regression coefficient -121.4 95% CI -183.8, -859.1 P<0.001) and lateral (regression coefficient -142.1 95% CI -241.8, -42.4 P=0.01) tibial cartilage volume data. Longitudinally, for every 1-score increase in baseline BML severity (range 0-4), the annual total tibial cartilage loss was increased by 1.14% (95% CI 0.29%, 1.87% P=0.01). The risk of knee joint replacement over 4 years increased with increasing BML score (odds ratio 1.57 95% CI 1.04, 2.35 P=0.03). The prevalence and severity of BMLs are associated with less tibial cartilage volume and greater cartilage loss over 2 years. Moreover, severity of BMLs was positively associated with risk of knee joint replacement over 4 years. This provides further support for the importance of BMLs in identifying those with OA most likely to progress. Identifying factors that prevent or reduce the severity of BMLs may provide an important target in the prevention of disease progression and treatment of OA, and the subsequent need for arthroplasty.
Publisher: Research Square Platform LLC
Date: 11-02-2020
Abstract: Objective To describe associations between hand abnormalities on MRI or radiographs (X-ray) and pain and function in a cross-sectional study of community-based older adults. Methods Distal and proximal interphalangeal index finger joints (n=221) were examined using MRI, X-ray, and hand examination. Hand pain, function, and stiffness were assessed using Australian/Canadian hand osteoarthritis index (AUSCAN) questionnaire. Grip strength was assessed using dynamometer. Models were adjusted for age, sex, and other MRI or X-ray abnormalities. Results Absence of collateral ligament (CLs) on MRI (relative risk RR=3.15 (95% confidence interval 1.33, 7.50), and joint space narrowing (JSN) on X-ray (RR=2.96 (1.33, 6.58)) was associated with having a painful joint after adjustment for confounders. JSN was also associated with tender joints (RR=2.19 (1.01, 4.76)). Effusion-synovitis was associated with better AUSCAN pain scores (OR=0.51 (0.28, 0.94)) and JSN with worse AUSCAN pain scores (odds ratio OR=1.67 (1.13, 2.48)). Absent CLs were also associated with stiffer joints (OR=3.12 (1.26, 7.70)) and weaker grip strength (β=-1.69 (-2.95, -0.43)) independent of pain and other features JSN was also associated with weaker grip strength (β=-0.87 (-1.62, -0.14)). No other MRI or X-ray abnormalities were associated with pain or function independent of age, sex or pain. Conclusion Most MRI abnormalities were not associated with pain and function cross-sectionally. Absent CLs and JSN were associated with painful joints and weak grip strength independent of pain and other imaging features. JSN was also associated with tender joints and absent CLs with stiff joints. Unexpectedly, effusions were associated with reduced odds of pain.
Publisher: Springer Science and Business Media LLC
Date: 02-2000
DOI: 10.1007/PL00004176
Publisher: Elsevier BV
Date: 04-2013
Publisher: Elsevier BV
Date: 04-2018
Publisher: BMJ
Date: 06-01-2202
DOI: 10.1136/ANNRHEUMDIS-2013-203954
Abstract: To determine if the dietary supplements, glucosamine and/or chondroitin, result in reduced joint space narrowing (JSN) and pain among people with symptomatic knee osteoarthritis. A double-blind randomised placebo-controlled clinical trial with 2-year follow-up. 605 participants, aged 45-75 years, reporting chronic knee pain and with evidence of medial tibio-femoral compartment narrowing (but retaining >2 mm medial joint space width) were randomised to once daily: glucosamine sulfate 1500 mg (n=152), chondroitin sulfate 800 mg (n=151), both dietary supplements (n=151) or matching placebo capsules (n=151). JSN (mm) over 2 years was measured from digitised knee radiographs. Maximum knee pain (0-10) was self-reported in a participant diary for 7 days every 2 months over 1 year. After adjusting for factors associated with structural disease progression (gender, body mass index (BMI), baseline structural disease severity and Heberden's nodes), allocation to the dietary supplement combination (glucosamine-chondroitin) resulted in a statistically significant (p=0.046) reduction of 2-year JSN compared to placebo: mean difference 0.10 mm (95% CI 0.002 mm to 0.20 mm) no significant structural effect for the single treatment allocations was detected. All four allocation groups demonstrated reduced knee pain over the first year, but no significant between-group differences (p=0.93) were detected. 34 (6%) participants reported possibly-related adverse medical events over the 2-year follow-up period. Allocation to the glucosamine-chondroitin combination resulted in a statistically significant reduction in JSN at 2 years. While all allocation groups demonstrated reduced knee pain over the study period, none of the treatment allocation groups demonstrated significant symptomatic benefit above placebo. NCT00513422 www.clinicaltrials.gov.
Publisher: Oxford University Press (OUP)
Date: 22-10-2002
DOI: 10.1093/JAC/DKF246
Abstract: Linezolid, the first oxazolidinone antibacterial agent to be developed for clinical use, was licensed in the UK in early 2001. We report the first three ex les of resistant enterococci (two isolates of Enterococcus faecium and one Enterococcus faecalis) isolated in the UK, which were obtained from patients who had received linezolid. The linezolid MICs for the resistant isolates were 64 mg/L. Pulsed-field gel electrophoresis (PFGE) analysis of the linezolid-susceptible and -resistant isolates from two of the patients, combined with sequence analysis of rRNA, indicated that resistance developed in previously susceptible strains, most probably via a point mutation in the 23S rRNA.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 05-1996
DOI: 10.1007/BF01622740
Abstract: Approximately, 70% of cervical cancer cases worldwide are attributable to HPV-16 and HPV-18, with HPV-associated cancers being the second most common infection-related cancers globally. However, there´s paucity of data about this infective agent in Central Nigeria. In a cross-sectional study, we evaluated the seroprevalence of HPV-16 immunoglobulin G (IgG) and risk determinants among women in Central Nigeria as a first step towards evaluating anti-HPV IgM antibody for active cases and determining incidence. Blood s les were collected between August 2016 and January 2018, from 400 consenting women of childbearing age (15-49 years) who completed structured questionnaires. S les were analyzed using HPV-16 specific IgG ELISA kits (Cusabio Co. Ltd, Germany). Statistical analysis was performed to determine predictors. Overall, we found that 128 (32.0%) had IgG antibody against HPV-16. Seroprevalence by age was 50.0% (15-19 years), 55.0% (20-24 years), 12.9% (25-29 years), 50.0% (30-34 years), 32.1% (35-39 years), 18.2% (40-44 years) and 19.4% (45-49 years) respectively. Factors associated with infection were age (P=0.0002 95% CI 5.06-31.51), occupation (P<0.0001 95% CI 1.4-12.6), number of sex partners (P=0.0037 95% CI 1.27-49.93), history of genital warts (P=0.0203 95% CI 1.34-9.55) and education level (P<0.0001 95% CI 3.89-60.11). In addition, forty six (11.5%) reported having the history of genital warts with 268 (67.0%) and 132 (33.0%) subjects being married and single respectively. In iduals who were either artisans or civil servants were 260 (65.0%), whereas 140 (35.0%) were students. Majority, 324 (81.0%), had either primary, secondary or tertiary education with 76 (19.0%) of the subjects having no formal education. In respect of sexual behaviour, 196 (49.0%) reported having at least two sexual partners, out of which 64 (16.0%) had three or more. These findings provide high serological evidence of exposure to HPV-16 in Central Nigeria with implications for national and regional intervention initiatives.
Publisher: The Endocrine Society
Date: 12-1998
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Elsevier BV
Date: 08-2020
Publisher: Elsevier BV
Date: 08-2021
DOI: 10.1016/J.JOCA.2021.04.013
Abstract: The purpose of this study is to describe predictors of total hip replacement (THR) in community dwelling older adults. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. At baseline, participants had assessment of radiographic OA and cam morphology (from pelvic radiographs), shape mode scores and hip bone mineral density (BMD from dual energy X-ray absorptiometry (DXA)). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression. Incidence of THR for OA over 14 years was 4.6% (37/801). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.83/SD 95% CI 1.1-3.04), shape mode 4 score (non-spherical femoral head) (RR 0.59/SD 95% CI 0.36-0.96), cam morphology (α > 60°) (RR 2.2/SD 95% CI 1.33-3.36), neck of femur BMD (RR 2.09/SD, 95% CI 1.48-2.94) and bone marrow lesions (BMLs) increased risk of THR (RR 7.10/unit 95% CI 1.09-46.29). In addition to hip pain and radiographic hip OA, measures of hip shape, cam morphology, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Elsevier BV
Date: 04-2018
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: Wiley
Date: 28-03-2016
DOI: 10.1002/ART.39526
Abstract: To describe the natural history of quantitatively measured knee effusion-synovitis and the longitudinal associations between effusion-synovitis and knee structural factors, including cartilage defects, cartilage volume, subchondral bone marrow lesions, and meniscal pathology, in older adults. A total of 406 subjects (with a mean age of 63 years, 50% women) were randomly selected at baseline and followed up 2.7 years later. T2- or T1-weighted fat saturation magnetic resonance imaging was used to assess knee effusion-synovitis maximal area, cartilage defects, cartilage volume, bone marrow lesions, and meniscal pathology at baseline and follow-up. Multivariable generalized linear regression was performed to analyze the associations between the maximal area of effusion-synovitis and other joint structural factors after adjustment for age, sex, body mass index, tibial bone area, and/or radiographic osteoarthritis (OA). Over 2.7 years of follow-up, the size of effusion-synovitis increased in 29%, remained stable in 50%, and decreased in 22% of the participants. Baseline effusion-synovitis maximal area was significantly associated with changes in knee cartilage defects (β = 0.18 [95% confidence interval (95% CI)] 0.07, 0.29), bone marrow lesions (β = 0.17 [95% CI 0.05, 0.30]), and cartilage volume (β = -0.40 [95% CI -0.71, -0.09]) but not with change in meniscal pathology. In contrast, baseline structural measures were not associated with change or increase in effusion-synovitis maximal area. Our findings indicate that knee effusion-synovitis is not static in older adults. It is predictive of, but not predicted by, other structural abnormalities, suggesting a potential role in early knee OA changes.
Publisher: BMJ
Date: 06-2013
Publisher: Wiley
Date: 25-02-2021
DOI: 10.1002/ACR.24128
Abstract: To describe cross-sectional associations between features observed on ultrasound (US) or clinical joint examination and hand symptoms among community-dwelling older adults (n = 519), and to determine whether such associations are independent of age, sex, body mass index, and other imaging features. Hand pain, function, and stiffness were assessed using a visual analog scale (VAS) and the Australian/Canadian Hand Osteoarthritis (AUSCAN) index. Standardized clinical and US examinations were performed, and grip strength was assessed using a dynamometer. Data were analyzed using hurdle and linear models and adjusted for demographic factors and other features. Abnormal findings on joint examination and on US imaging are common in older adults with and without hand pain. Greater numbers of tender joints were associated with greater pain (VAS: β = 2.63 [95% confidence interval (95% CI) 1.88, 3.39] AUSCAN pain: β = 10.57 [95% CI 4.00, 17.13]), poorer AUSCAN function (β = 4.07 [95% CI 1.28, 6.86]), and poorer grip strength (β = -0.15 [95% CI -0.27, -0.03]). Power Doppler imaging (PDI) synovitis was associated with greater pain (VAS: β = 2.61 [95% CI 1.03, 4.19] AUSCAN pain: β = 13.07 [95% CI 3.82, 22.32]), but not function. Joint deformity was associated with poorer function (β = 4.51 [95% CI 1.75, 7.26]) and grip strength (β = -0.23 [95% CI -0.40, -0.05]), but not pain. Gray-scale synovitis was associated only with poorer grip strength (β = -0.22 [95% CI -0.41, -0.04]). Associations with function and grip strength were partially mediated by pain. Joints that are tender on palpation or have US-identified PDI synovitis are potential treatment targets for hand pain. Treating tender joints and preventing hand deformity is required to improve hand function in community-dwelling older adults.
Publisher: Oxford University Press (OUP)
Date: 16-07-2003
Publisher: BMJ
Date: 29-01-2014
Publisher: Wiley
Date: 18-11-2009
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.PHYSIO.2016.06.001
Abstract: Age-related changes in the trunk (abdominal and lumbar multifidus) muscles and their impact on physical function of older adults are not clearly understood. To systematically summarise studies of these trunk muscles in older adults. Cochrane Library, Pubmed, EMBASE and CINAHL were searched using terms for abdominal and MF muscles and measurement methods. Two reviewers independently assessed studies and included those reporting measurements of abdominal muscles and/or MF by ultrasound, computed tomography, magnetic resonance imaging or electromyography of adults aged ≥50 years. A best evidence synthesis was performed. Best evidence synthesis revealed limited evidence for detrimental effects of ageing or spinal conditions on trunk muscles, and conflicting evidence for decreased physical activity or stroke having detrimental effects on trunk muscles. Thicknesses of rectus abdominis, internal oblique and external oblique muscles were 36% to 48% smaller for older than younger adults. Muscle quality was poorer among people with moderate-extreme low back pain and predicted physical function outcomes. Study heterogeneity precluded meta-analysis. Overall, the evidence base in older people has significant limitations, so the role of physiotherapy interventions aimed at these muscles remains unclear. The results point to areas in which further research could lead to clinically useful outcomes. These include determining the role of the trunk muscles in the physical function of older adults and disease developing and testing rehabilitation programmes for older people with spinal conditions and lower back pain and identifying modifiable factors that could mitigate age-related changes.
Publisher: Oxford University Press (OUP)
Date: 19-04-2021
DOI: 10.1093/RHEUMATOLOGY/KEAB358
Abstract: To investigate the impact of total number and patterns of comorbidities on health-related quality of life (HRQoL) and identify the most prevalent and influential comorbidity patterns in people with OA over 10 years. Participants from the Tasmanian Older Adult Cohort aged 50–80 years, with self-reported OA and data on comorbidities and HRQoL were included. Participants were interviewed at baseline (n = 398), 2.5 (n = 304), 5 (n = 269) and 10 years (n = 191). Data on the self-reported presence of 10 chronic comorbidities were collected at baseline. HRQoL was assessed using the Assessment of Quality of Life-4-Dimensions. The long-term impacts of the number and of the nine most prevalent combinations of cardiovascular (CVD), non-OA musculoskeletal (Ms), metabolic and respiratory comorbidities on HRQoL over 10 years were analysed using linear mixed regressions. Compared with comorbidity-free OA participants, the health state utility (HSU) of those with 2 or ≥3 comorbidities was respectively −0.07 and −0.13 units lower over 10 years, largely driven by reduced scores for independent living, social relationships and psychological wellness. Comorbidity patterns including ‘CVD+Ms’ were most influential, and associated with up to 0.13 units lower HSU, mostly through negative impacts on independent living (up to −0.12), psychological wellness (up to −0.08) and social relationship (up to −0.06). Having more comorbidities negatively impacted OA patients’ long-term HRQoL. OA patients with CVD and non-OA musculoskeletal conditions had the largest HSU impairment, and therefore optimal management and prevention of these conditions may yield improvements in OA patients’ HRQoL.
Publisher: Springer Science and Business Media LLC
Date: 31-05-2022
DOI: 10.1007/S00198-022-06435-6
Abstract: We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
Publisher: BMJ
Date: 13-07-2013
Publisher: Springer Science and Business Media LLC
Date: 2014
DOI: 10.1186/AR4496
Publisher: BMJ
Date: 06-2016
Publisher: Wiley
Date: 08-2005
DOI: 10.1359/JBMR.050317
Publisher: BMJ
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 24-07-2003
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: Springer Science and Business Media LLC
Date: 04-07-2019
DOI: 10.1038/S41598-019-46185-W
Abstract: To identify serum biomarker(s) for predicting knee cartilage volume loss over time, we studied 139 knee osteoarthritis (OA) patients from a previous 24-month clinical trial cohort. Targeted metabolomic profiling was performed on serum collected at baseline. The pairwise metabolite ratios as proxies for enzymatic reaction were calculated and used in the analysis. Cartilage volume loss between baseline and 24 months was assessed quantitatively by magnetic resonance imaging (MRI). Data revealed an association between the serum ratio of lysophosphatidylcholine 18:2 (lysoPC 18:2) to phosphatidylcholine 44:3 (PC44:3) and the cartilage volume loss in the lateral compartment (β = −0.21 ± 0.04, p = 8.53*10 −7 ) and with joint degradation markers, COMP (r = 0.32, p = 0.0002) and MMP1 (r = 0.26, p = 0.002). The significance remained after adjustment for age, sex, BMI, diabetes, hypertension, dyslipidemia, and the treatment taken in the original study. As the ratio indicated the over activation of the conversion pathway of PC to lysoPC catalyzed by phospholipase A 2 (PLA 2 ), we assessed and found that a specific PLA 2 , PLA 2 G5, was significantly increased in human OA cartilage and synovial membrane (85% and 19% respectively, both p 0.04) compared to controls, and its overexpression correlated with IL-6 (r = 0.63, p = 0.0008). Our data suggest that the serum lysoPC 18:2 to PC44:3 ratio is highly associated with a greater risk of cartilage volume loss of the knee and warrants further investigation in an independent cohort.
Publisher: Elsevier BV
Date: 04-2012
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: Wiley
Date: 28-07-2014
DOI: 10.1002/ACR.22292
Abstract: Although mental health is related to the persistence of musculoskeletal pain, our understanding of the relationship between mental health and foot pain is limited. Subsequently, we conducted a 3-year longitudinal study to examine the relationship between mental health and foot pain in a community-based population. Eighty-three community-dwelling participants (mean ± SD body mass index [BMI] 35.3 ± 9.0 kg/m2) who had foot pain at study inception in 2008 and for whom measures of mental health (Short Form 36 [SF-36] health survey mental component summary [MCS]) were available, were invited to take part in this followup study in 2011. Change in foot pain was determined by the difference between the Manchester Foot Pain and Disability Index score at baseline and followup therefore, a decrease in the score indicated improved foot pain and an increase indicated deterioration in foot pain. Linear regression was used to determine the factors affecting change in foot pain. Of the 62 respondents (75% response rate, 49 women and 13 men), there were 27 (44%) whose foot pain deteriorated. A higher MCS score of the SF-36 health survey at baseline was associated with a slower progression of foot pain (β coefficient −0.29, 95% confidence interval −0.42, −0.01), adjusted for age, sex, BMI, and physical health. Mental health is associated with changes in foot pain. Clinicians dealing with this population should consider the contribution of mental health in their management and treatment of foot pain.
Publisher: Elsevier BV
Date: 06-1999
DOI: 10.1385/JCD:2:2:109
Abstract: The aims of this study of premenopausal parous women were to determine whether low bone mass could be accurately identified by clinical risk factors and to describe the effect of an information and bone mineral density (BMD) feedback program on lifestyle behavior. The subjects were a convenience s le of 271 women who took part in a cohort study of cot death in 1988, and in a population-based study of the determinants of bone mass in 1996. These subjects were provided with BMD feedback according to their T-score. Those with a score < -1.0 at either the femoral neck or lumbar spine were sent a letter indicating that their BMD was low (n = 72), whereas those scoring above -1.0 at both sites (n = 199) were told that their BMD was normal. Both groups were given a comprehensive osteoporosis information leaflet. In late 1997 we were able to contact 256 subjects (95%). In logistic regression, the presence or absence of low BMD was correctly classified in 79% of cases (p < 0.0001) by a model containing body mass index, fracture history, smoking, breastfeeding history, and sports participation. The model had poor sensitivity (38%) but high specificity (93%). At follow-up, those with low BMD had similar smoking cessation rates (16 vs 17%, p = 0.93) but higher rates of increased calcium intake (61 vs 9%), calcium supplement use (39 vs 4%), and increased physical activity (41 vs 17%) (all p < 0.001) in comparison with those with normal BMD. We conclude that a feedback program can alter self-reported behavior in young women for at least 12 mo and that the magnitude of effect is greatest in those with low BMD. Identification of these subjects by clinical risk factors is good but suboptimal, suggesting that measurement of BMD may be necessary to target most accurately and effectively those at highest risk.
Publisher: Oxford University Press (OUP)
Date: 18-03-2011
Publisher: Elsevier BV
Date: 04-2014
Publisher: Springer Science and Business Media LLC
Date: 12-03-2018
DOI: 10.1007/S00198-018-4446-4
Abstract: Relationships between objectively assessed free-living physical activity (PA) and changes in bone health over time are poorly understood in older adults. This study suggests these relationships are sex-specific and that body composition may influence the mechanical loading benefits of PA. To investigate associations of objectively assessed PA and bone health in community-dwelling older adults. This secondary analysis of a subset of the Tasmanian Older Adult Cohort study included participants with PA assessed utilising ActiGraph GT1M accelerometers over 7 days (N = 209 participants, 53% female mean ± SD age 64.5 ± 7.2 years). Steps/day and PA intensity were estimated via established thresholds. Bone mineral content (BMC) was acquired at the total hip, lumbar spine, legs and whole body by DXA at baseline and approximately 2.2 years later. Relationships between PA and BMC were assessed by multivariable linear regression analyses adjusted for age, smoking status, height and total lean mass. Men with above-median total hip BMC completed significantly less steps per day, but there was no significant difference in PA intensity compared with those with below-median BMC. There were no significant differences in PA in women stratified by median BMC. In women, steps/day were positively associated with leg BMC (B = 0.178 P = 0.017), and sedentary behaviour was negatively associated with leg BMC (- 0.165 0.016) at baseline. After adjustment for confounders including lean mass and height, higher sedentary behaviour at baseline was associated with declines in femoral neck BMC (- 0.286 0.011) but also with increases in pelvic BMC (0.246 0.030) in men and increases in total hip BMC (0.215 0.032) in women, over 2.2 years. No other significant longitudinal associations were observed after adjustment for body composition. Associations of accelerometer-determined sedentary behaviour and PA with bone health in older adults differ by sex and anatomical site and are mediated by body composition.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2019
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Springer Science and Business Media LLC
Date: 02-2003
Publisher: The Journal of Rheumatology
Date: 07-2011
Abstract: To determine the association of knee bone size, cartilage volume, and body mass index (BMI) at baseline with knee cartilage loss over 2 years in younger or middle-aged adults. A total of 324 subjects (mean age 45 yrs, range 26–61) were measured at baseline and about 2 years later. Knee cartilage volume and bone size were determined using T1-weighted fat-saturated magnetic resonance imaging. In multivariable analysis, baseline knee bone size was negatively associated with annual change in knee cartilage volume at medial and lateral tibial sites (ß = −0.62% to −0.47%/cm 2 , all p 0.001). The associations disappeared at medial tibial site after adjustment for baseline cartilage volume and became of borderline statistical significance at lateral tibial site after adjustment for both baseline cartilage volume and osteophytes (ß = −0.29, p = 0.059). Baseline knee cartilage volume was consistently and negatively associated with annual change in knee cartilage volume at all 3 medial tibial, lateral tibial, and patellar sites (ß = −4.41% to −1.37%/ml, all p 0.001). Baseline BMI was negatively associated with an annual change in knee cartilage volume, but only in subjects within the upper tertile of baseline cartilage volume, even after adjusting for cartilage defects (ß = −0.16% to −0.34%/kg/m 2 , all p 0.05). Our study suggests that both higher baseline tibial bone area and knee cartilage volume (most likely due to cartilage swelling) are associated with greater knee cartilage loss over 2 years. A higher BMI was associated with greater knee cartilage loss only in subjects with higher baseline cartilage volume.
Publisher: Oxford University Press (OUP)
Date: 29-03-2021
Abstract: This study aims to describe the relationships between physical activity (PA), body composition, and multimorbidity over 10 years. Participants (N = 373 49% women average age 61.3 ± 6.7 years) were followed for 10 years. Multimorbidity was defined by self-report as the presence of 2 or more of 12 listed chronic conditions. PA (steps per day) at baseline was assessed by pedometer, handgrip strength (HGS) by dynamometer, and appendicular lean mass (ALM) and total body fat mass by dual-energy x-ray absorptiometry. Relative HGS and ALM were calculated by iding each body mass index (BMI). Regression cubic splines were used to assess evidence for a nonlinear relationship. After 10 years, 45% participants had multimorbidity. There was a nonlinear relationship between PA and multimorbidity—PA was associated with lower multimorbidity risk among in iduals who engaged in & 000 steps/d (relative risk [RR] = 0.91, 95% CI: 0.85, 0.97, per 1 000 steps/d), but not among those who participated in ≥10 000 steps/d (RR = 1.04, 95% CI: 0.93, 1.09, per 1 000 steps/d). Higher BMI (RR = 1.05, 95% CI: 1.02, 1.08, per kg/m2) and fat mass (RR = 1.03, 95% CI: 1.01, 1.04, per kg), and lower relative HGS (RR = 0.85, 95% CI: 0.77, 0.94, per 0.1 psi/kg/m2) and ALM (RR = 0.93, 95% CI: 0.88, 0.98, per 0.1 kg/kg/m2) were linearly associated with a higher risk of multimorbidity. Absolute HGS and ALM were not significantly associated with multimorbidity. These findings highlight the potential clinical importance of maintaining adequate levels of PA and of reducing adiposity and maintaining muscle function for minimizing the risk of multimorbidity in older adults.
Publisher: BMJ
Date: 19-05-2021
DOI: 10.1136/ANNRHEUMDIS-2021-EULAR.2735
Abstract: Osteoarthritis (OA) is the most common form of arthritis, and its impact is increasing year by year due to an aging population and lack of effective treatments. One of the main structural pathological changes of OA is the loss of articular cartilage. Tools that can predict cartilage loss would help identify people at high risk, thus preventing OA development. Using a metabolomics approach, the current study aimed to identify serum metabolomic signatures for predicting the loss of knee cartilage volume over 10 years in a well-established community-based cohort - the Tasmania Older Adult Cohort (TASOAC). TASOAC is an on-going, prospective, population-based study of older adults who were randomly selected from the roll of electors in Southern Tasmania, Australia. Participants had a right knee magnetic resonance imaging (MRI) scan at baseline and a 10-year follow-up. Cartilage volume was measured in the medial, lateral, and patellar compartments and change in cartilage volume over 10 years was calculated as percentage change per year. Fasting serum s les collected at 2.6-year follow-up were metabolomically profiled using the TMIC Prime Metabolomics Profiling Assay which measures a total of 143 metabolites. 129 metabolite concentrations passed the quality control and the pairwise ratios of them as the proxies of enzymatic reaction were calculated. Linear regression models were used to test the association between each of the metabolite ratios and change in cartilage volume in each of the knee compartments with adjustment for age, sex, and body mass index (BMI). The significance was defined at a=3.0×10 -6 to control multiple testing of 16,512 ratios with Bonferroni method. A total of 344 participants (51% females) were included. The mean baseline age was 62.83±6.13 years and the mean BMI was 27.48±4.41 kg/m 2 . The average follow-up time was 10.84±0.66 years. Cartilage volume reduced by 1.34±0.72%, 1.06±0.58%, and 0.98±0.46% per year in the medial, lateral, and patellar compartments, respectively. Our data showed that an increased ratio of hexadecenoylcarnitine (C16:1) to tetradecanoylcarnitine (C14) was associated with a 0.12±0.02% per year reduction in patellar cartilage volume (p = 8.80×10 -7 ). An increased ratio of hexadecenoylcarnitine (C16:1) to dodecanoylcarnitine (C12) was also associated with a 0.12±0.02% per year reduction in patellar cartilage volume (p = 2.66×10 -6 ). While there were several metabolite ratios associated with cartilage volume loss in the medial and lateral compartments, none of them reached the predefined significance level. Our data suggested that alteration of fatty acid β-oxidation is involved in knee cartilage loss, especially in the patellar compartment, and the serum ratio of C16:1 to C14 and to C12 could be used to predict long-term patellar cartilage loss. We thank all the study participants who made the study possible. The original TASOAC study was supported by the National Health and Medical Research Council (NHMRC) and the current study was supported by the Canadian Institutes of Health Research (CIHR). None declared
Publisher: Springer Science and Business Media LLC
Date: 31-10-2018
DOI: 10.1007/S11926-018-0796-3
Abstract: Pain is the most prominent symptom in osteoarthritis. Pain experience is a complex and multifactorial phenomenon. This review, therefore, offers a brief overview of the literature on factors from main pain dimensions and summarizes current evidence for identifying pain phenotypes in knee osteoarthritis. Peripheral structural damage has been traditionally considered a source of pain and this has strengthened with MRI studies however, a discordance between structural damage and pain severity suggests in idual variations in pain presentation which may be determined by genetic, environmental (obesity), psychological, and neurological factors. Each of the factors may play its role or intact with other factors to contribute to the variation which can partly explain the overall lack of treatment efficacy with the current "one-size-fits-all" treatment approach. Identifying pain phenotypes in knee osteoarthritis is promising to develop in idualized treatments however, the validity and reliability of osteoarthritis pain phenotypes have not been tested in clinical practice. Given the heterogeneity of osteoarthritis pain, peripheral, psychological, and neurological factors are considered key phenotypic dimensions in the identification of pain phenotypes. This new concept allows for patients' stratification for clinical trials, thus providing the potential for in idualized interventions in patients with osteoarthritis pain.
Publisher: American Medical Association (AMA)
Date: 21-04-2020
Publisher: Springer Science and Business Media LLC
Date: 08-1997
Abstract: To explore the relationship between urinary sodium (the best measure of salt intake), urinary calcium, urinary deoxypyridinoline (DPYR) and bone mass. Cross-sectional study. Population based s le of healthy Hobart residents. One hundred and fifty-four (M = 34, F = 120) subjects invited to take part from a systematic s le of the electoral roll and a single newspaper advertisement. In both sexes, urinary sodium correlated moderately with urinary DPYR (r = 0.32, P < 0.0001) and urinary calcium (r = 0.37, P < 0.0001). In multivariate analysis, the combination of urinary sodium, total body bone area, age and sex explained 22% of the variation in log-transformed DPYR (P < 0.00001). In univariate analysis, both urinary sodium and urinary DPYR were strongly associated with bone mineral content and bone mineral density at all sites but this association disappeared after adjustment for confounders particularly body weight. This study has shown that salt intake is associated with markers of bone resorption in a population-based s le of males and females and appears likely to be a risk factor for osteoporosis despite the lack of a demonstrable association between bone mass and a single measure of urinary sodium excretion. Further studies are needed to define the effect of salt intake on bone mass and fractures more clearly. These studies will need to be either longitudinal or interventional in design with repeated measures of urinary sodium so that habitual sodium intake can be accurately assessed and regression dilution bias can be minimised.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2011
DOI: 10.1007/S00198-010-1180-Y
Abstract: The association between hormonal contraceptive use and bone mineral density remains controversial. Hormonal contraceptive use is positively associated with bone mass in young premenopausal women. Cross-sectional analysis of data collected from women aged 26-36 years (n = 687) in the Childhood Determinants of Adult Health study-a longitudinal study investigating childhood determinants of cardiovascular disease, diabetes, and other chronic diseases in adulthood. Participants were not currently pregnant or breast-feeding. Contraceptive use was obtained by self-administered questionnaire. Women were categorized as combined oral contraceptive users (n = 219), progestogen-only contraceptive users (n = 43), and non-users of hormonal contraceptives (n = 425). Bone mass was measured by quantitative ultrasound. Compared with women who were not using any hormonal contraceptives, women using combined oral contraceptives had significantly higher values of broadband ultrasound attenuation (BUA), speed of sound, and quantitative ultrasound index. These associations remained after adjustment for confounders. Progestogen-only contraceptive users had higher BUA than non-users, but the differences were not statistically significant in this small group. Combined oral contraceptive use was associated with higher bone mass measured by quantitative ultrasound in this population-based s le of premenopausal women aged 26-36 while progestogen-only contraceptives appeared to have no deleterious effect on bone mass.
Publisher: BMJ
Date: 06-2016
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/ANNRHEUMDIS-2020-EULAR.2262
Abstract: Weight, dietary patterns, vitamin D, physical activity and grip strength have been suggested to be associated with bone loss in older adults. However, studies have yet been performed to investigate the associations between these factors and radial bone microarchitecture. This study aimed to describe the associations of weight, dietary patterns, serum 25-hydroxyvitamin D (25(OH)D) concentrations, physical activity and grip strength with bone measures in older adults. Cross-sectional data on 201 older adults (mean age 72 years, female 46%) from a population-based cohort study were analysed. Weight, dietary patterns, serum 25(OH)D concentrations, physical activity (steps per day), grip strength were collected and analysed from baseline to 10-year follow-up. Areal bone mineral density (aBMD) at spine, hip and whole body were measured by dual-energy X-ray absorptiometry (DXA). Radial cortical and trabecular bone microarchitectures were measured by high-resolution peripheral computed tomography (HRpQCT). Multivariable linear regression was used to analyse associations of study factors with bone measures. Weight was positively associated with radial bone area (total: β=0.18, 95% CI: 0.07, 0.29 cortical: β=0.12, 95% CI: 0.03, 0.21 trabecular: β=0.18, 95% CI: 0.05, 0.32), and was inversely associated with compact cortical volumetric bone mineral density (vBMD) (β= -0.19, 95% CI: -0.37, -0.01) and trabecular thickness (β= -0.25, 95% CI: -0.43, -0.07). Ten-year changes in weight were not significantly associated with bone measures, apart from radial trabecular separation (β= 0.15, 95%CI: 0.009, 0.28). Western dietary pattern scores were inversely associated with radial vBMD (total: β= -0.17, 95% CI: -0.32, -0.01 cortical: β= -0.19, 95% CI: -0.34, -0.04 compact cortical: β= -0.19, 95% CI: -0.34, -0.04 outer transitional zone: β= -0.20, 95% CI: -0.35, -0.06), and were positively associated with cortical porosity (cortical: β= 0.18, 95% CI: 0.03, 0.33 compact cortical: β= 0.19, 95% CI: 0.04, 0.34 outer transitional zone: β= 0.20, 95% CI: 0.06, 0.35). Steps per day were not significantly associated with bone measures, apart from inner transitional zone area and thickness (β= 0.12, 95% CI: 0.003, 0.24 β= 0.19, 95% CI: 0.05, 0.33). Healthy food pattern scores, serum 25(OH)D and grip strength were not significantly associated with radial HRpQCT measures. Higher weight, but not weight change, was beneficial for radial cortical and trabecular bone area but also associated with worse compact cortical vBMD and trabecular thickness. Higher western dietary pattern scores had adverse effects on radial vBMD and cortical porosity while physical activity had inconsistent associations. None declared
Publisher: Springer Science and Business Media LLC
Date: 23-06-2016
DOI: 10.1007/S12603-015-0559-Z
Abstract: Age-related declines in skeletal muscle mass may confer significant metabolic consequences for older adults. Associations of low muscle mass and metabolic syndrome (MetS) in Caucasians, and comparisons with associations observed in Asian populations, have not been reported. We examined associations of low muscle mass and metabolic syndrome (MetS) in Asian and Caucasian middle-aged and older men and women using criteria for low muscle mass. Two population-based studies of Australian (Tasmanian Older Adult Cohort Study TASOAC N=1005) and Korean (Korean Sarcopenic Obesity Study KSOS N=376) community-dwelling adults, mean age 62 and 58 years, respectively. Appendicular lean mass (aLM) determined by dual-energy X-ray absorptiometry and normalised to height squared (aLM/Ht2), weight (aLM/Wt) or body mass index (aLM/BMI). Participants in the lowest sex-specific 20% for aLM measures were defined as having low muscle mass. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III criteria. Although Australians demonstrated generally unfavourable anthropometric and metabolic characteristics compared to Koreans, prevalence of MetS was similar (29.5% in Australians and 31.4% in Koreans, respectively). Low aLM/Ht2 was associated with significantly reduced likelihood of MetS in both Australians (OR: 0.30, 95% CI 0.19 - 0.46) and Koreans (OR: 0.31, 95% CI 0.16 - 0.62). Conversely, low aLM/BMI was associated with increased odds for MetS in Australians (OR: 1.78, 95% CI 1.12 - 2.84), but not Koreans (OR: 1.33, 95% CI = 0.67 - 2.64). Low aLM/BMI is associated with significantly increased likelihood of MetS in Australian adults, but not Koreans, suggesting potential differences in effects of low muscle mass relative to body mass on cardiometabolic health in Caucasian and Asian middle-aged and older adults. Low muscle mass relative to height is associated with reduced likelihood of MetS in both populations.
Publisher: BMJ
Date: 09-2004
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.AAP.2010.11.003
Abstract: Thoroughbred jumps racing jockeys have a fall rate greater than their flat racing counterparts. Previous studies have focused on factors that contribute to falls by horses but, to date, there has not been a study of risk factors for falls to jockeys in jumps races. Data on race-day falls were extracted from stipendiary stewards reports lodged with Principal Racing Authorities following each race meeting. Denominator data were provided by Racing Information Services Australia on races conducted from August 2002 until July 2009. Univariable and multivariable analyses, estimating incidence rate ratios, were conducted using Poisson regression. In multivariable analysis in hurdle racing, important predictors of falls were higher club level, larger field size, greater prize money, provisionally licensed jockeys and older jockeys. There were significant interactions between jockey licence and prize money jockey age and previous rides this meeting race grade and race distance horse age and field size and club level and field size. In steeplechase racing, important predictors were type of jump with lowest fall rates in races over Mark III jumps compared to standard fences, provisionally licensed jockeys, jockeys having had previous rides at a meeting, and larger field size. There were significant interactions between the number of previous starts by the horse and field size race distance and prize money and race distance and previous rides this meeting. This study has identified factors for falls in jumps racing that could form the basis for targeted strategies to improve occupational health and safety standards.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 08-01-2020
DOI: 10.1007/S10067-019-04920-8
Abstract: To identify subgroups of community-dwelling older adults and to assess their longitudinal associations with long-term osteoarthritis (OA) outcomes. 1046 older adults aged 50-80 years were studied. At baseline, body mass index (BMI), pedometer-measured ambulatory activity (AA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) determined knee pain and information on comorbidities were obtained. Tibial cartilage volume and bone-marrow lesions (BMLs) were assessed using MRI at baseline and 10 years and total knee replacements (TKR) by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Latent class analysis was used to determine participant subgroups, considering baseline BMI, AA, pain and comorbidities, and linear mixed-effects or log-binomial models were used to assess the associations. Three subgroups/classes were identified: subgroup 1 (43%): Normal/overweight participants with higher AA, lower pain and lower comorbidities subgroup 2 (32%): Overweight participants with lower AA, mild pain and higher comorbidities subgroup 3 (25%): Obese participants with lower AA, mild pain and higher comorbidities. Subgroup 3 had greater cartilage volume loss (β - 60.56 mm Our findings suggest the existence of homogeneous subgroups of participants and support the utility of identifying patterns of characteristics/risk factors that may cluster together and using them to identify subgroups of people who may be at a higher risk of developing and/or progressing OA. Key Points • Complex interplay among characteristics/factors leads to conflicting evidence between ambulatory activity and knee osteoarthritis. • Distinct subgroups are identifiable based on ambulatory activity, body mass index, knee pain, and comorbidities. • Identifying subgroups can be used to determine those who are at risk of developing rogressing osteoarthritis.
Publisher: Oxford University Press (OUP)
Date: 30-06-2017
Publisher: Springer Science and Business Media LLC
Date: 18-08-2011
DOI: 10.1007/S00198-011-1741-8
Abstract: Thinness is a risk factor for fractures, but the effect of obesity on fracture risk is less clear. We found an association between measures of obesity and prevalence and number of vertebral deformities in women but not in men, in a cross-sectional study of 1,011 participants aged 50-80 years. Low body weight is well recognised as a risk factor for fractures, but the association between overweight and fracture risk is less well described. This cross-sectional study describes the association between measures of obesity and vertebral deformities in 1,011 male and female participants in the Tasmanian Older Adult Cohort study. Vertebral deformities (anterior wedging) of T4-L4 were determined by morphometric dual-emission X-ray absorptiometry. Body fat was assessed as weight, body mass index (BMI), waist-hip ratio (WHR), waist circumference and DXA measures of trunk fat (in percent) and total fat mass. The mean age of participants was 63 ± 7 years, and mean BMI was 28 ± 5. Prevalent thoracic vertebral deformities were associated with increasing weight [standardised β (Sβ) 0.29, p = 0.003], BMI (Sβ 0.33, p < 0.001), trunk fat (Sβ 0.20, p = 0.03), waist circumference (Sβ 0.19, p = 0.03) and fat mass (Sβ 0.23, p = 0.03), but not the WHR in women, and only with decreasing total fat mass in men. In addition, the number of vertebral deformities increased as weight, BMI or fat mass increased in women (all p < 0.05) but decreased with increasing total fat mass in men. Associations between fat mass and vertebral deformities were mainly linear, but there was some evidence of a threshold effect in women with a BMI ≥ 35. There is a deleterious association between increasing amounts of body fat in women but not in men and the prevalence and number of vertebral deformities, which may reflect loading of the thoracic spine.
Publisher: MDPI AG
Date: 16-09-2010
DOI: 10.3390/NU2090985
Publisher: BMJ
Date: 10-2004
Publisher: Wiley
Date: 10-2012
DOI: 10.1111/J.1445-5994.2012.02788.X
Abstract: This study aims to describe the lifetime picture of vitamin D deficiency, as measured by serum 25(OH)D concentration, in Tasmania (latitude 43°S). Five cross-sectional studies were used: a s le of primary schoolchildren (n = 201, aged 7-8 years), two s les of adolescents (s le 1: n = 374, aged 15-18 years s le 2: n = 136, aged 16-19 years), a s le of young to middle-aged adults (n = 262, aged 19-59 years) and a s le of older adults (n = 1092, aged 50-80 years). In winter/spring, approximately two-thirds of the adolescents and adults (young, middle-aged and older) had 25(OH)D levels ≤50 nmol/L, and around 10% had 25(OH)D levels ≤25 nmol/L. The prevalence of vitamin D deficiency was much lower for primary schoolchildren (11.5% < 50 nmol/L, 0.5% ≤ 25 nmol/L). In summer/autumn, approximately one-third of the adolescents and adults had 25(OH)D levels ≤50 nmol/L, and very few had 25(OH)D levels ≤25 nmol/L. For the adolescents and adults, even among those who reported the highest category of sun exposure, approximately 45% had 25(OH)D levels ≤50 nmol/L in winter/spring. Vitamin D deficiency was uncommon among our s le of primary school children but increased substantially during the teenage years and seemed to remain high throughout the rest of life, suggesting that mild vitamin D deficiency is endemic in Tasmania apart from in the very young.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: BMJ
Date: 04-12-2014
DOI: 10.1136/ANNRHEUMDIS-2014-206005
Abstract: To investigate whether offspring having at least one parent with a total knee replacement for severe primary knee osteoarthritis (OA) have an increased risk of worsening knee pain over 8 years as compared with controls with no family history of knee OA. A total of 219 participants (mean age 48 years, range 29-61 years) with 115 offspring and 104 controls participated in this study. Knee pain was respectively assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 2 years and 10 years. T1-weighted or T2-weighted fat saturated MRI of the right knee was performed to assess knee cartilage defects, bone marrow lesions, effusion, meniscal extrusion and tears. Compared with controls, the prevalence of knee pain for offspring was similar at 2 years (56% vs 54%, p=0.764) and higher at 10 years (74% vs 54%, p=0.002). Over 8 years, offspring more frequently had an increase in total knee pain (66% vs 41% ≥1 point increase, p=0.003) and in all subscales apart from walking (all p<0.05). In multivariable analysis, after adjustment for confounders and structural factors, offspring had an elevated risk of worsening total knee pain (OR=2.16, 95% CI 1.14 to 4.12), as well as each subscale except for walking and standing (OR=1.95 to 3.30, all p<0.05). Offspring with a family history of knee OA have an increased risk of worsening knee pain, which is independent of structural factors, suggesting that genetic factors may be involved in the pathogenesis of knee pain.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: Oxford University Press (OUP)
Date: 10-07-2023
Abstract: Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (& .8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia. Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (& .8 m/s). Agreement and prevalence estimates were compared using Cohen’s Kappa (CK). Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR & .50 kg, area under curve [AUC] = 0.68) and men (GR & .05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8–1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK & .2) between EWGSOP2 and SDOC. Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently.
Publisher: Oxford University Press (OUP)
Date: 03-08-2012
DOI: 10.1093/RHEUMATOLOGY/KES201
Abstract: There have been no reported studies of the association between parity and cartilage in young in iduals. The aim of this study was to describe the association between parity, cartilage volume and cartilage defects in women aged 31-41 years. Cross-sectional study of 144 women, mean age 36 years and BMI 25 kg/m(2), who were participants in an established prospective study. Parity was assessed using a questionnaire. Knee (medial tibial, lateral tibial and patellar) cartilage volume, cartilage defects (grade 0-4 depending on the severity of cartilage thickness loss at tibial and patellar sites) and tibial bone area were assessed using T1-weighted fat-suppressed MRI. The prevalence of cartilage defects (grade ≥2) in this population was 13%. Parity was associated with a higher risk of cartilage defects at the patellar [prevalence ratio (PR) per birth 1.52, 95% CI 1.05, 2.21 PR parous vs nulliparous 1.93, 95% CI 0.66, 5.65], but not tibial sites, after adjustment for confounders including age, BMI, smoking, physical activity, knee injury and tibial bone area. This association between parity and patellar cartilage defects was stronger for those women who had three or more births (vs nulliparous, PR 5.27, 95% CI 1.39, 20.01). There were no significant associations between parity and cartilage volume. Parity was associated with knee cartilage defects primarily at the patellar site in this s le of young women. This association was more apparent with increasing number of live births, suggesting a possible adverse effect of parity on knee cartilage.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2008
DOI: 10.1007/S00198-007-0458-1
Abstract: This study of 415 adolescent children examined the association between four different measures of bone mass and prevalent fracture (N = 160 children). DXA measures and calcaneal ultrasound (but not radial ultrasound or metacarpal index) were associated with upper limb fracture, suggesting heel ultrasound is also a discriminator of fractures in children. The aim of the study was to describe the association between different measures of bone mass and prevalent fracture in adolescents. A total of 415 adolescents (150 girls and 265 boys), mean age 16.3 years were examined. Dual energy X-ray absorptiometry (DXA) measures were performed at hip, spine, radius and total body. Calcaneal bone ultrasound attenuation (BUA), speed of sound (SOS), and stiffness were assessed by a Sahara densitometer. Radial ultrasound SOS was assessed by a Sunlight 8000P machine. Metacarpal index was calculated from a left hand X-ray. Prevalent fractures were assessed by questionnaire. A total of 160 adolescents (39%) reported at least one previous fracture (106 upper limb, 53 lower limb, one other for first fracture). Significantly lower DXA measures, heel BUA, and heel stiffness was observed in those with a history of upper limb fracture (all P < 0.05). Despite significant correlations between all the bone mass measures, radial ultrasound and metacarpal index did not discriminate those with fracture from those without. Similar associations were present for number of fractures. No bone measure was able to discriminate lower limb fracture. Both calcaneal quantitative ultrasound and DXA are able to discriminate adolescents with a history of upper limb fracture from those without.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: American Medical Association (AMA)
Date: 27-03-2006
DOI: 10.1001/ARCHINTE.166.6.651
Abstract: Knee cartilage defects may play an important role in early osteoarthritis, but little is known about their natural history. Knee cartilage defect score (range, 0-4), cartilage volume, and bone surface area were determined using T1-weighted fat-saturated magnetic resonance imaging in 325 subjects (mean age, 45 years) at baseline and 2 years later. Thirty-three percent of the subjects had a worsening (>or=1-point increase) and 37% of the subjects had an improvement (>or=1-point decrease) in cartilage defect score in any knee compartment during 2.3 years. A worsening in cartilage defect score was significantly associated with female sex (odds ratio [OR], 3.09 and 3.64 in the medial and lateral tibiofemoral compartments) and baseline factors, including age (OR, 1.05 per year in the medial tibiofemoral compartment), body mass index (OR, 1.08 in the lateral tibiofemoral compartment), tibiofemoral osteophytes (OR, 6.22 and 6.04 per grade), tibial bone area (OR, 1.24 and 2.07 per square centimeter), and cartilage volume (OR, 2.91 and 1.71 per milliliter in the medial tibiofemoral and patellar compartments). An improvement in cartilage defect score had similar but reversed associations with these factors (except for sex), including a decrease in body mass index (OR, 1.23 in the medial tibiofemoral compartment). Knee cartilage defects are variable, and changes are associated with female sex, age, and body mass index. Increases are associated with baseline cartilage volume, bone size, and osteophytes, suggesting a role for these in the pathogenesis of cartilage defects. Interventions such as weight loss may improve knee cartilage defects.
Publisher: American Academy of Pediatrics (AAP)
Date: 08-2004
Abstract: Objective. Children with severe hemophilia are at risk for reduced bone mineral density (BMD) because of reduced weight-bearing exercise and hepatitis C infection. Reduced bone density in childhood is a risk factor for osteoporosis in later life. Study Design. We performed a cross-sectional survey of bone density among 19 children with severe hemophilia, at the Royal Children’s Hospital. Results were correlated with findings of blinded objective evaluations of the joints of the lower limb and with hepatitis C status. Results. The mean lumbar bone mineral apparent density for patients was reduced (0.102 g/cm3), compared with that for control subjects (0.113 g/cm3). The mean areal BMD z score was −0.92, which was significantly reduced, compared with that for control subjects. The difference in bone density was independent of body size. There was a statistically significant relationship between the lumbar BMD z scores and the maximal single joint evaluation scores, but there was no difference based on hepatitis C status. Conclusions. Our results suggest that children with severe hemophilia have reduced BMD. Patients at risk are those with signs of hemophilic arthropathy. Because osteoporosis may complicate the future treatment of patients with hemophilia, screening of young patients for reduced bone density is recommended.
Publisher: Oxford University Press (OUP)
Date: 16-08-2023
DOI: 10.1093/RHEUMATOLOGY/KEAC469
Abstract: There is increasing evidence for the involvement of vascular disease in the pathogenesis of knee OA. Popliteal artery wall thickness can be used as a surrogate marker of atherosclerosis. We examined the association between popliteal artery wall thickness and knee cartilage volume in in iduals with symptomatic knee OA. This prospective cohort study analysed 176 participants from a randomized placebo-controlled trial examining the effect of atorvastatin on structural progression in knee OA. The participants underwent MRI of the study knee at baseline and 2-year follow-up. Popliteal artery wall thickness and tibial cartilage volume were measured from MRI using validated methods. The top quartile of the rate of tibial cartilage volume loss was defined as rapid progression. At baseline, every 10% increase in popliteal artery wall thickness was associated with 120.8 mm3 (95% CI 5.4, 236.2, P = 0.04) lower of medial tibial cartilage volume and 151.9 mm3 (95% CI 12.1, 291.7, P = 0.03) lower of lateral tibial cartilage volume. Longitudinally, for every 10% increase in popliteal artery wall thickness, the annual rate of medial tibial cartilage volume loss was increased by 1.14% (95% CI 0.09%, 2.20%, P = 0.03), and there was a 2.28-fold (95% CI 1.07, 4.83, P = 0.03) risk of rapid progression of medial tibial cartilage loss, adjusted for age, sex, BMI, tibial bone area, smoking, vigorous physical activity, and intervention group allocation. The findings support a role for vascular pathology in the progression of knee OA. Targeting atherosclerosis has the potential to improve outcomes in knee OA.
Publisher: Springer Science and Business Media LLC
Date: 15-11-2021
DOI: 10.1186/S12891-021-04842-0
Abstract: Hand osteoarthritis is a common and disabling problem without effective therapies. Accumulating evidence suggests the role of local inflammation in causing pain and structural progression in hand osteoarthritis, and hand osteoarthritis with synovitis is a commonly encountered clinical phenotype. Methotrexate is a well-established, low-cost, and effective treatment for inflammatory arthritis with a well-described safety profile. The aim of this multicentre, randomised, double-blind, placebo-controlled trial is to determine whether methotrexate reduces pain over 6 months in patients with hand osteoarthritis and synovitis. Ninety-six participants with hand osteoarthritis and synovitis will be recruited through the Osteoarthritis Clinical Trial Network (Melbourne, Hobart, Adelaide, and Perth), and randomly allocated in a 1:1 ratio to receive either methotrexate 20 mg or identical placebo once weekly for 6 months. The primary outcome is pain reduction (assessed by 100 mm visual analogue scale) at 6 months. The secondary outcomes include changes in physical function and quality of life assessed using Functional Index for Hand Osteoarthritis, Australian Canadian Osteoarthritis Hand Index, Health Assessment Questionnaire, Michigan Hand Outcomes Questionnaire, Short-Form-36, tender and swollen joint count, and grip strength, and structural progression assessed using progression of synovitis and bone marrow lesions from magnetic resonance imaging and radiographic progression at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups. This study will provide high-quality evidence to address whether methotrexate has an effect on reducing pain over 6 months in patients with hand osteoarthritis and synovitis, with major clinical and public health importance. While a positive trial will inform international clinical practice guidelines for the management of hand osteoarthritis, a negative trial would be highly topical and change current trends in clinical practice. Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000877381. Registered 15 June 2017, www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373124
Publisher: Wiley
Date: 05-2017
DOI: 10.1111/IMJ.8_13457
Publisher: Springer Science and Business Media LLC
Date: 18-11-2017
DOI: 10.1007/S12603-016-0843-6
Abstract: Purpose: To compare the performance of low muscle mass and function with falls risk, incident fracture and mortality over 10 years. 1041 participants (50% women mean age 63±7.5 years) were prospectively followed for 10 years. Falls risk was measured using the Physiological Profile Assessment, fractures were self-reported and mortality was ascertained from the death registry. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry. Four anthropometric: (ALM/height2, ALM/body mass index, ALM/weight×100, a residuals method of ALM on height and total body fat) and four performance-based measures: (handgrip strength, lower-limb muscle strength, upper and lower-limb muscle quality) were examined. Participants in the lowest 20% of the sex-specific distribution for each anthropometric and performance-based measure were classified has having low muscle mass or function. Regression analyses were used to estimate associations between each anthropometric and performance-based measure at baseline and 10-year falls risk, incident fractures and mortality. Mean falls risk z-score at 10 years was 0.64 (SD 1.12), incident fractures and mortality over 10 years were 16% and 14% respectively. All baseline performance-based measures were significantly associated with higher falls risk score at 10 years. Low handgrip (RR 1.55, 95% CI: 1.09, 2.20) and ALM/body mass index (RR 1.54, 95% CI: 1.14, 2.08) were the only significant predictors of fracture and mortality respectively. Low handgrip strength, a simple and inexpensive test could be considered in clinical settings for identifying future falls and fractures. ALM/ body mass index could be most suitable in estimating 10-year mortality risk, but requires specialised equipment.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.MATURITAS.2011.07.010
Abstract: Methodological differences among studies of vasomotor symptoms limit rigorous comparison or systematic review. Vasomotor symptoms generally include hot flushes and night sweats although other associated symptoms exist. Prevalence rates vary between and within populations, but different studies collect data on frequency, bothersomeness, and/or severity using different outcome measures and scales, making comparisons difficult. We reviewed only cross-cultural studies of menopausal symptoms that explicitly examined symptoms in general populations of women in different countries or different ethnic groups in the same country. This resulted in the inclusion of nine studies: Australian/Japanese Midlife Women's Health Study (AJMWHS), Decisions At Menopause Study (DAMeS), Four Major Ethnic Groups (FMEG), Hilo Women's Health Survey (HWHS), Mid-Aged Health in Women from the Indian Subcontinent (MAHWIS), Penn Ovarian Aging Study (POAS), Study of Women's Health Across the Nation (SWAN), Women's Health in Midlife National Study (WHiMNS), and Women's International Study of Health and Sexuality (WISHeS). These studies highlight the methodological challenges involved in conducting multi-population studies, particularly when languages differ, but also highlight the importance of performing multivariate and factor analyses. Significant cultural differences in one or more vasomotor symptoms were observed in 8 of 9 studies, and symptoms were influenced by the following determinants: menopausal status, hormones (and variance), age (or actually, the square of age, age(2)), BMI, depression, anxiety, poor physical health, perceived stress, lifestyle factors (hormone therapy use, smoking and exposure to passive smoke), and acculturation (in immigrant populations). Recommendations are made to improve methodological rigor and facilitate comparisons in future cross-cultural menopause studies.
Publisher: Springer Science and Business Media LLC
Date: 23-01-2006
Abstract: Limited information is available on ways to influence osteoporosis risk in premenopausal women. This study tested four hypotheses regarding the effects of in idualized bone density (BMD) feedback and different educational interventions on osteoporosis preventive behavior and BMD in pre-menopausal women, namely: that women are more likely to change calcium intake and physical activity if their BMD is low that group education will be more efficacious at changing behavior than an information leaflet that BMD feedback and group education have independent effects on behavior and BMD and, that women who improve their physical activity or calcium intake will have a change in bone mass over 2 years that is better than those who do not alter their behavior. We performed a 2-year randomized controlled trial of BMD feedback according to T-score and either an osteoporosis information leaflet or small group education in a population-based random s le of 470 healthy women aged 25–44 years (response rate 64%). Main outcome measures were dietary calcium intake, calcium supplement use, smoking behavior, physical activity, endurance fitness, lower limb strength and BMD. We used paired t-tests, one-way ANOVA and linear regression techniques for data analysis. Women who had feedback of low BMD had a greater increase in femoral neck BMD than those with normal BMD (1.6% p.a. vs. 0.7% p.a., p = 0.0001), but there was no difference in lumbar spine BMD change between these groups (0.1% p.a. vs. 0.08% p.a., p = 0.9). Both educational interventions had similar increases in femoral neck BMD (Leaflet = +1.0% p.a., Osteoporosis self-management course = + 1.3% p.a., p = 0.4). Femoral neck BMD change was only significantly associated with starting calcium supplements (1.3 % p.a, 95%CI +0.49, +2.17) and persistent self-reported change in physical activity levels (0.7% p.a., 95%CI +0.22, +1.22). In idualized BMD feedback combined with a minimal educational intervention is effective at increasing hip but not spine bone density in premenopausal women. The changes in behavior through which this was mediated are potentially important in the prevention of other diseases, thus measuring BMD at a young age may have substantial public health benefits, particularly if these changes are sustained.
Publisher: Cambridge University Press (CUP)
Date: 25-06-2018
DOI: 10.1017/S0007114518001174
Abstract: The aim of this study was to determine whether vitamin D supplementation and maintaining vitamin D sufficiency are associated with changes in inflammatory and metabolic biomarkers in patients with knee osteoarthritis (OA) and vitamin D deficiency. A total of 413 participants with symptomatic knee OA and vitamin D deficiency were enrolled in a randomised, placebo-controlled trial and received 1·25 mg vitamin D 3 or placebo monthly for 24 months across two sites. In this post hoc analysis, 200 participants from one site (ninety-four from the placebo group and 106 from the vitamin D group mean age 63·1 ( sd 7·3) years, 53·3 % women) were randomly selected for measurement of serum levels of inflammatory and metabolic biomarkers at baseline and 24 months using immunoassays. In addition, participants were classified into two groups according to serum 25-hydroxyvitamin D (25(OH)D) levels at months 3 and 24: (1) not consistently sufficient (25(OH)D≤50 nmol/l at either month 3 or 24, n 61), and (2) consistently sufficient (25(OH)D nmol/l at both months 3 and 24, n 139). Compared with placebo, vitamin D supplementation had no significant effect on change in serum high-sensitive C-reactive protein, IL-6, IL-8, IL-10, leptin, adiponectin, resistin, adipsin and apelin. Being consistently vitamin D sufficient over 2 years was also not associated with changes in these biomarkers compared with not being consistently sufficient. Vitamin D supplementation and maintaining vitamin D sufficiency did not alter serum levels of inflammatory and metabolic biomarkers over 2 years in knee OA patients who were vitamin D insufficient, suggesting that they may not affect systemic inflammation in knee OA patients.
Publisher: Elsevier BV
Date: 04-2016
Publisher: BMJ
Date: 06-2015
Publisher: Wiley
Date: 02-2018
DOI: 10.1111/IMJ.13654
Abstract: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices. To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices. A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016). A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%) Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%) Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%) Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%). This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.
Publisher: Springer Science and Business Media LLC
Date: 17-01-2009
DOI: 10.1007/S00198-008-0830-9
Abstract: Serum 25(OH)D levels decline without sunlight exposure. We studied 120 expeditioners to Antarctica to determine the skeletal and hormonal responses to sunlight deprivation. With emerging vitamin D insufficiency, serum calcium decreased, PTH increased, and bone loss at the proximal femur was observed. Baseline serum 25(OH)D levels >100 nmol/L prevented vitamin D insufficiency. Vitamin D stores deplete without adequate sunlight exposure unless supplementation is provided. We studied 120 healthy adults who spent a year in Antarctica as a model for sunlight deprivation to define the timing and magnitude of the skeletal and hormonal responses to emerging vitamin D insufficiency. Fasting blood s les were assessed at baseline, 6 and 12 months for serum 25-hydroxyvitamin D (25(OH)D), osteocalcin (OC), bone formation (P1NP) and resorption (CTx), PTH and calcium. Lumbar spine and proximal femur BMD was measured using DXA. Differences over time were determined using repeated measures ANOVA. Percent changes were expressed as (Delta value/(value A + value B)/2) x 100. Relationships between outcome measures were determined using Spearman's correlations. Vitamin D insufficiency (<50 nmol/L) was observed in 85% of expeditioners by 6 months when serum calcium decreased and PTH increased (p < 0.01). By 12 months, OC increased by 7.4 +/- 3.0% (p < 0.05), and BMD decreased by 1.0 +/- 2.0% at the total proximal femur (p 50 nmol/L), sunlight deprivation produced vitamin D insufficiency within 4 months unless baseline values were >100 nmol/L. Supplementation may be necessary for expeditioners with limited access to UV light.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Wiley
Date: 06-2021
DOI: 10.1002/ACR.24371
Abstract: The present study was undertaken to determine whether vitamin D supplementation or maintaining sufficient vitamin D level reduces foot pain over 2 years in patients with symptomatic knee osteoarthritis (OA). A post hoc study was conducted from a randomized, double‐blind, placebo‐controlled trial named the Vitamin D Effect on Osteoarthritis (VIDEO) study. Symptomatic knee OA patients with serum 25‐hydroxyvitamin D levels between 12.5 nmoles/liter and 60 nmoles/liter were included and randomly allocated to either monthly vitamin D 3 or placebo treatment (1:1) for 2 years. Manchester Foot Pain and Disability Index (MFPDI) was used to evaluate foot pain and disabling foot pain was defined as at least 1 of the 10 functional limitation items (items 1–9 and 11) being documented as on “most/every day(s)” in the last month. A repeated‐measures, mixed‐effects model was used to analyze the change of MFPDI scores between groups adjusting for potential confounders. A total of 413 patients with a mean age of 63.2 years (49.7% males) were enrolled and 340 completed the study. The mean MFPDI score was 22.8 ± 7.3, with 23.7% of participants having disabling foot pain at baseline. There were significant differences in MFPDI scores change between groups over 2 years, with more improvements in the vitamin D group than in the placebo group (–0.03 versus 1.30 P = 0.013) and more improvement in those maintaining sufficient vitamin D levels (n = 226) than those who did not (n = 114) (–0.09 versus 2.19 P = 0.001). Vitamin D supplementation and maintenance of sufficient vitamin D levels may improve foot pain in those with knee OA.
Publisher: Elsevier BV
Date: 10-2010
Publisher: BMJ
Date: 15-04-2015
Publisher: Elsevier BV
Date: 04-2013
Publisher: BMJ
Date: 10-11-2012
Publisher: Oxford University Press (OUP)
Date: 18-08-2010
DOI: 10.1093/RHEUMATOLOGY/KEQ255
Abstract: Obesity is an important risk factor for knee OA. Evidence suggests that fat and muscle have differential effects on the pathogenesis of disease. The aim of this study was to examine the relationship between body composition and knee structure, including knee cartilage volume, defects and bone marrow lesions (BMLs). A total of 153 subjects aged 25-60 years, 81% females, were recruited across a range of BMI (18-55 kg/m2) for a study examining the relationship between obesity and musculoskeletal disease. MRI was performed of the dominant knee. Cartilage volume, defects and BMLs were measured using validated methods. Body composition was measured using dual X-ray absorptiometry. There was an 81 (95% CI: 69, 94) mm3 increase in cartilage volume for every 1 kg increase in skeletal muscle mass. Fat mass was not significantly associated with cartilage volume. Fat mass, but not skeletal muscle mass, was a risk factor for cartilage defects and BMLs. For every 1 kg increase in total body fat there was an increased risk of cartilage defects (OR=1.31, 95% CI: 1.04, 1.64) and BMLs (OR=1.09, 95% CI: 1.01, 1.18). In this relatively healthy population, fat mass was associated with increased cartilage defects and BMLs, which are features of early knee OA. In contrast, skeletal muscle mass was positively associated with cartilage volume, which may be due to coinheritance, a commonality of environmental factors associated with cartilage accrual or a protective effect of increased muscle.
Publisher: Elsevier BV
Date: 04-2017
Publisher: American Medical Association (AMA)
Date: 17-04-2013
Publisher: Public Library of Science (PLoS)
Date: 09-12-2021
DOI: 10.1371/JOURNAL.PONE.0260925
Abstract: Chronic plantar heel pain (CPHP) is associated with calcaneal bone spurs, but its associations with other calcaneal bone features are unknown. This study therefore aimed to determine associations between having CPHP and bone density and microarchitecture of the calcaneus. We assessed 220 participants with CPHP and 100 age- and sex-matched population-based controls. Trabecular bone density, thickness, separation and number, BV/TV, and cortical density, thickness and area were measured using a Scanco Xtreme1 HR-pQCT scanner at a plantar and mid-calcaneal site. Clinical, physical activity and disease history data were also collected. Associations with bone outcomes were assessed using multivariable linear regression adjusting for age, sex, physical activity, BMI and ankle plantarflexor strength. We assessed for potential effect modification of CPHP on these covariates using interaction terms. There were univariable associations at the plantar calcaneus where higher trabecular bone density, BV/TV and thickness and lower trabecular separation were associated with CPHP. In multivariable models, having CPHP was not independently associated with any bone outcome, but modified associations of BMI and ankle plantarflexor strength with mid-calcaneal and plantar bone outcomes respectively. Beneficial associations of BMI with mid-calcaneal trabecular density (BMI-case interaction standardised X/unstandardised Y beta -10.8(mgHA/cm 3 ) (se 4.6), thickness -0.002(mm) (se 0.001) and BV/TV -0.009(%) (se 0.004) were reduced in people with CPHP. Beneficial associations of ankle plantarflexor strength with plantar trabecular density (ankle plantarflexor strength -case interaction -11.9(mgHA/cm 3 ) (se 4.4)), thickness -0.003(mm) (se 0.001), separation -0.003(mm) (se 0.001) and BV/TV -0.010(%) (se 0.004) were also reduced. CPHP may have consequences for calcaneal bone density and microarchitecture by modifying associations of BMI and ankle plantarflexor strength with calcaneal bone outcomes. The reasons for these case-control differences are uncertain but could include a bone response to entheseal stress, altered loading habits and/or pain mechanisms. Confirmation with longitudinal study is required.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.AMJMED.2009.03.022
Abstract: The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on knee osteoarthritis progression are unclear. The aim of this longitudinal study was to determine the associations between use of NSAIDs and changes in knee cartilage volume and knee cartilage defects over 2.9 years in older adults. T(1)-weighted fat-suppressed magnetic resonance imaging on the right knee was performed in a total of 395 randomly selected subjects (mean age 62 years, range 51-80 years, and 50% female) to assess knee cartilage volume at tibial sites and knee cartilage defects (0-4 scale) at baseline and 2.9 years later. Medication use in the last month was recorded by questionnaire. Compared with nonusers of NSAIDs (n = 334), users of cyclooxygenase (COX)-2 inhibitors (n = 40) had decreased knee cartilage defect development in the medial tibiofemoral compartment (odds ratio [OR] 0.4, 95% confidence interval [CI], 0.2-0.99), whereas users of conventional NSAIDs (n = 21) had increased knee cartilage defect development in both medial (OR 3.1, 95% CI, 1.0-9.1) and lateral (OR 2.6, 95% CI, 1.0-6.7) tibiofemoral compartments. Comparing users of COX-2 inhibitors with users of conventional NSAIDs, the latter had higher knee cartilage volume loss (-5.3% vs -3.1% at medial tibia and -3.6% vs -1.1% at lateral tibia all P <.05). All associations were adjusted for potential confounders including knee pain and radiographic osteoarthritis. This study suggests that nonselective NSAIDs may have deleterious effects, while selective COX-2 inhibitors might have beneficial effects on knee cartilage. Randomized controlled trials examining knee structure to confirm this finding are warranted.
Publisher: Wiley
Date: 27-09-2017
DOI: 10.1002/ACR.23166
Abstract: Hip morphology plays a significant role in the incidence and progression of hip osteoarthritis (OA). We hypothesized that hip shape would also be associated with other key factors and tested this in a longitudinal community-based cohort combining radiographic, magnetic resonance imaging (MRI), dual-energy x-ray absorptiometry (DXA), and clinical data. Baseline DXA images of the left hip of 831 subjects from the Tasmanian Older Adult Cohort were analyzed using an 85-point statistical shape model. Hip pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, and muscle strength was measured using a dynamometer. Hip structural changes were assessed using MRI and radiographic OA using plain radiographs. Six shape modes accounted for 68% of shape variation. At baseline, modes 1, 2, 4, and 6 were associated with radiographic hip OA modes 1, 3, 4, and 6 were correlated with hip cartilage volume and all except mode 2 were correlated with muscle strength. Higher mode 1 and lower mode 3 and mode 6 scores at baseline predicted hip pain at followup and higher mode 1 and mode 2 scores were associated with hip effusion-synovitis. Higher scores for mode 2 (decreasing acetabular coverage) and lower scores for mode 4 (nonspherical femoral head) at baseline predicted 10-year total hip replacement (THR), while mode 4 alone was correlated with bone marrow lesions (BMLs), effusion-synovitis, and increased cartilage signal. Hip shape is associated with radiographic OA, THR, hip pain, effusion-synovitis, BMLs, muscle strength, and hip structural changes. These data suggest that different shape modes reflect multiple facets of hip OA.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 22-10-2018
DOI: 10.1038/S41366-018-0234-7
Abstract: To describe the associations of childhood and adulthood adiposity measures with knee cartilage thickness, volume and bone area in young adults. Childhood and adulthood adiposity measures (weight, height, waist circumference and hip circumference) of 186 participants were collected in 1985 (aged 7-15 years) and during 2004-2006 (aged 26-36 years). Knee magnetic resonance imaging was conducted during 2008-2010 (aged 31-41 years) and cartilage thickness, volume and bone area were measured using a quantitative approach (Chondrometrics, Germany). Linear regressions were used to examine the above associations. The prevalence of overweight was 7.6% in childhood and 42.1% in adulthood. Childhood weight (β = - 5.57 mm Childhood weight and BMI were negatively but adult weight was positively associated with adult bone area. Adult WHR and the change in WHR from childhood to adulthood were negatively associated with cartilage thickness, volume, and bone area. These suggest early-life adiposity measures may affect knee structures in young adults.
Publisher: Elsevier BV
Date: 04-2006
DOI: 10.1016/J.JOCD.2006.02.004
Abstract: The interpretation of bone density measurement in children is difficult due to a number of factors including rapid change in body size and uncertain clinical significance of bone density in children. This study asked two questions. (1) Is there a preferred bone density measurement site or type for fracture risk in children? (2) What is the best way to interpret bone density in children? This population-based case control study included 321 upper limb fracture cases and 321 class- and sex- matched randomly selected controls. Bone density at the hip, spine, and total body (including the arm) was measured by a Hologic QDR2000 densitometer (Waltham, MA) and examined as bone area (BA), bone mineral content (BMC), bone mineral density (BMD), bone mineral apparent density (BMAD), and BMC/lean mass (BMCLM). The only dual-energy X-ray absorptiometry (DXA) variables that were consistently associated with fracture risk in both boys and girls were spine BMD and BMAD for total upper limb fractures, and spine and hip BMAD for wrist and forearm fractures. No significant associations were observed for BA and BMCLM and inconsistent associations for BMC and other BMD sites. Five-yr fracture risk varied from 15-24% depending on site and gender in a child with a Z-score of -3. In the controls, all DXA variables were associated with age, height, and weight, but the weakest associations were with BMAD. In conclusion, in this study the spine BMAD had the strongest and most consistent association with upper limb fracture risk in children. The associations with age and body size imply that age specific Z-scores will be the most convenient for interpretation of DXA measures in children. Five-yr wrist and forearm fracture risk has potential as a clinical endpoint of immediate relevance.
Publisher: Wiley
Date: 1999
DOI: 10.1359/JBMR.1999.14.1.146
Abstract: There have been no studies of smoking during pregnancy and bone mineralization in children. The objective of this population-based longitudinal study was to determine whether maternal smoking during pregnancy is associated with bone mass and other growth variables in prepubertal children. We studied 330 8-year-old male and female children representing 47% of those who originally took part in a study of risk factors for Sudden Infant Death Syndrome in 1988. The main outcome measures were bone mineral density measured by a Hologic QDR2000 densitometer: birth weight, placental weight, height, and weight. Maternal smoking during pregnancy was associated with deficits in growth with these children having lower height (-1.53 cm, 95% confidence interval [CI] -3.03 to -0.03) and a trend to lower weight (-1.35 kg, 95% CI -2.75 to 0.11) at age 8. Furthermore, there was a disproportionate deficit in bone mass such that those children whose mothers smoked during pregnancy had lower size adjusted bone mass at the lumbar spine (-0.019 g/cm2, 95% CI -0.033 to -0.005) and femoral neck (-0.018 g/cm2, 95%CI -0.034 to -0.002) but not total body (-0.005 g/cm2, 95% CI -0.015 to 0.005). This association was only present for children born at term. Mothers who smoked during pregnancy also had lower placental weight (- 56 g, 95% CI -95 to -17), and further adjustment for placental weight led to nonsignificant results for smoking with both growth and bone parameters, suggesting that these associations may be mediated through placental size and function. Maternal smoking habit in 1996 was not significantly associated with bone mass at any site. In conclusion, this study has demonstrated a long-term negative association between maternal smoking during pregnancy and both growth and bone mass in children born at term, and suggests that the timing of exposure rather than the dose or duration is critical. If these associations are present in other populations and they persist until the attainment of peak bone mass, then our findings suggest that osteoporosis prevention programs should start very early in the life cycle.
Publisher: Springer Science and Business Media LLC
Date: 21-07-2020
Publisher: Elsevier BV
Date: 04-2014
Publisher: BMJ
Date: 09-2017
Publisher: OMICS Publishing Group
Date: 06-2013
DOI: 10.2217/IJR.13.29
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 29-06-2010
DOI: 10.1002/ART.27467
Abstract: There is limited longitudinal evidence relating subchondral bone changes to cartilage damage and loss. The aim of this study was to describe the association between baseline tibial bone area and tibial subchondral bone mineral density (BMD) with tibial cartilage defect development and cartilage volume loss. A total of 341 subjects (mean age 63 years, range 52-79 years) underwent measurement at baseline and approximately 2.7 years later. Tibial knee cartilage volume, cartilage defects (graded on a scale of 0-4), and bone area were determined using T1-weighted fat suppression magnetic resonance imaging. Tibial subchondral BMD was determined using dual x-ray absorptiometry. In multivariable analysis, baseline bone area positively predicted cartilage defect development at the medial and lateral tibial sites (odds ratio [OR] 1.6 per 1 SD increase, 95% confidence interval [95% CI] 1.0, 2.6, and OR 2.4 per 1 SD increase, 95% CI 1.4, 4.0, respectively) and cartilage volume loss at the medial tibial site (beta = -34.9 per 1 SD increase, 95% CI -49.8, -20.1). In contrast, baseline subchondral BMD positively predicted cartilage defect development at the medial tibial site only (OR 1.6 per 1 SD increase, 95% CI 1.2, 2.1) and was not associated with cartilage loss. The results of this study demonstrated that bone area predicted medial and lateral cartilage defect development and medial cartilage volume loss, while subchondral BMD predicted medial defect development but not cartilage loss. These associations were independent of each other, indicating there are multiple mechanisms by which subchondral bone changes may lead to cartilage damage.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Wiley
Date: 05-12-2017
Publisher: Springer Science and Business Media LLC
Date: 22-08-2020
DOI: 10.1186/S12891-020-03589-4
Abstract: Histological and epidemiological data suggest that increased signal intensity at the proximal patellar tendon on magnetic resonance imaging is a response to tendon loading. As patellofemoral geometry is a mediator of loading, we examined the association between patellofemoral geometry and the prevalence of increased signal intensity at the patellar tendon in community-based middle-aged adults. Two hundred-one adults aged 25–60 years in a study of obesity and musculoskeletal health had the patellar tendon assessed from magnetic resonance imaging. Increased signal intensity at the proximal patellar tendon was defined as hyper-intense regions of characteristic pattern, size and distribution on both T1- and T2-weighted sequences. Indices of patellofemoral geometry, including Insall-Salvati ratio, patellofemoral congruence angle, sulcus angle, and lateral condyle-patella angle, were measured from magnetic resonance imaging using validated methods. Binary logistic regression was used to examine the association between patellofemoral geometrical indices and the prevalence of increased signal intensity at the patellar tendon. The prevalence of increased signal intensity at the patellar tendon was 37.3%. A greater Insall-Salvati ratio (odds ratio 0.80, 95% confidence interval 0.66–0.97 per 0.1 change in the ratio, p = 0.02), indicative of a higher-riding patella, and a larger patellofemoral congruence angle (odds ratio 0.91, 95% confidence interval 0.85–0.98 per 5 degree change in the angle, p = 0.01), indicating a more laterally placed patella, were associated with reduced odds of increased signal intensity at the patellar tendon. Sulcus angle and lateral condyle-patella angle were not significantly associated with the odds of increased signal intensity at the patellar tendon. In community-based asymptomatic middle-aged adults, increased signal intensity at the patellar tendon was common and associated with Insall-Salvati ratio and patellofemoral congruence angle, suggesting a biomechanical mechanism. Such work is likely to inform tissue engineering and cell regeneration approaches to improving outcomes in those with tendon pathology.
Publisher: Elsevier BV
Date: 04-2013
Publisher: SAGE Publications
Date: 2019
Abstract: The aim of this study was to compare the efficacy and safety of zoledronic acid (ZA) plus intravenous methylprednisolone (VOLT01) to ZA, and placebo for knee osteoarthritis. A single-center, double-blind, randomized controlled trial (RCT) was carried out. Adults (aged ⩾50 years) with knee osteoarthritis, significant knee pain [⩾40 mm on a 100 mm visual analog scale (VAS)], and magnetic resonance imaging-detected bone marrow lesion (BML) were randomized to receive a one-off administration of VOLT01, ZA, or placebo. The primary hypothesis was that VOLT01 was superior to ZA in having a lower incidence of acute phase responses (APRs) over 3 days. Secondary hypotheses were that VOLT01 was noninferior to ZA, and both treatments were superior to placebo in decreasing BML size over 6 months and in improving knee pain [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and VAS] and function (WOMAC) over 3 and 6 months. A total of 117 patients (62.2 ± 8.1 years, 63 women) were enrolled. The incidence of APRs was similar in the VOLT01 (90%) and ZA (87%) groups ( p = 0.74). VOLT01 was superior to ZA in improving knee pain and function after 6 months and noninferior to ZA in reducing BML size. However, BML size change was small in all groups and there were no between-group differences. Compared with placebo, VOLT01 but not ZA improved knee function and showed a trend toward improving knee pain after 6 months. Administering intravenous methylprednisolone with ZA did not reduce APRs or change knee BML size over 6 months, but in contrast to ZA or placebo, it may have a beneficial effect on symptoms in knee osteoarthritis. Australian New Zealand Clinical Trials Registry: ACTRN12613000039785.
Publisher: BMJ
Date: 19-05-2021
DOI: 10.1136/ANNRHEUMDIS-2021-EULAR.2762
Abstract: There is increasing use of complementary and alternative medicines (CAMs) alone or as an adjuvant therapy to conventional palliative medicines. 1 However, there remains clinical uncertainty about the benefit of CAMs in the management of osteoarthritis in older population. To describe the association between CAM use (alone or in combination with conventional analgesics) with knee symptoms and structural changes amongst a representative s le of Tasmanian older adults. A total of 1,099 participants were selected from the Tasmania Older Adult Cohort Study (TASOAC), an ongoing prospective population-based study. Exposure to CAM and conventional medications was classified into four categories according to the national drug code directory: 2 CAM only, conventional analgesics only, both CAM and conventional analgesics, and neither CAMs nor conventional analgesics. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a 1.5-T MRI of the right knee was performed at baseline and follow-up (around 2.6 years). Longitudinal associations were assessed using mixed effect linear models. At baseline, participants‘ mean age was 63, 86.5% (n=951) reported any medication use. The prevalence of CAM use was 35.0% and of conventional analgesics was 58.6%. Over follow-up, the analgesic only group had a significant increase in WOMAC pain, function, and stiffness scores compared to those who took neither CAMs nor conventional analgesics. There was a statistically significant femoral cartilage volume loss across all four groups, and no statistical difference was found between participants who takes both CAMs and analgesics group and the reference group, but participant in the CAM only or the analgesics only groups loss statistically significant more femoral cartilage volume than the reference group (Table 1). Table 1. Association of change in clinical knee symptoms and knee structural changes over 2.6 years with different medications groups. Mean change for reference group* Change for each category, coefficient (95% confident intervals) CAMs Both Analgesics Reference group* No. of participants 327 128 257 387 327 WOMAC pain (5-50) -0.95 (-1.42, -0.48) 0.04 (-0.85, 0.93) 0.32 (-0.4, 1.04) 0.78 (0.13, 1.43) Ref WOMAC function (17-170) -3.09 (-4.52, -1.67) 1.02 (-1.7, 3.73) 1.39 (-0.81, 3.59) 2.32 (0.33, 4.31) Ref WOMAC stiffness (2-20) -0.39 (-0.62, -0.17) 0.15 (-0.28, 0.58) 0.35 (0, 0.7) 0.40 (0.09, 0.72) Ref Femoral cartilage volume (mL) -187.98 (-228.79, -147.18) -113.81 (-192.60, -35.03) -1.92 (-65.00, 61.17) -127.19 (-186.31, -68.06) Ref *Reference group=participants taken neither CAMs nor conventional analgesics CAM use alone or in combination with conventional analgesics may associate with slower progression of knee pain. Conclusive evidence on the longitudinal benefits of CAM in the management of osteoarthritis among older adults warrants more studies. [1] Steel A, McIntyre E, Harnett J, et al . Complementary medicine use in the Australian population: Results of a nationally-representative cross-sectional survey. Sci Rep 2018 8 :17325. [2] National Center for Health Statistics . Long-term Care Drug Database System: Drugs by NDC Class Code, Drug Code and Name 2007 Available from: chs/data/nnhsd/DrugsbyNDCClass3.pdf [accessed date: 2020 23 December]. The data were fitted using mixed effect linear models, which were constructed by entering baseline medication group, phase, the interaction between medication group and phase, covariates (baseline age, sex, body mass index [BMI], baseline value of outcome), the interaction between the covariates and phase, random intercept, and random slope on phase (time). None declared
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.BERH.2014.07.004
Abstract: This review covers the evidence relating to lifestye modification in the big three musculoskeletal conditions: osteoarthritis, osteoporosis and rheumatoid arthritis. Lifestyle is of considerable importance in the first two and there is emerging evidence for rheumatoid arthritis despite it not traditionally being considered a lifestyle disease.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2015
Publisher: BMJ
Date: 06-2015
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.JOCA.2016.10.013
Abstract: Although being overweight or obese is an important risk factor for the development of knee osteoarthritis (OA), the interplay between weight and genetic factors remains unclear. This study aimed to examine the associations between weight and knee cartilage volume/defects over 10 years in offspring having at least one parent with a total knee replacement (TKR) for primary knee OA and in controls without a knee OA family history. 367 participants (183 offspring and 184 controls) aged from 26 to 61 years were recruited at baseline, and followed at 2 and 10 years later. T1-weighted magnetic resonance imaging (MRI) of the right knee was used to measure cartilage volume/defects at each time-point. Mixed-effects models were used with adjustment for potential confounders. Study participants were middle-age adults (mean age 45 years, mean weight 77.5 kg at baseline). In multivariable analysis, increasing body weight was deleteriously associated with medial tibiofemoral cartilage volume (β = -0.28 ml, per 1 SD increase, 95% CI -0.49 to -0.07) and presence of medial tibiofemoral cartilage defects (RR = 1.27, per 1 SD increase, 95% CI 1.07 to 1.51) in offspring over 10 years. Similar associations were observed for lateral tibiofemoral cartilage volume (β = -0.19 ml, P = 0.059), and defects (RR = 1.24, P = 0.049). However, there were no statistically significant associations between weight and cartilage volume or defects in controls. The adverse effects of increasing weight are stronger in the offspring of people with knee replacement for knee OA suggesting genetics-environment interaction with regard to overweight/obesity in the pathogenesis of knee OA particularly in the early stages.
Publisher: FapUNIFESP (SciELO)
Date: 03-2016
Publisher: Elsevier BV
Date: 2013
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JPEDS.2019.05.031
Abstract: To describe the association between fractures sustained at different stages of growth and bone measures in early adulthood. Participants (n = 201) in southern Tasmania were at birth at a higher risk of sudden infant death syndrome they were followed to age 25. Outcomes were areal bone mineral density at the spine, hip, and total body (by dual-energy x-ray absorptiometry) and trabecular and cortical bone measures at the radius and tibia (by high-resolution peripheral quantitative computed tomography). Fractures were self-reported and confirmed by radiographs at 8, 16, and 25 years of age. Multivariable linear regression was used to analyze the association of the occurrence of prepubertal (<9 years of age), pubertal (9-16 years of age), and postpubertal (17-25 years of age) fractures with all bone measures. Over 25 years, 99 participants had at least 1 fracture. For high-resolution peripheral quantitative computed tomography measures at age 25, prepubertal fractures were negatively associated with cortical and trabecular volumetric bone mineral density and most microarchitecture measures at both the tibia and radius. Prepubertal fractures had a significant association with smaller increase of areal bone mineral density from age 8 to 16 years and at 25 years of age compared with participants with no fractures. Pubertal fractures had no association with any bone measures and postpubertal fractures were only associated with a lower trabecular number at the tibia. Prepubertal fractures are negatively associated with areal bone mineral density increases during growth and high-resolution peripheral quantitative computed tomography bone measures in young adulthood. There is little evidence that fractures occurring from age 8 years onward with bone measures in young adulthood, implying that prepubertal fractures may be associated with bone deficits later in life.
Publisher: Wiley
Date: 11-2011
DOI: 10.1002/DDR.20472
Publisher: BMJ
Date: 30-10-1993
DOI: 10.1136/BMJ.307.6912.1111
Abstract: To investigate the utility of risk factors such as bone mineral density, lifestyle, and postural stability in the prediction of osteoporotic fractures. Longitudinal, epidemiological, and population based survey. City of Dubbo, New South Wales. All residents of Dubbo aged > or = 60 on 1 January 1989. Incidence of fracture for in idual subjects. The overall incidence of atraumatic fractures in men and women was 1.9% and 3.1% per annum respectively. The predominant sites of fracture were hip (18.9%), distal radius (18.5%), ribs and humerus (11.9% in each case), and ankle and foot (9.1% and 6.6% respectively). Major predictors of fractures in men and women were femoral neck bone mineral density, body sway, and quadriceps strength. Age, years since menopause, height, weight, and lifestyle factors were also correlated with bone mineral density and body sway and hence were indirect risk factors for fracture. Discriminant function analysis correctly identified 96% and 93% (sensitivities 88% and 81%) of men and women, respectively, who subsequently developed atraumatic fractures. Predictions based on this model indicated that a woman with a bone mineral density in the lowest quartile in the hip together with high body sway had a 8.4% probability of fracture per annum. This represented an almost 14-fold increase in risk of fracture compared with a woman in the highest bone mineral density quartile with low postural sway. An in idual with all three predictors in the "highest risk" quartile had a 13.1% risk of fracture per annum. Bone mineral density, body sway, and muscle strength are independent and powerful synergistic predictors of fracture incidence.
Publisher: BMJ
Date: 15-04-2015
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.YPMED.2005.11.006
Abstract: To assess whether a lifestyle intervention delivered to mothers might impact on osteoporosis preventive behaviors in their children. We performed a 2-year randomized controlled trial of in idualized bone mineral density feedback with either an osteoporosis information leaflet, or small group education, in a population-based s le of 354 mothers from Southern Tasmania, Australia in 2000-02. Main outcomes were maternal report of calcium intake and physical activity change in their children. Receiving small group education was associated with mothers' report of increasing children's calcium intake (odds ratio 2.3, 95% confidence interval 1.4, 3.8), as was low t-score feedback (odds ratio 2.0, 95% confidence interval 1.2, 3.3). Mothers who increased their own physical activity were more often reported increasing both physical activity (odds ratio 2.7, 95% confidence interval 1.5, 5.0) and calcium intake in their children (odds ratio 2.2, 95% confidence interval 1.3, 3.7). Mothers who commenced calcium supplements more often reported increasing children's calcium intake (odds ratio 2.6, 95% confidence interval 1.0, 6.7) but not physical activity. Both bone mineral density feedback and small group education delivered to mothers are effective at inducing maternally reported osteoporosis preventive behavior change in their children. These results require confirmation by studies with objective outcome measures.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.JOCA.2017.09.005
Abstract: To describe prevalence of osteophytes (OPs) detected only by magnetic resonance imaging (MRI) but not by standard X-ray in older adults and to evaluate longitudinal associations with knee structural changes. 837 participants were randomly selected from the local community and had MRI scans to assess knee OPs and other structures. OPs detected only by MRI but not by standard X-ray were defined as MRI-detected early OPs (MRI-OPs for short). OPs detected by both MRI and X-ray were defined as established-OPs. The prevalence of MRI-OPs was 50% while the prevalence of established-OPs was 10% and no-OPs was 40% at total tibiofemoral (TF) compartment at baseline. Compared with no-OPs, participants with MRI-OPs had greater risks of increased cartilage defects in all TF compartments (RR 1.37, 95%CI 1.07-1.74) and bone marrow lesions (BMLs) only in medial TF compartment (RR 1.49, 95%CI 1.06-2.11), after adjustment for age, sex, BMI, cartilage defects, BMLs and/or joint space narrowing participants with established-OPs had greater cartilage volume loss at total (β -2.02, 95%CI -3.86, -0.17) and lateral tibial sites (β -5.63, 95%CI -9.93, -1.32), greater risks of increased cartilage defects in total (RR 1.66, 95%CI 1.15-2.40) and medial TF compartments (RR 1.49, 95%CI 1.20-1.69) and BMLs in all TF compartments (RR 1.88, 95%CI 1.22-2.89), after adjustment for covariates. MRI-OPs were associated with changes in knee structures, and the associations were similar but not as prominent as those for established-OPs. These suggest MRI-OPs may have a role to play in knee early-stage osteoarthritic progression.
Publisher: SAGE Publications
Date: 15-12-2011
Abstract: Magnetic resonance imaging (MRI) enables a noninvasive, three-dimensional assessment of the entire joint, simultaneously allowing the direct visualization of articular cartilage. Thus, MRI has become the imaging modality of choice in both clinical and research settings of musculoskeletal diseases, particular for osteoarthritis (OA). Although radiography, the current gold standard for the assessment of OA, has had recent significant technical advances, radiographic methods have significant limitations when used to measure disease progression. MRI allows accurate and reliable assessment of articular cartilage which is sensitive to change, providing the opportunity to better examine and understand preclinical and very subtle early abnormalities in articular cartilage, prior to the onset of radiographic disease. MRI enables quantitative (cartilage volume and thickness) and semiquantitative assessment of articular cartilage morphology, and quantitative assessment of cartilage matrix composition. Cartilage volume and defects have demonstrated adequate validity, accuracy, reliability and sensitivity to change. They are correlated to radiographic changes and clinical outcomes such as pain and joint replacement. Measures of cartilage matrix composition show promise as they seem to relate to cartilage morphology and symptoms. MRI-derived cartilage measurements provide a useful tool for exploring the effect of modifiable factors on articular cartilage prior to clinical disease and identifying the potential preventive strategies. MRI represents a useful approach to monitoring the natural history of OA and evaluating the effect of therapeutic agents. MRI assessment of articular cartilage has tremendous potential for large-scale epidemiological studies of OA progression, and for clinical trials of treatment response to disease-modifying OA drugs.
Publisher: Oxford University Press (OUP)
Date: 06-2017
DOI: 10.1111/BJD.15539
Publisher: Springer Science and Business Media LLC
Date: 11-08-2023
Publisher: OMICS Publishing Group
Date: 06-2013
DOI: 10.2217/IJR.13.19
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.2165/00063030-200822040-00003
Abstract: Systemic lupus erythematosus (SLE) is a classic autoimmune disease characterized by a myriad of immune system aberrations, most likely resulting from pathogenic autoantibody production, immune complex deposition, and subsequent end-organ damage. B cells play a key role in the pathogenesis therefore, B-cell-targeted therapies, including B-cell depletion and blockage of B-cell survival factors such as B-lymphocyte stimulator (BLyS), are potential therapeutic targets for SLE. In uncontrolled clinical trials from approximately 20 studies, rituximab--a mouse-human chimeric anti-CD20 monoclonal antibody that effectively depletes B cells--has been demonstrated to reduce disease activity and decrease serum autoantibodies, with a clinical response of 86% in a case series of approximately 400 SLE patients with refractory disease, with or without concomitant use of cyclophosphamide. Epratuzumab, a humanized anti-CD22 monoclonal antibody that partially depletes B cells, has also been shown to reduce disease activity but not to decrease autoantibody levels in patients with moderately active SLE. Randomized controlled phase I/II trials in patients with active SLE have documented that belimumab, a humanized anti-BLyS monoclonal antibody, reduces B-cell numbers, inhibits disease activity and decreases anti-double-stranded DNA autoantibody in SLE patients. All these therapies are well tolerated, but accompanying infectious complications have been observed. Other B-cell-targeted therapies such as 'humanized' monoclonal antibodies to CD20 (e.g. ocrelizumab) and agents that interrupt B-cell/T-cell interactions also have potential, and the efficacy of these, along with rituximab, belimumab and epratuzumab, needs to be determined by randomized controlled trials.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2010
Publisher: AMPCo
Date: 04-1997
Publisher: Wiley
Date: 05-2008
DOI: 10.1359/JBMR.071209
Publisher: Springer Science and Business Media LLC
Date: 26-11-2015
DOI: 10.1038/GENE.2015.49
Abstract: Acute anterior uveitis (AAU) involves inflammation of the iris and ciliary body of the eye. It occurs both in isolation and as a complication of ankylosing spondylitis (AS). It is strongly associated with HLA-B*27, but previous studies have suggested that further genetic factors may confer additional risk. We sought to investigate this using the Illumina Exomechip microarray, to compare 1504 cases with AS and AAU, 1805 with AS but no AAU and 21 133 healthy controls. We also used a heterogeneity test to test the differences in effect size between AS with AAU and AS without AAU. In the analysis comparing AS+AAU+ cases versus controls, HLA-B*27 and HLA-A*02:01 were significantly associated with the presence of AAU (P<10(-300) and P=6 × 10(-8), respectively). Secondary independent association with PSORS1C3 (P=4.7 × 10(-5)) and TAP2 (P=1.1 × 10(-5)) were observed in the major histocompatibility complex. There was a new suggestive association with a low-frequency variant at zinc-finger protein 154 in the AS without AAU versus control analysis (zinc-finger protein 154 (ZNF154), P=2.2 × 10(-6)). Heterogeneity testing showed that rs30187 in ERAP1 has a larger effect on AAU compared with that in AS alone. These findings also suggest that variants in ERAP1 have a differential impact on the risk of AAU when compared with AS, and hence the genetic risk for AAU differs from AS.
Publisher: The Royal Australian College of General Practitioners
Date: 06-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: John Wiley & Sons, Ltd
Date: 24-01-2005
Publisher: Elsevier BV
Date: 04-2015
Publisher: Springer Science and Business Media LLC
Date: 10-08-2020
DOI: 10.1186/S12891-020-03532-7
Abstract: Hip effusion-synovitis may be relevant to osteoarthritis (OA) but is of uncertain etiology. The aim of this study was to describe the cross-sectional and longitudinal associations of hip effusion-synovitis with clinical and structural risk factors of OA in older adults. One hundred ninety-six subjects from the Tasmanian Older Adult Cohort (TASOAC) study with a right hip STIR (Short T1 Inversion Recovery) Magnetic Resonance Imaging (MRI) on two occasions were included. Hip effusion-synovitis CSA (cm 2 ) was assessed quantitatively. Hip pain was determined by WOMAC (Western Ontario and McMaster Universities Osteoarthritis) while hip bone marrow lesions (BMLs), cartilage defects (femoral and/or acetabular) and high cartilage signal were assessed on MRI. Joint space narrowing (0–3) and osteophytes (0–3) were measured on x-ray using Altman’s atlas. Of 196 subjects, 32% ( n = 63) had no or a small hip effusion-synovitis while 68% ( n = 133) subjects had a moderate or large hip effusion-synovitis. Both groups were similar but those with moderate or large hip effusion-synovitis were older, had higher BMI and more hip pain. Cross-sectionally, hip effusion-synovitis at multiple sites was associated with presence of hip pain [Prevalence ratio (PR):1.42 95%CI:1.05,1.93], but not with severity of hip pain. Furthermore, hip effusion-synovitis size associated with femoral defect (βeta:0.32 95%CI:0.08,0.56). Longitudinally, and incident hip cartilage defect (PR: 2.23 95%CI:1.00, 4.97) were associated with an increase in hip effusion-synovitis CSA. Furthermore, independent of presence of effusion-synovitis, hip BMLs predicted incident (PR: 1.62 95%CI: 1.13, 2.34) and worsening of hip cartilage defects (PR: 1.50 95%CI: 1.20, 1.86). While hip cartilage defect predicted incident (PR: 1.11 95%CI: 1.03, 1.20) and worsening hip BMLs (PR: 1.16 95%CI: 1.04, 1.30). Hip effusion-synovitis at multiple sites (presumably reflecting extent) may be associated with hip pain. Hip BMLs and hip cartilage defects are co-dependent and predict worsening hip effusion-synovitis, indicating causal pathways between defects, BMLs and effusion-synovitis.
Publisher: Public Library of Science (PLoS)
Date: 04-11-2015
Publisher: Oxford University Press (OUP)
Date: 27-09-2006
DOI: 10.1093/RHEUMATOLOGY/KEI108
Abstract: Cartilage defects are present in subjects with knee osteoarthritis (OA). Although they are often present in healthy subjects, there is little data on the natural history of cartilage defects. The aim of this study was to examine the change in cartilage defects over 2 yr and to identify factors associated with this change. One hundred and twenty-four healthy subjects underwent magnetic resonance imaging of their dominant knee at baseline and follow-up. Cartilage defects were scored (0-4) at five sites. Bone size was determined at medial and lateral tibial plateau and patella. Height, weight, body mass index and physical activity were measured by standard protocols. Eighty-six subjects completed the study. The mean cartilage defect score of each tibiofemoral compartment increased over time. However, medial and lateral tibiofemoral defect score decreased in 5% of the subjects. Cartilage defects were more likely to progress in males than females in each in idual compartment (P<0.001 for medial tibiofemoral, P=0.005 for lateral tibiofemoral and P=0.01 for patellar cartilage). Baseline cartilage defect score was negatively associated with the progression of cartilage defects in each compartment (all P<0.001). Although knee cartilage defects progressed over time in the majority of normal subjects, those of the highest severity tended to regress. Male gender and baseline cartilage defect score were the main factors associated with the progression of cartilage defects. Larger studies will be required to identify factors associated with the progression and regression of lesions.
Publisher: FapUNIFESP (SciELO)
Date: 2011
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.JOCA.2013.10.022
Abstract: There is evidence to suggest vascular involvement in the initiation and progression of osteoarthritis (OA). The relationship between large artery characteristics and pathogenesis of OA has not been investigated and was the aim of this study. Large artery characteristics (i.e., aortic stiffness, brachial and central blood pressure (BP) variables) and bone marrow lesions (BMLs measured by magnetic resonance imaging as a surrogate index of OA) were recorded in 208 participants (aged 63 ± 7 years mean ± SD) with symptomatic knee OA. Relationships between large artery characteristics and BML were assessed by multiple regression adjusting for age, sex and body mass index. There was a high prevalence of BML presence in the study population (70%), but no significant difference between participants with and without BML for all large artery and BP variables (P > 0.05 all). Furthermore, there were no significant relationships between BML size and aortic stiffness (r = -0.033, P = 0.71), central pulse pressure (r = 0.028, P = 0.74), augmentation index (r = 0.125, P = 0.14), brachial pulse pressure (r = 0.005, P = 0.95) or brachial systolic BP (r = -0.066, P = 0.44). When participants were stratified according to high or low aortic stiffness, there was no significant difference between groups regarding the proportion of those with a BML (64% vs. 70% respectively P = 0.69). Variables indicative of large artery characteristics are not significantly correlated with BML size or presence in people with symptomatic knee OA. Thus, large artery characteristics may not have a causative influence in the development of OA, but this needs to be confirmed in prospective studies.
Publisher: Wiley
Date: 28-09-2010
DOI: 10.1111/J.1600-0838.2010.01229.X
Abstract: To describe prospective associations between ambulatory activity (AA), body composition and muscle function in older adults, 697 community-dwelling participants (49% female mean age=62 ± 7 years) were assessed for changes in body fat and leg lean mass using dual-energy x-ray absorptiometry, leg strength using dynamometer, and whole body muscle quality (WBMQ an estimate of specific force) over 2.6 ± 0.4 years. AA was negatively associated with fat mass in both sexes but baseline AA did not predict change in fat mass. Habitual AA was weakly, but significantly, negatively associated with change in total body fat (-0.16 kg/step × 10(3)/day, P=0.011) and trunk fat (-0.12 kg/step × 10(3)/day, P=0.044) in men. Habitual AA was also weakly, but significantly, positively associated with change in leg lean mass in both men and women (both P<0.05), as well as change in leg strength (1.37 kg/step × 10(3)/day, P=0.001) and WBMQ (0.03 kg/kg/step × 10(3)/day, P=0.002) in women only. Partial R(2)s for these associations were in the range of 1.2-3.2%. Although, these associations are modest, increases in objectively assessed physical activity may represent a target for improving body composition and muscle function in community-dwelling older adults.
Publisher: BMJ
Date: 06-08-2013
Publisher: Elsevier BV
Date: 04-2018
Publisher: Wiley
Date: 21-11-2006
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.SEMARTHRIT.2019.10.001
Abstract: To describe the associations of glucose homeostasis and metabolic syndrome (MetS) measures with knee cartilage defects and cartilage volume in young adults. Fasting blood biochemistry, waist circumference and blood pressure measures were collected 4-5 years prior to knee magnetic resonance imaging (MRI) scans. Blood measures included levels of glucose, insulin, triglyceride and high-density lipoprotein cholesterol (HDL-C). Homeostatic model assessment 2-insulin resistance (HOMA2-IR), HOMA2-beta cell function (HOMA2-β), HOMA2-insulin sensitivity (HOMA-S) and MetS were calculated or defined. Knee cartilage defects and cartilage volume were measured from MRI scans. Data were analysed using log binomial or linear regressions. Among 328 participants (47.3% were females, aged 26-36 years at baseline), 40 (12.7%) had hyperglycaemia and 21 (6.7%) had MetS. Glucose homeostasis measures (except fasting glucose) were associated with tibiofemoral cartilage defects (fasting insulin: relative risk (RR) 1.05, 95% confidence interval (CI) 1.01 to 1.08 HOMA2-IR: 1.44, 1.08 to 1.92 HOMA2-β: 2.59, 1.33 to 5.07 HOMA2-S: 0.36, 0.18 to 0.72), but not patellar cartilage defects. There were no associations between glucose homeostasis measures and knee cartilage volume. High waist circumference (RR 2.32, 95% CI 1.18 to 4.54) and low HDL-C (RR 1.99, 95% CI 1.08 to 3.69) were associated with tibiofemoral cartilage defects, but no other associations were observed between MetS or its components and cartilage defects or volume. Insulin resistance, high waist circumference and low HDL-C were associated with higher risk of tibiofemoral cartilage defects, suggesting glucose homeostasis and some MetS components may affect early cartilage damage in young adults.
Publisher: Wiley
Date: 11-2010
DOI: 10.1111/J.1532-5415.2010.03147.X
Abstract: To describe associations between dietary nutrient intake and progression of sarcopenia, the age-related loss of muscle mass and strength. Prospective cohort study of community-dwelling older adults. Southern Tasmania, Australia. Seven hundred forty noninstitutionalized older adults (50% female mean age 62 ± 7) randomly s led from electoral rolls. Dietary nutrient intake was examined at baseline and follow-up (2.6 ± 0.4 years later) using The Cancer Council Victoria's Food Frequency Questionnaire (FFQ). Appendicular lean mass (aLM) was assessed using dual X-ray absorptiometry and muscle strength of the knee extensors using a dynamometer. Failing to meet the recommended dietary intake for protein was associated with significantly lower aLM at baseline (-0.81 kg, 95% confidence interval (CI) = -1.54 to -0.08) and follow-up (-0.79 kg, 95%CI = -1.42 to -0.17). Energy-adjusted protein intake was a positive predictor of change in aLM over 2.6 years (β = 0.10, P = .003). Energy-adjusted intake of iron (β = 0.07, P = .02), magnesium (β = 0.07, P=.02), phosphorus (β = 0.07, P = .047), and zinc (β = 0.08, P = .02) were positive predictors of change in aLM, whereas retinol (β = -0.09, P = .005) was a negative predictor of change in aLM after adjustment for protein intake. No significant associations were observed between nutrient intake and muscle strength. Protein and several other dietary nutrients are associated with muscle mass and rate of muscle loss (but not strength) in older adults, suggesting that multiple dietary components may ameliorate the progression of sarcopenia.
Publisher: Elsevier BV
Date: 08-2003
DOI: 10.1016/S0378-5122(03)00151-8
Abstract: To describe the association of reproductive and hormonal factors with the presence and severity of hand osteoarthritis (OA) in Tasmanian women. Cross-sectional study of 348 women from 76 families. A structured questionnaire collected information regarding reproductive history and the use of estrogen containing medications. Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal (CMC) joints, as well as Heberden's nodes (HN) based on hand photography. The prevalence of hand OA was high in this s le at 65-70%. Parity, increasing age at menopause and years of menstruation were associated with both symptomatic hand OA and a more severe DIP score (but not presence of radiographic disease) while both current and ever use of hormone replacement therapy (HRT) were significantly associated with increased prevalence of HN and severity of HN and DIP OA (all P<0.05). HRT usage less than 5 years was associated with increased severity of both DIP disease and HN. No factors were associated with CMC disease apart from ever breast-feeding which was protective (OR 0.37, 95% CI 0.18-0.79). These results require confirmation in clinical trials or carefully controlled longitudinal studies but suggest that estrogen exposure around the time of disease onset (either endogenous or exogenous) may have a "priming" effect on the severity of DIP OA while breast-feeding in earlier life may be protective for CMC OA.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 07-2005
Publisher: Elsevier BV
Date: 04-2014
Publisher: Bentham Science Publishers Ltd.
Date: 05-2008
DOI: 10.2174/157488708784223862
Abstract: Ibandronate is a potent bisphosphonate which has been most thoroughly assessed in benign bone disease for use in the management of postmenopausal osteoporosis. Its use in corticosteroid-induced osteoporosis, Paget's disease and uncommon benign bone conditions such as localised transient osteoporosis (or bone marrow oedema syndrome) and sternocostoclavicular hyperostosis has also been explored. Recent randomised controlled trial evidence suggests that intermittent high dosage oral ibandronate may be as efficacious as a daily low dose regime for the treatment of post-menopausal osteoporosis, with only a mild increase in adverse events. Movement towards an extended gap between doses has implications for patient compliance and adherence and thus potential benefits for fracture prevention. This review aims to provide an overview of the evidence from randomised controlled trials in humans for the use of ibandronate in benign bone diseases. This includes a discussion of the development program and dosage regimens for the prevention and treatment of post-menopausal osteoporosis, as well as the use of ibandronate in corticosteroid induced osteoporosis, Paget's disease localised transient osteoporosis and sternoclavicular hyperostosis. Adverse effects and long-term safety data will also be reviewed.
Publisher: Springer Science and Business Media LLC
Date: 19-01-2005
Abstract: To describe associations between sociodemographic factors and calcium intake in premenopausal women. Cross-sectional study. Population-based. A total of 467 randomly selected, predominantly Caucasian Tasmanian women aged 25-44 y, response rate 63%. calcium intake, sociodemographic factors, anthropometrics, osteoporosis knowledge and self-efficacy. Education level, calcium-specific osteoporosis knowledge and self-efficacy were all independently associated with calcium intake (P<0.05). The odds of achieving the recommended dietary intake for calcium increased with higher levels of calcium-specific self-efficacy and knowledge, and decreased in smokers or if the household's main financial provider was unemployed (P<0.05). Women who have lower levels of education, who are in households where the main financial provider is unemployed, who are smokers, and those with low levels of calcium-specific self-efficacy and knowledge are at risk of not achieving adequate calcium intake. This information will assist targeting of public health strategies aimed at improving the calcium intake of premenopausal women.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.JOCA.2015.06.016
Abstract: There is growing interest in the role of intramuscular fat and how it may influence clinical outcomes. Vastus medialis (VM) is a functionally important quadriceps muscle that helps to stabilise the knee joint. This longitudinal study examined the determinants of VM fat infiltration and whether VM fat infiltration influenced knee cartilage volume. 250 participants without any diagnosed arthropathy were assessed at baseline between 2005 and 2008, and 197 participants at follow-up between 2008 and 2010. Ambulatory and sporting activity were assessed and magnetic resonance imaging (MRI) was used to determine knee cartilage volume and VM fat infiltration. Age, female gender, BMI and weight were positively associated with baseline VM fat infiltration (P ≤ 0.03), while ambulatory and sporting activity were negatively associated with VM fat infiltration (P ≤ 0.05). After adjusting for confounders, a reduction in VM fat infiltration was associated with a reduced annual loss of medial tibial (β = -10 mm(3) 95% CI -19 to 0 mm(3) P = 0.04) and patella (β = -18 mm(3) 95% CI -36 to 0 mm(3) P = 0.04) cartilage volume. This community-based study of healthy adults has shown that VM fat infiltration can be modified by lifestyle factors including weight loss and exercise, and reducing fat infiltration in VM has beneficial effect on knee cartilage preservation. The findings suggest that modifying VM fat infiltration via lifestyle interventions may have the potential to reduce the risk of knee OA.
Publisher: Wiley
Date: 09-03-2022
Abstract: Cam morphology contributes to the development of hip osteoarthritis (OA) but is less studied in the general population. This study describes its associations with clinical and imaging features of hip OA. Anteroposterior hip radiographs of 1019 participants from the Tasmanian Older Adult Cohort (TASOAC) were scored at baseline for α angle (cam morphology) in both hips. Using the Altman's atlas, radiographic hip OA (ROA) was assessed at baseline. Hip pain and right hip structural changes were assessed on a subset of 245 magnetic resonance images (MRI) at 5 years. Joint registry data for total hip replacement (THR) was acquired 14 years from baseline. Of 1906 images, cam morphology was assessed in 1016 right and 890 left hips. Cross‐sectionally, cam morphology modestly associated with age (prevalence ratio [PR]: 1.02 P = .03) and body mass index (BMI) (PR: 1.03‐1.07, P = .03) and strongly related to male gender (PR: 2.96, P .001). Radiographically, cam morphology was prevalent in those with decreased joint space (PR: 1.30 P = .03) and osteophytes (PR: 1.47, P = .03). Longitudinally, participants with right cam and high BMI had more hip pain (PR: 17.9, P = .02). At the end of 5 years of follow‐up these participants were also more likely to have structural changes such as bone marrow lesions (BMLs) (PR: 1.90 P = .04), cartilage defects (PR: 1.26, P = .04) and effusion‐synovitis at multiple sites (PR: 1.25 P = .02). Cam morphology at baseline in either hip predicted up to threefold risk of THR (PR: 3.19, P = .003) at the end of 14 years. At baseline, cam morphology was linked with age, higher weight, male gender, early signs of radiographic OA such as joint space narrowing (JSN) and osteophytes (OST). At follow‐up, cam predicted development of hip BMLs, hip effusion‐synovitis, cartilage damage and THR. These findings suggest that cam morphology plays a significant role in early OA and can be a precursor or contribute to hip OA in later life.
Publisher: Oxford University Press (OUP)
Date: 2003
DOI: 10.1093/RHEUMATOLOGY/KEG036
Abstract: To undertake a systematic review of randomized placebo-controlled trials to assess and rank the efficacy of pharmacological interventions in preventing radiological progression of rheumatoid arthritis. The two outcome measures were the weighted standardized mean difference and the odds of progression of X-ray scores pooled as close to 12 months as possible to minimize heterogeneity. A total of 38 trials were identified. Of these, 13 were excluded, leaving data on 3907 subjects. Infliximab, cyclosporin, sulphasalazine, leflunomide, methotrexate, parenteral gold, corticosteroids, auranofin and interleukin 1 receptor antagonist were statistically better than placebo in terms of change in erosion scores. All agents were equivalent statistically, with the exception of infliximab (which was superior to the last five agents). There were similar findings for the odds of progression, with the exception of auranofin (P=0.06) and the infliximab-methotrexate comparison (P=0.07). Other agents did not reach statistical significance in either outcome measure. With the exception of the antimalarials, the magnitude of the effect was consistent with the effect seen in short-term disease activity trials. There is published evidence which supports the efficacy of nine agents in decreasing radiological progression in rheumatoid arthritis.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2019
Publisher: MDPI AG
Date: 12-10-2022
DOI: 10.3390/JFMK7040084
Abstract: Osteoarthritis (OA) is a common joint disorder for which there is no cure. Current treatments are suboptimal. Exercise is a core treatment for knee OA, with muscle strengthening exercise commonly recommended. Yoga is a mind-body exercise intervention that can improve flexibility, muscle strength, balance, and fitness and potentially reduce symptoms of OA. However, there is a scarcity of robust, high-quality conclusive evidence on the efficacy of yoga in knee OA. We are currently conducting the first randomised comparative effectiveness and cost-effectiveness trial of a yoga program compared with a strengthening exercise program in patients with symptomatic knee OA. This study protocol describes the design and conduct of this trial. The YOGA study is a phase III, single-centre, parallel, superiority, randomised, active-controlled trial which will be conducted in Hobart, Australia. One hundred and twenty-six participants (63 in each arm) aged over 40 years with symptomatic knee OA will be recruited from the community and randomly allocated to receive either a 24-week yoga program (3×/week) or a strengthening exercise program (3×/week). The primary outcome will be change in knee pain over 12 weeks, assessed using a 100 mm visual analogue scale (VAS). The secondary outcomes include change in knee pain, patient global assessment, physical function, quality of life, gait speed, biomarkers, and others over 12 and 24 weeks. We will also assess whether the presence of neuropathic pain moderates the effects of yoga compared to strengthening exercise. Additional data, such as cost and resource utilization, will be collected for the cost-effectiveness analysis. The primary analysis will be conducted using an intention-to-treat approach. Adverse events will be monitored throughout the study. Once completed, this trial will contribute to the knowledge of whether yoga can be used as a simple, effective, low-cost option for the management of knee OA, thus saving economic costs in the healthcare system.
Publisher: Elsevier BV
Date: 12-2012
Publisher: Elsevier BV
Date: 12-2014
Publisher: Cold Spring Harbor Laboratory
Date: 25-05-2020
DOI: 10.1101/2020.05.24.20112250
Abstract: Knee osteoarthritis (OA) is the most common form of OA which affects knee joints and there is currently no disease-modifying treatment available for OA. Therefore, an ideal strategy to prevent the development of OA is to identify and intervene at the modifiable risk factors for the development and progression of OA. Early-life factors such as obesity and malalignment may affect the mechanical aspect of the knee (i.e. alterations in normal knee kinematics) and could be the risk factor for the development of knee OA in later life. Identifying early-life (gestational factors, congenital defects, childhood, adolescence, early adulthood) factors which affect the development of knee OA in later stages of the life may help to develop targeted prevention programs in early-life itself to prevent the development of knee OA. Hence, this systematic review protocol provides the method to be used to comprehensively summarise the existing evidence on early life modifiable risk factors associated with the development and progression of knee OA.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2021
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.JOCA.2014.05.018
Abstract: To describe cross-sectional associations between mass effect or signal intensity alteration of the suprapatellar fat pad (SPFP) with knee symptoms and structure in older adults. A cross-sectional s le of 904 randomly selected subjects (mean 62.4 years, 49.9% female) was studied. T1- or T2-weighted fat suppressed magnetic resonance imaging (MRI) was used to assess mass effect or signal intensity alteration of SPFP, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire. The Osteoarthritis Research Society International (OARSI) atlas was used to assess knee osteophyte, joint space narrowing (JSN) and radiographic osteoarthritis (ROA). Univariable and multivariable linear or logistic regression analyses were used to examine the associations. After adjustment for confounders including age, sex, body mass index (BMI), disease status, tibial bone area and/or ROA, the presence of SPFP mass effect was significantly associated with any knee pain (OR: 2.39 95% confidence interval (CI): 1.54, 3.70) and ROA (OR: 2.10 95% CI: 1.33, 3.31) but not with cartilage volume, cartilage defects or BMLs. The presence of SPFP signal intensity alteration was significantly associated with any knee pain (OR: 1.90 95% CI: 1.43, 2.53), ROA (OR: 1.83 95% CI: 1.37, 2.45), any BMLs (OR: 1.55 95% CI: 1.17, 2.06) but not with cartilage volume and cartilage defects. Significant associations with knee pain and BMLs were more evident in subjects with ROA. Presence of SPFP mass effect and/or signal intensity alteration combined was associated with any tibial cartilage defects (OR: 1.45 95% CI: 1.04, 2.04). SPFP mass effect and/or signal intensity alterations are deleteriously associated with knee pain, radiographic OA and BMLs in this cross-sectional study, suggesting that SPFP abnormalities may contribute to pain and structural abnormalities in the knee.
Publisher: Informa Healthcare
Date: 28-08-2009
DOI: 10.1517/13543780903203789
Abstract: IL-6, a glycoprotein composed of 212 amino acids in human, has a wide range of biological activity, including regulation of immune response, support of hematopoiesis, generation of acute-phase reactions and induction of inflammation and oncogenesis. Several approaches including inhibition of IL-6 production, blockage of IL-6 binding to IL-6 receptor, blockage of IL-6/IL-6R complex binding to gp 130 and blockage of the intracytoplasmic signal through gp 130 can be used to block IL-6 functions. To summarize pre-clinical development and efficacy and safety of anti-IL-6 therapies in the treatment of inflammatory and autoimmune diseases. Journal articles found within a PubMed search and data presented in abstract form from international conferences up to May 2009 are described in this review. Tocilizumab, which blocks IL-6 binding to IL-6 receptor, used as monotherapy or in combination with methotrexate for RA therapy leads to significant clinical response and amelioration of joint damage, which is superior to methotrexate. Some adverse events such as liver function disorders, hyperlipidemia, neutropenia, diarrhea and infection are observed in clinical trials. IL-6 blockers targeting directly IL-6 rather than the IL-6 receptor and fully human monoclonal antibody targeting the IL-6 receptor are currently under development. Overall, targeting IL-6 has provided a promising approach in the management of some inflammatory and autoimmune diseases.
Publisher: BMJ
Date: 27-06-2010
DOI: 10.1136/EBN.13.3.87
Publisher: Springer Science and Business Media LLC
Date: 13-02-2018
DOI: 10.1007/S00223-018-0402-8
Abstract: The aim of this study is to describe the association of bone marrow lesions (BMLs) present on two different MRI sequences with clinical outcomes, cartilage defect progression, cartilage volume loss over 2.7 years, and total knee replacement (TKR) over 13.3 years. 394 participants (50-80 years) were assessed at baseline and 2.7 years. BML presence at baseline was scored on T1-weighted fat-suppressed 3D gradient-recalled acquisition (T1) and T2-weighted fat-suppressed 2D fast spin-echo (T2) sequences. Knee pain, function, and stiffness were assessed using WOMAC. Cartilage volume and defects were assessed using validated methods. Incident TKR was determined by data linkage. BMLs were mostly present on both MRI sequences (86%). BMLs present on T2, T1, and both sequences were associated with greater knee pain and functional limitation (odds ratio = 1.49 to 1.70 all p < 0.05). Longitudinally, BMLs present on T2, T1, and both sequences were associated with worsening knee pain (β = 1.12 to 1.37, respectively p < 0.05) and worsening stiffness (β = 0.45 to 0.52, respectively all p < 0.05) but not worsening functional limitation or total WOMAC. BMLs present on T2, T1, and both sequences predicted site-specific cartilage defect progression (relative risk = 1.22 to 4.63 all p < 0.05) except at the medial tibial and inferior patellar sites. Lateral tibial and superior patellar BMLs present on T2, T1, and both sequences predicted site-specific cartilage volume loss (β = - 174.77 to - 140.67 p < 0.05). BMLs present on T2, T1, and both sequences were strongly associated with incident TKR. BMLs can be assessed on either T2- or T1-weighted sequences with no clinical predictive advantage of either sequence.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Wiley
Date: 09-07-2012
DOI: 10.1002/LARY.23436
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/BMJSEM-2021-001097
Abstract: The clinical relevance of MRI knee abnormalities in athletes is unclear. This study aimed to determine the prevalence of MRI knee abnormalities in Australian Rules Football (ARF) players and describe their associations with pain, function, past and incident injury and surgery history. 75 male players (mean age 21, range 16–30) from the Tasmanian State Football League were examined early in the playing season (baseline). History of knee injury/surgery and knee pain and function were assessed. Players underwent MRI scans of both knees at baseline. Clinical measurements and MRI scans were repeated at the end of the season, and incident knee injuries during the season were recorded. MRI knee abnormalities were common at baseline (67% bone marrow lesions, 16% meniscal tear/extrusion, 43% cartilage defects, 67% effusion synovitis). Meniscal tears/extrusion and synovial fluid volume were positively associated with knee symptoms, but these associations were small in magnitude and did not persist after further accounting for injury history. Players with a history of injury were at a greater risk of having meniscal tears/extrusion, effusion synovitis and greater synovial fluid volume. In contrast, players with a history of surgery were at a greater risk of having cartilage defects and meniscal tears/extrusion. Incident injuries were significantly associated with worsening symptoms, BML development and incident meniscal damage. MRI abnormalities are common in ARF players, are linked to a previous knee injury and surgery history, as well as incident injury but do not dictate clinical symptomatology.
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.JOCA.2014.11.016
Abstract: Osteoarthritis (OA) has a genetic component but it is uncertain if the offspring of those with knee OA are at a greater risk. The aim of this study was to describe radiographic OA (ROA) progression and cartilage loss over 10 years in a midlife cohort with some having a family history of OA and some community based controls. 220 participants [mean-age 45 (26-61) 57% female] were studied at baseline and 10 years. Half were adult offspring of subjects who underwent knee replacement for OA and the remainder were randomly selected controls. Joint space narrowing (JSN) and osteophytes were assessed on radiographs and cartilage volume (tibial, femoral and patellar), cartilage defects, bone marrow lesions (BMLs) and meniscal tears were assessed on Magnetic resonance imaging (MRI). For ROA, there was a significant difference between offspring and controls in unadjusted analysis for change in total ROA, medial JSN, total medial, total lateral and total osteophyte scores. This difference persisted for medial JSN (difference in ratios = +1.93 (+1.04, +3.51)) only, after adjustment for confounders and baseline differences. In unadjusted analysis for cartilage loss, offspring lost more cartilage at the medial tibial (difference in means = -79.13 (-161.92, +3.71)) site only. This difference became of borderline significance after adjustment for baseline differences (P = 0.055). The offspring of subjects having a total knee replacement have a greater worsening of ROA (both JSN and osteophytes) and higher medial tibial cartilage volume loss over 10 years. Most of these changes are mediated by differences in baseline characteristics of offspring and controls except for increase in medial JSN.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2009
Publisher: BMJ
Date: 23-05-2022
DOI: 10.1136/ANNRHEUMDIS-2022-EULAR.4778
Abstract: Knee osteoarthritis is the most prevalent chronic musculoskeletal debilitating disease. Current treatments are only symptomatic and to improve this, we need a robust prediction model to stratify patients at an early stage according to the risk of joint structure disease progression. Some genetic factors, including single nucleotide polymorphism (SNP) genes and mitochondrial (mt)DNA haplogroups/clusters, have been linked to this disease. For the first time, we aim to determine, by using machine learning, whether some SNP genes and mtDNA haplogroups/clusters alone or combined could predict early knee osteoarthritis structural progressors. Participants (901) were first classified for the probability of being structural progressors. Genotyping included SNP genes TP63, FTO, GNL3, DUS4L, GDF5, SUPT3H, MCF2L, TGFA, mtDNA haplogroups H, J, T, Uk, others, and clusters HV, TJ, KU, C-others. They were considered for prediction with major risk factors of osteoarthritis, namely, age and body mass index (BMI). Seven supervised machine learning methodologies were evaluated. The support vector machine was used to generate gender-based models. The best input combination was assessed using sensitivity and synergy analyses. Validation was performed using 10-fold cross-validation as well as an external cohort (TASOAC). From 277 models, two were defined. Both used age and BMI in addition for the first one of the SNP genes TP63, DUS4L, GDF5, FTO with an accuracy of 85.0% the second profits from the association of mtDNA haplogroups and SNP genes FTO and SUPT3H with 82.5% accuracy. The highest impact was associated with the haplogroup H, the presence of CT alleles for rs8044769 at FTO , and the absence of AA for rs10948172 at SUPT3H . Validation accuracy with the cross-validation (about 95%) and the external cohort (90.5%, 85.7%, respectively) was excellent for both models. This study introduces a novel source of decision support in precision medicine in which, for the first time, two models were developed consisting of i) age, BMI, TP63, DUS4L, GDF5, FTO and ii) the optimum one as it has one less variable: age, BMI, mtDNA haplogroup, FTO, SUPT3H. Such a framework is translational and would be of benefit to patients at risk of structural progressive knee osteoarthritis. The authors would like to thank the Osteoarthritis Initiative (OAI) participants and Coordinating Center for their work in generating the clinical and radiological data of the OAI cohort and for making them publicly available. The OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258 N01-AR-2-2259 N01-AR-2-2260 N01-AR-2-2261 N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories Novartis Pharmaceuticals Corporation, GlaxoSmithKline and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners. None of the authors are part of the OAI investigator team. Moreover, the authors are also grateful to the TASOAC participants. A special thanks to ArthroLab Inc. for having provided the MRI data used for classifying structural progressors for each in idual. Hossein Bonakdari: None declared, Jean-Pierre Pelletier Shareholder of: ArthroLab Inc., Grant/research support from: Work supported in part by the Osteoarthritis Research Unit of the University of Montreal Hospital Research Centre and the Chair in Osteoarthritis from the University of Montreal., Francisco J. Blanco: None declared, Ignacio Rego-Perez: None declared, Alejandro Durán-Sotuela: None declared, Dawn Aitken: None declared, Graeme Jones: None declared, Flavia Cicuttini: None declared, Afshin Jamshidi Grant/research support from: Received a bursary from the Canada First Research Excellence Fund through the TransMedTech Institute in Canada., François Abram Employee of: was an employee of ArthroLab Inc., Johanne Martel-Pelletier Shareholder of: ArthroLab Inc., Grant/research support from: Work supported in part by the Osteoarthritis Research Unit of the University of Montreal Hospital Research Centre and the Chair in Osteoarthritis from the University of Montreal.
Publisher: Wiley
Date: 04-2005
DOI: 10.1002/ART.20964
Abstract: To compare associations between anthropometric and lifestyle factors and femoral head cartilage volume/thickness and radiographic features of osteoarthritis (OA) and to provide evidence of construct validity for magnetic resonance imaging (MRI) assessment of femoral cartilage volume and thickness. We studied a cross-sectional s le of 151 randomly selected subjects (79 men, 72 women mean age 63 years) from the Tasmanian Older Adult Cohort Study. A sagittal T1-weighted fat-suppression MRI scan of the right hip was performed to determine femoral head cartilage volume, cartilage thickness, and size. An anteroposterior radiograph of the pelvis with weight bearing was performed and scored for radiographic evidence of OA in the right hip. Other factors measured were height, weight, leg strength, serum vitamin D levels, and bone mineral density. Hip cartilage volume was significantly associated with female sex, body mass index, and femoral head size, whereas hip cartilage thickness was significantly associated only with the size of the femoral head. Only female sex was significantly associated with the total radiographic OA score and the joint space narrowing (JSN) score, but not the osteophyte score. Radiographic JSN of the hip, especially axial JSN (but not osteophytes), was significantly correlated with hip cartilage volume and thickness. Femoral head cartilage volume and thickness have modest but significant construct validity when correlated with radiographic findings. Furthermore, the generally stronger associations with volume compared with radiographic OA suggest that MRI may be superior at identifying risk factors for hip OA.
Publisher: Wiley
Date: 27-09-2021
DOI: 10.1002/ART.41760
Abstract: To determine whether atorvastatin slows tibial cartilage volume loss in patients with symptomatic knee osteoarthritis (OA) in a multicenter, randomized, double‐blind, placebo‐controlled trial. Participants ages 40–70 years were randomized to receive oral atorvastatin (40 mg once daily) (n = 151) or matching placebo (n = 153). The primary end point was annual percentage change in tibial cartilage volume over 2 years, assessed using magnetic resonance imaging (MRI). The prespecified secondary end points were progression of cartilage defects and bone marrow lesions over 2 years, which were assessed using MRI and change in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index pain, stiffness, and function scores. A total of 248 of 304 participants (81.6%) completed the trial (mean age 55.7 years 55.6% women). The annual change in tibial cartilage volume differed minimally between the atorvastatin and placebo groups (mean change –1.66% versus –2.17%, between‐group difference 0.50% [95% confidence interval (95% CI) –0.17%, 1.17%]). There were no significant differences in the progression of cartilage defects (odds ratio [OR] 0.86 [95% CI 0.52, 1.41]) or progression of bone marrow lesions (OR 1.00 [95% CI 0.62, 1.63]). Moreover, there were no significant differences in change in WOMAC pain, stiffness, or function scores over 2 years between the atorvastatin and placebo groups (mean change in pain score –36.0 versus –29.5, adjusted difference –2.7 [95% CI –27.1, 21.7] mean change in stiffness score –14.2 versus –11.8, adjusted difference –0.2 [95% CI –12.2, 11.8] mean change in function score –89.4 versus –87.5, adjusted difference 0.3 [95% CI –83.1, 83.6]). The incidence of adverse events (AEs) was similar between the atorvastatin and placebo groups (57 [37.7%] versus 52 [34.0%] experiencing AEs). Treatment with oral atorvastatin (40 mg once daily), compared to placebo, did not significantly reduce cartilage volume loss over 2 years in patients with symptomatic knee OA. These findings do not support the use of atorvastatin for the treatment of knee OA.
Publisher: Informa UK Limited
Date: 15-05-2013
DOI: 10.3109/13697137.2013.794778
Abstract: Although low back pain and obesity are major health issues for women, our understanding of the relationship between these conditions is limited. This study aimed to investigate the relationship between occupational activities and low back pain and disability in obese and non-obese, middle-aged females. Eighty-nine obese and 56 non-obese participants were recruited for a community-based study of musculoskeletal health. Low back pain intensity and disability were examined using the Chronic Pain Grade Questionnaire and participants were asked about their involvement in occupational activities. More manual activity and heavy lifting, bending or squatting were found to be associated with low back pain intensity in obese females (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.14-2.94 OR 3.02, 95% CI 1.24-7.37, respectively), but not in non-obese females (OR 0.83, 95% CI 0.42-1.63 OR 0.81, 95% CI 0.25-2.6, respectively), after adjusting for age and recreational activity. Similarly, there were also relationships between performance of more manual activity and heavy lifting, bending or squatting and low back disability in the obese (OR 1.68, 95% CI 1.07-2.63 OR 2.79, 95% CI 1.21-6.46, respectively), but not in the non-obese (OR 0.88, 95% CI 0.36-2.13 OR 1.78, 95% CI 0.39-8.22, respectively). Obese females who perform predominately manual activity or heavy lifting, bending or squatting at work have high levels of low back pain and disability, independent of their recreational activity. This was not the case for non-obese, female workers. Although longitudinal investigation is needed, these findings highlight the role of obesity in low back pain and disability for middle-aged females in occupational settings.
Publisher: Elsevier BV
Date: 04-2021
Publisher: BMJ
Date: 06-2013
Publisher: Elsevier BV
Date: 04-2014
Publisher: BMJ
Date: 30-12-2014
DOI: 10.1136/ANNRHEUMDIS-2014-206676
Abstract: To describe the cross-sectional and longitudinal associations between knee regional effusion-synovitis and structural changes in older adults. A total of 977 subjects were randomly selected from the local community (mean 62 years, 50% female) at baseline and 404 were followed up 2.6 years later. T2-weighted MRI was used to assess knee effusion-synovitis in four subregions: suprapatellar pouch, central portion, posterior femoral recess and subpopliteal recess. Knee cartilage defects, cartilage volume and bone marrow lesions (BMLs) were measured using MRI at baseline and follow-up. Cross-sectionally, effusion-synovitis in most subregions was significantly associated with a higher risk of cartilage defects, BMLs and reduced cartilage volume. Longitudinally, suprapatellar pouch effusion-synovitis at baseline predicted an increase in cartilage defects (p .01), loss of cartilage volume (p=0.04) and an increase in BMLs (p=0.02) in multivariable analyses. The significant associations of effusion-synovitis with cartilage volume and BMLs disappeared after adjustment for cartilage defects. Effusion-synovitis in whole knee joint (p .01) and subpopliteal recess (p .05) was consistently associated with longitudinal changes in cartilage defects but not in cartilage volume and BMLs. There are independent associations between knee joint effusion-synovitis and knee cartilage defects in both cross-sectional and longitudinal analyses, suggesting a potential causal relationship. The associations of effusion-synovitis with BMLs and cartilage volume were largely dependent on cartilage defects, suggesting potential causal pathways.
Publisher: Elsevier BV
Date: 06-2017
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 09-2011
Publisher: S. Karger AG
Date: 2011
DOI: 10.1159/000325910
Abstract: Fetal and early life may be a critical period for the development and/or programming of metabolic systems, including the skeleton. There are increasing human data from cohort studies on the association between early life nutrition and bone development in children. Breastfed children initially have lower bone mass than bottle-fed children, but longer-term studies suggest that they have higher bone mass (size adjusted) by age 8 years, especially in children born at term. By the time of peak bone mass, both preterm and term children have higher bone mass indicating a different bone accrual trajectory curve. These children also have lower fracture risk. Diet in utero has also been associated with subsequent bone mass from ages 6 to 16 years (but not fracture). Positive associations include milk, phosphorus, magnesium, potassium, protein, folate, calcium and vitamin D, while fat intake is negative. Smoking also interferes with bone mineralization possibly due to impaired placental function, but this deleterious effect on bone mass appears to diminish over time. All of these associations are statistically significant and independent of important confounders and later environmental exposures, suggesting that osteoporosis prevention programs need to start very early in the life cycle.
Publisher: BMJ
Date: 05-04-2012
DOI: 10.1136/INJURYPREV-2011-040255
Abstract: Apprentice thoroughbred racing jockeys have a higher fall rate than their more experienced counterparts. The authors describe rates of occurrence and investigate risk factors for falls among less-experienced thoroughbred flat racing jockeys in Australia who commenced their race riding career between August 2002 and July 2009. Data on race-day falls were extracted from stewards' reports. Denominator data were provided by Racing Information Services Australia on races conducted in Australia. HRs were estimated using time-to-event (survival analysis) methods. Factors found to be associated with falls by less-experienced jockeys (as indicated by number of career rides or career stage) were older jockey age at commencement of career (p=0.001), fewer previous rides this meeting (p<0.001), fewer previous starts by the horse (p<0.001), younger horse age (p<0.001), lower race grade (p<0.001), lower prize money (p<0.001), shorter race distance (p<0.001) and drier track rating (p<0.001). Apprentice experience was inversely and strongly associated with increased rates of falls (p<0.001). Three indicators of less accomplished horses (lower race grade, fewer previous starts by the horse and less prize money at stake) and two race conditions (drier tracks and shorter race distance) were found to be associated with a progressively higher hazard of falls for less-experienced jockeys. This study identified factors that preferentially contribute to falls by inexperienced jockeys. The authors suggest that consideration be given to restricting apprentice jockeys with little race-riding experience from riding horses that have not yet won a race (maiden) or that have had few previous race starts.
Publisher: Springer Science and Business Media LLC
Date: 26-01-2018
DOI: 10.1038/S41430-018-0098-X
Abstract: Vitamin D deficiency is common in adolescents but the optimal dosage regimen for correcting deficiency is unknown. To test the safety and efficacy of two different vitamin D dosage regimens to correct vitamin D deficiency in adolescents. In this 12-month, double-blind, randomized placebo-controlled trial, 28 adolescents (serum 25 hydroxyvitamin D (25(OH)D) of 21 to 50 nmol/L) were randomly assigned to one of three groups: monthly (n = 9 vitamin D3 50,000 IU orally monthly plus three placebo tablets 3-monthly), 3-monthly (n = 9 150,000 IU (3 × 50,000 IU tablets) 3-monthly and placebo orally monthly), or placebo (n = 10 placebo monthly and three placebo tablets 3-monthly). Serum 25(OH)D was measured at baseline, 3, 6 and 12 months. Two participants withdrew after their baseline measurement from the 3-monthly group. At 12 months, one participant was deficient (≤50 nmol/L) in both the monthly and 3-monthly groups, whereas six out of ten in the placebo remained deficient (P = 0.055). At 12 months, the average serum 25(OH)D levels for the monthly, 3-monthly and placebo groups were 76.4, 64.7 and 49.7 nmol/L, respectively (P < 0.001 and P = 0.04 for differences between monthly and placebo groups and 3-monthly and placebo groups respectively, after adjustment for age, sex and seasonal variation). Adherence was 100% and adverse events were minor. Both 50,000 IU monthly and 150,000 IU 3-monthly of vitamin D3 safely and effectively corrects vitamin D deficiency in adolescents. These data provide treatment options which can be used by health practitioners to tailor vitamin D dosage regiments according to patient preference and context.
Publisher: Elsevier BV
Date: 04-2021
Publisher: American Medical Association (AMA)
Date: 08-03-2016
Abstract: Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current trial evidence is contradictory. To compare the effects of vitamin D supplementation vs placebo on knee pain and knee cartilage volume in patients with symptomatic knee osteoarthritis and low vitamin D levels. A multicenter randomized, double-blind, placebo-controlled clinical trial in Tasmania and Victoria, Australia. Participants with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D (12.5-60 nmol/L) were enrolled from June 2010 to December 2011. The trial was completed in December 2013. Participants were randomly assigned to receive monthly treatment with oral vitamin D3 (50,000 IU n = 209) or an identical placebo (n = 204) for 2 years. Primary outcomes were change in tibial cartilage volume (assessed using magnetic resonance imaging [MRI]) and change in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score (0 [no pain] to 500 [worst pain]) from baseline to month 24. Secondary outcomes were cartilage defects and bone marrow lesions (assessed using MRI). Of 413 enrolled participants (mean age, 63.2 years 50% women), 340 (82.3%) completed the study. The level of 25-hydroxyvitamin D increased more in the vitamin D group (40.6 nmol/L) than in the placebo group (6.7 nmol/L) (P < .001) over 2 years. There were no significant differences in annual change of tibial cartilage volume or WOMAC pain score. There were no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions. Adverse events (≥ 1 per patient) occurred in 56 participants in the vitamin D group and in 37 participants in the placebo group (P = .04). [table: see text]. Among patients with symptomatic knee osteoarthritis and low serum 25-hydroxyvitamin D levels, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or WOMAC knee pain score over 2 years. These findings do not support the use of vitamin D supplementation for preventing tibial cartilage loss or improving WOMAC knee pain in patients with knee osteoarthritis. clinicaltrials.gov Identifier: NCT01176344 anzctr.org.au Identifier: ACTRN12610000495022.
Publisher: Springer Science and Business Media LLC
Date: 02-2001
Abstract: Symptomatic fractures are a significant problem in terms of both morbidity and financial cost. Marked variation in both total and site-specific fracture incidence has been documented internationally but there is limited within-country data. This prospective population-based study documented the incidence of all symptomatic fractures occurring from July 1, 1997 to June 30, 1999 in adults > or =50 years of age resident in Southern Tasmania (total population > or = 50 years: 64688). Fractures were ascertained by reviewing reports from all the radiology providers within the area. There were 701 fractures in men and 1309 fractures in women. The corresponding fracture incidence in men and women was 1248 and 1916 per 100000 person-years, respectively. Residual lifetime fracture risk in a person aged 50 years was 27% for men and 44% for women with fractures other than hip fractures constituting the majority of symptomatic fracture events. These fracture risk estimates remained remarkably constant with increasing age. In comparison to Geelong, there were significantly lower hip fracture rates (males: RR 0.59, 95% CI 0.45-0.76 females: RR 0.61, 95% CI 0.53-0.71) but significantly higher distal forearm fractures (males: RR 1.87, 95% CI 1.10-3.78 females: RR 1.31, 95% CI 1.11-1.55) and total fractures in men (RR 1.31, 95% CI 1.17-1.46) but not women (RR 1.05, 95% CI 0.98-1.13). In contrast, Southern Tasmania had lower age-standardized rates of all fractures compared with Dubbo (RR 0.28-0.79). In conclusion, this study provides compelling evidence that fracture incidence varies between different geographic sites within the same country, which has important implications for health planning. In addition, the combination of high residual fracture risk and short life expectancy in elderly subjects suggests fracture prevention will be most cost-effective in later life.
Publisher: Cambridge University Press (CUP)
Date: 14-07-2022
DOI: 10.1017/S0007114521002658
Abstract: We aimed to describe associations between diet quality in adolescence and adulthood and knee symptoms in adulthood. Two hundred seventy-five participants had adolescent diet measurements, 399 had adult diet measurements and 240 had diet measurements in both time points. Diet quality was assessed by Dietary Guidelines Index (DGI), reflecting adherence to Australian Dietary Guidelines. Knee symptoms were collected using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were analysed using zero-inflated negative binomial regressions. The overall adolescent DGI was not associated with adult knee symptoms, although lower intake of discretionary foods (e.g. cream, alcohol, bacon and cake) in adolescence was associated with lower pain (mean ratio (MR) 0·96) and dysfunction (MR 0·94). The overall adult DGI was not associated with knee symptoms however, limiting saturated fat was associated with lower WOMAC (Pain: MR 0·93 stiffness: MR 0·93 dysfunction: MR 0·91), drinking water was associated with lower stiffness (MR 0·90) and fruit intake was associated with lower dysfunction (MR 0·90). Higher DGI for dairy products in adulthood was associated with higher WOMAC (Pain: MR 1·07 stiffness: MR 1·13 dysfunction: MR 1·11). Additionally, the score increases from adolescence to adulthood were not associated with adult knee symptoms, except for associations between score increase in limiting saturated fat and lower stiffness (MR 0·89) and between score increase in fruit intake and lower dysfunction (MR 0·92). In conclusion, the overall diet quality in adolescence and adulthood was not associated with knee symptoms in adulthood. However, some diet components may affect later knee symptoms.
Publisher: BMJ
Date: 27-09-2013
DOI: 10.1136/ANNRHEUMDIS-2013-203308
Abstract: To investigate cross-sectional and longitudinal associations between serum leptin levels and knee cartilage thickness in older adults. A prospective cohort of 163 randomly selected subjects (mean 63 years, range 52–78, 46% women) was studied. Knee cartilage thickness at medial tibial, lateral tibial, femoral and patellar sites was determined using T1-weighted fat-suppressed MRI. Serum leptin levels were measured by radioimmunoassay. Radiographic osteoarthritis, body fat (%), trunk fat (%), weight and height were measured, and body mass index (BMI) was calculated. Cross-sectionally, serum levels of leptin were negatively associated with femoral (β: −0.013, 95% CI −0.022 to −0.003), medial tibial (β: −0.009, 95% CI −0.018 to −0.001), lateral tibial (β: −0.012, 95% CI −0.021 to −0.003) and patellar (β: −0.014, 95% CI −0.026 to −0.002) cartilage thickness after adjustment for covariates. Moreover, BMI, trunk fat and total body fat were negatively associated with cartilage thickness, and the significant associations disappeared after further adjustment for leptin. Longitudinally, both baseline leptin and change in leptin were associated with greater changes in medial tibial cartilage thickness (β: −0.004, 95% CI −0.007 to −0.001 and β: −0.009, 95% CI −0.018 to −0.001, respectively) in multivariable analyses. Serum levels of leptin are independently and consistently associated with reduced cartilage thickness cross-sectionally and longitudinally. In addition, the associations between adiposity measures and cartilage thickness are mediated by leptin, suggesting leptin may play a key role in cartilage thinning.
Publisher: Springer Science and Business Media LLC
Date: 19-07-2019
DOI: 10.1007/S00198-019-05080-W
Abstract: Maintaining mobility is an important aspect of health and well-being in older men. This literature review describes several modifiable and nonmodifiable risk factors impacting bone, muscle, and joint health. Exercise and nutritional interventions may help to prevent the progressive deterioration in bones, muscles, and joints impacting mobility in later life. Limitations in mobility are increasingly recognized as a major public health problem due to an aging population and growing number of older in iduals affected by disabling comorbidities. Despite increasing numbers and debilitating consequences, there are no guidelines providing recommendations on strategies to maintain mobility for healthy aging among older men. This narrative review aims to fill this literature gap. PubMed, Scopus, and Google Scholar databases were searched using predefined search terms. Primary studies, exploratory analyses, cross-sectional surveys, meta-analyses, evidence-based clinical reviews, and guidelines from nationally recognized societies focusing on mobility in older men and key elements including bone, muscle and joint health, and balance were selected. Several modifiable and nonmodifiable risk factors have been reported in the literature that impact bone, muscle, and joint health and predispose older men to falls and fractures. The most common conditions impacting bones, muscles, and joints are osteoporosis, sarcopenia, and osteoarthritis, respectively. In addition to being key contributors to disability in the elderly, these conditions are all associated with a higher mortality risk. Although more studies are required, current evidence supports the use of various nonpharmacological (mainly exercise and nutrition) and/or pharmacological treatment modalities to help prevent and/or reverse these conditions. Incorporating lifestyle interventions involving exercise and nutrition at a younger age can help prevent the age-related, progressive deterioration in bones, muscles, and joints that can reduce mobility in later life. Established barriers to physical activities (e.g., poor health, social isolation) in men are important to consider for optimizing outcomes.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Wiley
Date: 10-2000
DOI: 10.1359/JBMR.2000.15.10.1998
Abstract: The aim of this study was to estimate heritability of bone density in premenopausal women, prepubertal male, and prepubertal female child pairs. We studied 291 pairs (mothers, mean age, 33 years, range 22-45 years children, mean age, 7.92 years, range 7.32-8.92 years). Bone density and body composition were assessed by dual-energy X-ray absorptiometry. Height and weight were measured in both mother and child. Body size-adjusted heritability estimates for areal bone density (g/cm2) were all statistically significant (femoral neck, 59% lumbar spine, 38% total body, 41%) and were consistently and significantly higher in mother-daughter pairs (n = 105) as compared with mother-son pairs (n = 186). Heritability estimates for bone mineral apparent density (BMAD g/cm3) were marginally lower but remained statistically significant at all sites (femoral neck, 51% lumbar spine, 32% total body, 38%). Maternal osteopenia was associated with significant reductions in bone mass at all sites in the children (femoral neck, 0.75 SD and p < 0.0001 lumbar spine, 0.61 SD and p < 0.0001 total body, 0.43 SD and p = 0.012). Mother-child bone areal bone density correlation coefficients and prediction of low bone mass in the child were greater (but this did not reach statistical significance) if the corresponding anatomical site in the mother was used for prediction with the exception of the total body. These data confirm that heritability of bone mass extends to prepubertal children and is gender- and possibly site-specific as well as under separate genetic control to growth. Furthermore, the strength of the mother-child association is such that bone density screening of mothers would make it possible to identify most prepubertal children at higher risk of osteoporosis in later life.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.JOCA.2016.10.024
Abstract: To describe cross-sectional and longitudinal associations between serum levels of interleukin (IL) - 6, IL-17A, IL-17F, IL-23 and knee bone marrow lesions (BMLs) in patients with knee osteoarthritis (OA). Patients (n = 192) with symptomatic knee OA (mean 63 years, range 50-79, female 53%) were assessed at baseline and after 24 months. At each time point, serum IL-6, IL-17A, IL-17F and IL-23 were measured using Bio-Plex Baseline IL-6 (quarters) were significantly associated with total knee BMLs (P < 0.01 for the trend) as well as associated with an increase in BML score (P = 0.05 for the trend), after adjustment for confounders. Baseline IL-17F and IL-23 (highest quarters vs others) was associated with an increase in BML score in females (P = 0.04 for IL-17F P = 0.01 for IL-23), but not in males, in multivariable analyses. In contrast, IL-17A was not significantly associated with BMLs in either females or males. IL-6 is associated with increased knee BMLs in both females and males with OA. Serum IL-17F and IL-23 predicted increased knee BML scores in females only, suggesting that inflammation is involved in BML pathogenesis in knee OA, especially in women. ClinicalTrials.gov identifier: NCT01176344 Australian New Zealand Clinical Trials Registry: ACTRN12610000495022.
Publisher: Wiley
Date: 13-03-2014
DOI: 10.1002/OBY.20734
Abstract: To determine whether obesity concurrent with sarcopenia (low muscle mass) or dynapenia (low muscle strength) is associated with increased falls risk in middle-aged and older adults. 5-year prospective cohort study including 674 community-dwelling volunteers (mean ± SD age 61.4 ± 7.0 years 48% female). Sarcopenia and dynapenia were defined as lowest sex-specific tertiles for dual-energy X-ray (DXA)-assessed appendicular lean mass (adjusted for height and fat mass) or lower-limb strength, respectively. Obesity was defined as the highest tertiles of DXA-assessed total or trunk fat mass. Change in falls risk was calculated using the Physiological Profile Assessment (z-scores: 0-1 = mild increased risk 1-2 = moderate increased risk >2 = marked increased risk). Multivariable linear regression analyses revealed mild but significantly increased falls risk scores for dynapenic obesity (change in mean z-score compared to non-dynapenic, non-obese group: 0.33, 95% CI 0.06-0.59 [men] and 0.46, 95% CI 0.21-0.72 [women]) and dynapenia (0.25, 95% CI 0.05-0.46 [women only]). Dynapenic obesity, but not sarcopenic obesity, is predictive of increased falls risk score in middle-aged and older adults. In clinical settings, muscle function assessments may be useful for predicting falls risk in obese patients.
Publisher: BMJ
Date: 19-02-2014
DOI: 10.1136/ANNRHEUMDIS-2013-204763
Abstract: To estimate the global burden of hip and knee osteoarthritis (OA) as part of the Global Burden of Disease 2010 study and to explore how the burden of hip and knee OA compares with other conditions. Systematic reviews were conducted to source age-specific and sex-specific epidemiological data for hip and knee OA prevalence, incidence and mortality risk. The prevalence and incidence of symptomatic, radiographic and self-reported hip or knee OA were included. Three levels of severity were defined to derive disability weights (DWs) and severity distribution (proportion with mild, moderate and severe OA). The prevalence by country and region was multiplied by the severity distribution and the appropriate disability weight to calculate years of life lived with disability (YLDs). As there are no deaths directly attributed to OA, YLDs equate disability-adjusted life years (DALYs). Globally, of the 291 conditions, hip and knee OA was ranked as the 11th highest contributor to global disability and 38th highest in DALYs. The global age-standardised prevalence of knee OA was 3.8% (95% uncertainty interval (UI) 3.6% to 4.1%) and hip OA was 0.85% (95% UI 0.74% to 1.02%), with no discernible change from 1990 to 2010. Prevalence was higher in females than males. YLDs for hip and knee OA increased from 10.5 million in 1990 (0.42% of total DALYs) to 17.1 million in 2010 (0.69% of total DALYs). Hip and knee OA is one of the leading causes of global disability. Methodological issues within this study make it highly likely that the real burden of OA has been underestimated. With the aging and increasing obesity of the world's population, health professions need to prepare for a large increase in the demand for health services to treat hip and knee OA.
Publisher: BMJ
Date: 06-2015
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.JOCA.2008.05.013
Abstract: Identifying factors that influence the rate of cartilage loss at the knee may help to prevent or delay the progression of knee osteoarthritis (OA). Changes in knee alignment alter knee joint load and may affect the rate of cartilage loss. The aim of this study was to determine whether change in knee alignment between baseline and 2 years is associated with a change in knee cartilage volume in knee OA in the subsequent 2.5 years. Seventy-eight adults with symptomatic knee OA were recruited using a combined strategy. Radiographs were performed at time 0 and 2 years to determine change in knee alignment, measured on a continuous scale. Magnetic Resonance Imaging was performed at 2 and 4.5 years to determine annual percentage change in medial and lateral tibial cartilage volumes. In multivariate analyses, for every 1 degrees change toward genu valgum, there is an associated 0.44% reduction in the rate of annual medial tibial cartilage volume loss (95% CI: -0.85%, -0.04%, P=0.03). Similarly, because our measures of change in alignment and cartilage volume were continuous, these results also implied that for every 1 degrees change toward genu varum, there was an associated 0.44% increase in the rate of annual medial tibial cartilage volume loss. Change in knee angle did not significantly affect the rate of loss of the lateral tibial cartilage volume (P=0.95). Our results have demonstrated that progressive change toward genu valgum reduced the annual rate of medial tibial cartilage volume loss in people with knee OA, without expediting the rate of lateral tibial cartilage volume loss. These findings suggest that methods to reduce varus alignment may delay the progression of medial tibiofemoral OA and warrant further investigation.
Publisher: Oxford University Press (OUP)
Date: 25-10-2019
DOI: 10.1093/RHEUMATOLOGY/KEZ498
Abstract: To describe associations of body composition, physical activity and physical performance with knee cartilage thickness and subchondral bone area in young adults. Body composition, physical activity and physical performance were measured 4–5 years prior to knee MRI. Cartilage thickness and bone area were measured quantitatively from MRI. Associations were assessed using linear regression analysis, with mediators being identified using mediation analysis. Participants (n = 186) were 31–41 years of age when the MRI was acquired and 48% were female. Greater lean mass was positively associated with cartilage thickness [β = 6.52 μm/kg (95% CI 0.86, 12.18)] and bone area [β = 13.37 mm2/kg (95% CI 5.43, 21.31)]. Physical performance measures were positively associated with cartilage thickness [long jump: β = 2.44 μm/cm (95% CI 0.70, 4.18) hand grip strength: 7.74 μm/kg (95% CI 1.50, 13.98) physical work capacity: 1.07 μm/W (95% CI 0.29, 1.85)] and bone area [long jump: β = 3.99 mm2/cm (95% CI 0.64, 7.34) hand grip strength: 19.06 mm2/kg (95% CI 7.21, 30.92) leg strength: 3.18 mm2/kg (95% CI 1.09, 5.28) physical work capacity: 3.15 mm2/W (95% CI 1.70, 4.60)]. Mediation analysis suggested these associations were mediated by lean mass (effect mediated: 27–95%). Greater lean mass and better physical performance measured 4–5 years prior were associated with greater knee cartilage thickness and subchondral bone area in young adults, and the associations of physical performance were largely mediated by lean mass. These findings suggest lean mass may play an important role in maintaining knee joint health in young adults.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 04-2013
Publisher: Wiley
Date: 26-08-2015
DOI: 10.1002/ACR.22588
Abstract: We aimed to determine the associations between childhood physical performance measures and tibial cartilage volume and tibial bone area in adults 25 years later. Participants (n = 330, ages 31-41 years, female 47%) were selected from the Australian Schools Health and Fitness Survey of 1985. The participants underwent T1-weighted fat-suppressed magnetic resonance imaging (MRI) of their knees. Tibial bone area and cartilage volume were measured from MRI. Childhood measures, including physical work capacity at 170 beats per minute (PWC170 ), leg strength, number of sit-ups, long-run, and short-run were measured in 1985. PWC170 and leg strength measures were repeated after 20 years in their adulthood. Linear regression analysis was used to determine the association of performance measures with cartilage volume. There were consistent positive associations of all childhood measures, including PWC170 (β = 0.38 cm(2) per 10 watts, 95% confidence interval [95% CI] 0.15, 0.60), leg strength, long-run, short-run, and sit-ups with adult medial and total tibial bone area. Similarly, there was an association of PWC170 and sit-ups with adult medial tibial cartilage volume. After further adjustment for tibial bone area, the association between PWC170 and medial and total (β = 0.08 cm(3) per 10 watts, 95% CI 0.02, 0.10) tibial cartilage volume decreased in magnitude but remained significant. Childhood physical performance measures, especially PWC170 , were associated with knee tibial bone area and cartilage volume in adulthood. The associations with cartilage volume appeared to be partially mediated by bone area. This suggests physical performance measures in childhood can independently influence adult knee structures.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.MSKSP.2016.11.013
Abstract: Test-retest reliability of the combined process of ultrasound imaging (USI) and image measurement of thickness of abdominal and upper lumbar multifidus (MF) muscles and MF cross sectional area (CSA) of older adults has not been established. Imaging muscles of older adults can be challenging due to age-related changes in the spine and skeletal muscle so establishing test-retest reliability in this population is important. This study aimed to evaluate test-retest reliability of USI of abdominal and MF muscle thickness and MF CSA for adults aged 50-79 years. One operator took single sets of ultrasound images of abdominal and MF muscles of 23 adults aged 50-79 years participating in a clinical trial of vitamin D supplementation for knee osteoarthritis, on two occasions, one week apart. Images were subsequently measured by a single examiner. Test-retest reliability for abdominal muscle thickness and MF CSA was substantial (intraclass correlation coefficients (ICC) > 0.81) and for MF thickness ranged from fair to substantial (ICC 0.55-0.86). The standard error of measurement (SEM) was low (0.02-0.21) in every case. ICCs were low and SEM values were high for percentage thickness change. The substantial test-retest reliability of abdominal and MF (L4-L5) muscle thickness and of MF CSA supports the use of USI as a clinical and research tool to assess abdominal and MF muscle thickness and MF CSA of older adults.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.JOCA.2019.05.030
Abstract: To examine the association of metabolic syndrome (MetS) and its components with knee pain severity trajectories. Data from a population-based cohort study were utilised. Baseline blood pressure, glucose, triglycerides and high-density lipoprotein (HDL) cholesterol were measured. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. Radiographic knee osteoarthritis (ROA) was assessed by X-ray. Pain severity was measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain questionnaire at each time-point. Group-based trajectory modelling was used to identify pain trajectories and multi-nominal logistic regression was used for analysis. Mediation analysis was performed to assess whether body mass index (BMI)/central obesity mediated the association between MetS, its components and pain trajectories. Among 985 participants (Mean ± SD age: 62.9 ± 7.4, 50% female), 32% had MetS and 60% had ROA. Three pain trajectories were identified: 'Minimal pain' (52%), 'Mild pain' (33%) and 'Moderate pain' (15%). After adjustment for potential confounders, central obesity increased risk of belonging to both 'Mild pain' and 'Moderate pain' trajectories as compared to the 'Minimal pain' trajectory group, but MetS [relative risk ratio (RRR): 2.26, 95%CI 1.50-3.39], hypertriglyceridemia (RRR: 1.75, 95%CI 1.16-2.62) and low HDL (RRR: 1.67, 95%CI 1.10-2.52) were only associated with 'Moderate pain' trajectory. BMI/central obesity explained 37-70% of these associations. Results were similar in those with ROA. MetS and its components are predominantly associated with worse pain trajectories through central obesity, suggesting that the development and maintenance of worse pain trajectories may be caused by MetS.
Publisher: Wiley
Date: 17-11-2023
DOI: 10.1002/ACR.24887
Abstract: To determine associations between chronic plantar heel pain (CPHP) and imaging biomarkers derived from magnetic resonance imaging (MRI) and ultrasonography. We compared 218 participants with CPHP with 100 age- and sex-matched population controls. We assessed imaging biomarkers on MRI (calcaneal bone marrow lesions [BMLs], plantar fascia [PF] signal and thickness, spurs, and fat pad signal) and B-mode ower Doppler ultrasound (PF thickness, echogenicity, and vascularity). Covariate data collected included demographic characteristics, disease history, clinical measures, and physical activity by accelerometry. Data were analyzed using multivariable conditional logistic regression. Plantar calcaneal BML size (mm Calcaneal BMLs and PF imaging biomarkers are associated with CPHP. Further research is required to understand whether these different markers represent distinct phenotypes of heel pain, and if so, whether there are specific treatment implications.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 05-2021
DOI: 10.1016/J.JOCA.2020.12.003
Abstract: To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.
Publisher: Informa UK Limited
Date: 10-2017
DOI: 10.2147/DDDT.S97959
Publisher: Wiley
Date: 02-08-2010
DOI: 10.1111/J.1365-2265.2010.03858.X
Abstract: Low 25-hydroxyvitamin D (25OHD) levels may be associated with both sarcopenia (the age-related decline in muscle mass and function) and low physical activity (PA). Our objective was to describe prospective associations between 25OHD, muscle parameters, and PA in community-dwelling older adults. Prospective, population-based study with a mean follow-up of 2·6 ± 0·4 years. Six hundred and eighty-six community-dwelling older adults (49% women mean ± SD 62 ± 7 years old). Appendicular lean mass percentage (%ALM) and body fat assessed by Dual-energy X-ray Absorptiometry, leg strength by dynamometer, leg muscle quality (LMQ), PA assessed by pedometer, self-reported sun exposure by questionnaire, and serum 25OHD measured by radioimmunoassay. Participants with 25OHD ≤50 nM had lower mean %ALM, leg strength, LMQ and PA (all P < 0·05). As a continuous function, baseline 25OHD was a positive independent predictor of change in leg strength (β = 5·74 kg, 95% CI 0·65, 10·82) and LMQ (β = 0·49 kg/kg, 95% CI 0·17, 0·82). Also, change in 25OHD was positively predicted by baseline %ALM (β = 2·03 pM .a., 95% CI 0·44, 3·62) leg strength (β = 0·30 pM .a., 95% CI 0·06, 0·53), LMQ (β = 4·48 pM .a., 95% CI 0·36, 8·61) and PA (β = 2·63 pM .a., 95% CI 0·35, 4·92) after adjustment for sun exposure and body fat. 25OHD may be important for the maintenance of muscle function, and higher skeletal muscle mass and function as well as general PA levels may also be beneficial for 25OHD status, in community-dwelling older adults.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JOCA.2017.01.015
Abstract: To investigate the longitudinal association between endogenous sex hormones and knee osteoarthritis (OA) structures and pain. We examined 200 participants (mean age 63.0 ± 7.3 years) from a clinical trial of vitamin D supplement for symptomatic knee OA. Serum levels of estradiol, progesterone, testosterone and sex hormone binding globulin (SHBG) were analyzed at baseline and 24 months later. Magnetic resonance imaging (MRI) scans of selected knee were obtained at both baseline and follow-up for the measurement of cartilage volume, cartilage defects, bone marrow lesions (BMLs) and effusion-synovitis volume. Knee pain was assessed using a 100 mm visual analogue scale (VAS). Longitudinal data were analyzed using linear mixed-effects model. One hundred and seven males and 93 females were included in this study. For females, after adjustment for age, body mass index (BMI), and vitamin D level, progesterone was positively associated with cartilage volume (β = 0.12 mm In women but not men, low serum levels of endogenous estradiol, progesterone and testosterone are associated with increased knee effusion-synovitis and possibly other OA-related structural changes. This may contribute to observed sex differences in knee OA.
Publisher: Springer Science and Business Media LLC
Date: 21-09-2013
Publisher: Informa UK Limited
Date: 2000
DOI: 10.3109/02770900009090816
Abstract: The aim of this cross-sectional study was to describe the role of asthma, asthma severity, and medication usage in bone mineralization of prepubertal children. Asthma severity, medication usage, and physical activity were assessed by questionnaire and objective measures in 330 children. Bone densitometry and body composition were measured by dual-energy x-ray absorptiometry. Asthma ever was reported by 110 subjects (33%). A diagnosis of asthma was not associated with any deficit in bone mass, whereas usage of inhaled corticosteroids (ICS) in the last year (but not past use) was associated with deficits in bone in the total body (only after adjustment for confounders), particularly for doses of > or =400 microg/day. These observations support current recommendations with regard to ICS usage in children, but require confirmation in longitudinal studies.
Publisher: Wiley
Date: 14-08-2007
Publisher: Elsevier BV
Date: 04-2019
Publisher: Informa UK Limited
Date: 19-05-2017
DOI: 10.1080/13697137.2017.1325461
Abstract: Turner syndrome (TS) is associated with hypogonadism, osteoporosis and fractures. We investigated the prevalence and risk factors for low bone density and fractures in a TS cohort. We included 76 TS patients (median age 28.5 years) attending a tertiary hospital between 1998 and 2015 who underwent dual-energy X-ray absorptiometry. Spine and femoral neck (FN) areal bone mineral density (aBMD) were compared with those of a control group. To adjust for smaller bone size, bone mineral apparent density (BMAD) was calculated. Primary amenorrhea was common (83%) in the TS cohort the median age of pubertal induction was 15 years (range 11-30 years), and non-continuous estrogen therapy (ET) recorded in 40%. Almost one-third of TS patients reported fractures. TS patients had lower median spinal aBMD (1.026 g/cm Delay in ET commencement was an independent risk factor for the lower bone density observed in women with TS. Early pubertal induction and ET compliance are important targets to optimize aBMD.
Publisher: BMJ
Date: 21-02-2012
DOI: 10.1136/ANNRHEUMDIS-2011-200970
Abstract: To compare the effect of a single infusion of zoledronic acid (ZA) with placebo on knee pain and bone marrow lesions (BMLs). Adults aged 50-80 years (n=59) with clinical knee osteoarthritis and knee BMLs were randomised to receive either ZA (5 mg/100 ml) or placebo. BMLs were determined using proton density-weighted fat saturation MR images at baseline, 6 and 12 months. Pain and function were measured using a visual analogue scale (VAS) and the knee injury and osteoarthritis outcome score (KOOS) scale. At baseline, mean VAS score was 54 mm and mean total BML area was 468 mm(2). VAS pain scores were significantly reduced in the ZA group compared with placebo after 6 months (-14.5 mm, 95% CI -28.1 to -0.9) but not after 3 or 12 months. Changes on the KOOS scales were not significant at any time point. Reduction in total BML area was greater in the ZA group compared with placebo after 6 months (-175.7 mm(2), 95% CI -327.2 to -24.3) with a trend after 12 months (-146.5 mm(2), 95% CI -307.5 to +14.5). A greater proportion of those in the ZA group achieved a clinically significant reduction in BML size at 6 months (39% vs 18%, p=0.044). Toxicity was as expected apart from a high rate of acute phase reactions in treatment and placebo arms. ZA reduces knee pain and areal BML size and increases the proportion improving over 6 months. Treatment of osteoarthritis may benefit from a lesion specific therapeutic approach. ACTRN 12609000399291.
Publisher: BMJ
Date: 06-2013
Publisher: BMJ
Date: 23-05-2022
DOI: 10.1136/ANNRHEUMDIS-2022-EULAR.1920
Abstract: While some in idual dietary nutrients/components have been shown to be associated with knee osteoarthritis (OA) progression, the associations of the dietary inflammatory index (DII), which reflects the overall inflammatory potential of a diet, with MRI-detected structural changes and pain have not been investigated. This longitudinal study aimed to determine whether DII scores are associated with knee structural changes and pain over a 10.7-year follow-up in community-dwelling older adults. This study utilised the data from a prospective population-based cohort study (mean age 63 years, 51% women) in which 1,099, 875, 768 and 563 participants completed assessments at baseline, 2.6, 5.1 and 10.7 years, respectively. T1-weighted or T2-weighted MRI of the right knee was performed to measure cartilage volume (CV) and bone marrow lesions (BMLs) at baseline and 10.7 years. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain questionnaire was used to measure knee pain at all assessments. Baseline energy-adjusted DII (E-DII) scores were calculated using a validated Food Frequency Questionnaire. X-ray was performed to assess radiographic knee osteoarthritis (ROA). Linear, log-binomial regression and linear mixed-effects modelling with adjustments for covariates were used to examine the associations of E-DII with CV loss, BML size increase and knee pain, respectively. Pain trajectories (i.e., ‘Minimal Pain’, ‘Mild Pain’, and ‘Moderate Pain’) were previously identified in this cohort using group-based trajectory modelling [1]. Multi-nominal logistic regression was used to examine the association between E-DII and pain trajectory groups. The mean E-DII at baseline was -0.48±1.39. In multivariable analyses, E-DII score was not associated with tibial CV loss and BML size increase [CV loss: β=0.03% per annum, 95%CI -0.01–0.06 BML size increase: relative risk (RR)=0.94, 95%CI 0.84–1.05 ]. Higher E-DII was associated with greater pain score over 10.7 years (β=0.21, 95%CI 0.004-0.43) and an increased risk of belonging to ‘Moderate pain’ as compared to ‘Minimal Pain’ trajectory group [relative risk ratio (RRR): 1.19, 95%CI 1.02-1.39] after adjustment for age, body mass index, physical activity, education level, employment, emotional problems, comorbidities, and ROA. Higher DII was associated with greater pain score and higher risk of more severe pain trajectory, but not structural changes, suggesting discordance between effects of diet on structural damage and pain, and that targeting pro-inflammatory diets may be beneficial to reduce pain. [1]Pan F, Tian J, Aitken D, Cicuttini F, Jones G. Predictors of pain severity trajectory in older adults: a 10.7-year follow-up study. Osteoarthritis Cartilage. 2018 (12):1619-26. None declared
Publisher: Elsevier BV
Date: 04-2018
Publisher: Springer Science and Business Media LLC
Date: 11-09-2022
DOI: 10.1186/S13063-022-06715-W
Abstract: There is an unmet need for treatments for knee osteoarthritis (OA). Effusion-synovitis is a common inflammatory phenotype of knee OA and predicts knee pain and structural degradation. Anti-inflammatory therapies, such as diacerein, may be effective for this phenotype. While diacerein is recommended for alleviating pain in OA patients, evidence for its effectiveness is inconsistent, possibly because studies have not targeted patients with an inflammatory phenotype. Therefore, we will conduct a multi-centre, randomised, placebo-controlled double-blind trial to determine the effect of diacerein on changes in knee pain and effusion-synovitis over 24 weeks in patients with knee OA and magnetic resonance imaging (MRI)-defined effusion-synovitis. We will recruit 260 patients with clinical knee OA, significant knee pain, and MRI-detected effusion-synovitis in Hobart, Melbourne, Adelaide, and Perth, Australia. They will be randomly allocated to receive either diacerein (50mg twice daily) or identical placebo for 24 weeks. MRI of the study knee will be performed at screening and after 24 weeks of intervention. The primary outcome is improvement in knee pain at 24 weeks as assessed by a 100-mm visual analogue scale (VAS). Secondary outcomes include improvement in volumetric (ml) and semi-quantitative (Whole-Organ Magnetic Resonance Imaging Score, 0–3) measurements of effusion-synovitis using MRI over 24 weeks, and improvement in knee pain (VAS) at 4, 8, 12, 16, and 20 weeks. Intention-to-treat analyses of primary and secondary outcomes will be performed as the primary analyses. Per protocol analyses will be performed as the secondary analyses. This study will provide high-quality evidence to determine whether diacerein improves pain, changes disease trajectory, and slows disease progression in OA patients with effusion-synovitis. If diacerein proves effective, this has the potential to significantly benefit the substantial proportion (up to 60%) of knee OA patients with an inflammatory phenotype. Australian and New Zealand Clinical Trial Registry ACTRN12618001656224 . Registered on 08 October 2018.
Publisher: Elsevier BV
Date: 04-2013
Publisher: Informa UK Limited
Date: 12-2014
DOI: 10.2147/BTAT.S33431
Publisher: BMJ
Date: 06-2013
Publisher: BMJ
Date: 23-05-2022
DOI: 10.1136/ANNRHEUMDIS-2022-EULAR.1922
Abstract: Lipid mediators have been suggested to have a role in pain sensitivity and response however, longitudinal data on lipid metabolites and persistent multisite musculoskeletal pain (MSMP) are lacking. This study was to identify lipid metabolic markers for persistent MSMP. Lipidomic profiling of 807 lipid species was performed on serum s les of 536 participants from a cohort study. MSMP was measured by a questionnaire and defined as painful sites ≥4. Persistent MSMP was defined as having MSMP at every visit. Logistic regression was used with adjustment for potential confounders. The Benjamini Hochberg method was used to control for multiple testing. A total of 530 s les with 807 lipid metabolites passed quality control. Mean age at baseline was 61.54±6.57 years and 50% were females. One hundred and twelve (21%) of the participants had persistent MSMP. Persistent MSMP was significantly associated with lower levels of monohexosylceramide (HexCer)(d18:1/22:0 and d18:1/24:0), acylcarnitine (AC)(26:0) and lysophosphatidylcholine (LPC)(18:1 [sn1], 18:2 [sn1], 18:2 [sn2], and 15-MHDA[sn1] [104_sn1]) after controlling for multiple testing. After adjustment for age, sex, body mass index, diabetes status, and physical activity, HexCer(d18:1/22:0 and d18:1/24:0) and LPC(18:1 [sn1] and 15-MHDA [sn1] [104_sn1]) were significantly associated with persistent MSMP [Odds Ratio (OR) ranging from 0.24 - 0.32]. Two lipid classes -- HexCer and LPC were negatively associated with persistent MSMP after adjustment for covariates (OR=0.19 and 0.21, respectively). This study identified four novel lipid signatures of persistent MSMP, suggesting that lipid metabolism is involved in the pathogenesis of persistent pain. None declared
Publisher: Springer Science and Business Media LLC
Date: 12-09-2022
DOI: 10.1186/S12916-022-02491-1
Abstract: Knee osteoarthritis is the most prevalent chronic musculoskeletal debilitating disease. Current treatments are only symptomatic, and to improve this, we need a robust prediction model to stratify patients at an early stage according to the risk of joint structure disease progression. Some genetic factors, including single nucleotide polymorphism (SNP) genes and mitochondrial (mt)DNA haplogroups/clusters, have been linked to this disease. For the first time, we aim to determine, by using machine learning, whether some SNP genes and mtDNA haplogroups/clusters alone or combined could predict early knee osteoarthritis structural progressors. Participants (901) were first classified for the probability of being structural progressors. Genotyping included SNP genes TP63 , FTO , GNL3 , DUS4L , GDF5 , SUPT3H , MCF2L , and TGFA mtDNA haplogroups H, J, T, Uk, and others and clusters HV, TJ, KU, and C-others. They were considered for prediction with major risk factors of osteoarthritis, namely, age and body mass index (BMI). Seven supervised machine learning methodologies were evaluated. The support vector machine was used to generate gender-based models. The best input combination was assessed using sensitivity and synergy analyses. Validation was performed using tenfold cross-validation and an external cohort (TASOAC). From 277 models, two were defined. Both used age and BMI in addition for the first one of the SNP genes TP63 , DUS4L , GDF5 , and FTO with an accuracy of 85.0% the second profits from the association of mtDNA haplogroups and SNP genes FTO and SUPT3H with 82.5% accuracy. The highest impact was associated with the haplogroup H, the presence of CT alleles for rs8044769 at FTO , and the absence of AA for rs10948172 at SUPT3H . Validation accuracy with the cross-validation (about 95%) and the external cohort (90.5%, 85.7%, respectively) was excellent for both models. This study introduces a novel source of decision support in precision medicine in which, for the first time, two models were developed consisting of (i) age, BMI, TP63 , DUS4L , GDF5 , and FTO and (ii) the optimum one as it has one less variable: age, BMI, mtDNA haplogroup, FTO , and SUPT3H . Such a framework is translational and would benefit patients at risk of structural progressive knee osteoarthritis.
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.JOCA.2017.01.007
Abstract: To describe cross-sectional and longitudinal associations between magnetic resonance imaging (MRI)-detected osteophytes (OPs) and knee structural abnormalities and knee pain in older adults. A prospective population-based cohort study of 895 participants aged 50-80 years (mean age 62 years, 50% female) was performed. T1-or T2-weighted fat suppressed MRI was used to assess knee OPs, cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and after 2.6 years. Radiographically-detected OPs were scored according to the Osteoarthritis Research Society International (OARSI) atlas. Knee pain was assessed using a self-administered questionnaire at baseline, 2.6 and 5 years later. 85% of participants had MRI-detected OPs at baseline, while 10% of participants had radiographically-detected OPs. Cross-sectionally, higher gardes of MRI-detected OPs in all compartments were significantly, independently and site-specifically associated with higher prevalences of cartilage defects and BMLs, lower cartilage volume and higher prevalence of knee pain. Longitudinally, higher gardes of baseline MRI-detected OPs site-specifically predicted greater risks of any increase in cartilage defects or BMLs, and loss of cartilage volume in medial and lateral tibiofemoral (LTF) and total compartments over 2.6 years in multivariable analyses. These significant associations were similar in those without radiographically-detected OPs. MTF and total OP scores were significantly associated with change in total knee pain over 2.6 and 5 years but these became non-significant after adjustment for cartilage defects and BMLs. MRI-detected knee OPs are common and appear to be clinically relevant to knee structural changes in older adults.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2012
DOI: 10.1007/S10067-012-2046-9
Abstract: Plasma glutathione peroxidase (GSH-Px) by enzyme-linked immunosorbent assay (ELISA) offers a complimentary measurement approach to traditional GSH-Px activity methods. The aim was to investigate whether GSH-Px measured by ELISA in rheumatoid arthritis patients was elevated compared to controls. This was a case-control study with rheumatoid arthritis patients recruited from private practice and gender and age-matched controls randomly selected from the electoral role. GSH-Px concentration was measured by ELISA. Plasma malondialdehyde was used as a measure of oxidative stress, and antioxidant capacity was measured based on reduction of Cu(++) to Cu(+) by antioxidants in the s le. Disease severity was measured using the Health Assessment Questionnaire-Disability Index (HAQ-DI) and C-reactive protein was measured using an immunoturbidometric method. A total of 74 patients were recruited, consisting of 35 rheumatoid arthritis cases and 39 healthy controls. There were no differences between rheumatoid arthritis cases and controls for oxidative stress and antioxidant capacity however, GSH-Px concentration was markedly elevated in the rheumatoid arthritis sufferers (85.9 ± 147.7 versus 17.3 ± 13.0 mg/L, respectively mean ± SD p < 0.01). GSH-Px levels were not associated with severity measured by the HAQ-DI or C-reactive protein. Patients with rheumatoid arthritis demonstrated increased GSH-Px consistent with an adaptive upregulation of GSH-Px to protect against oxidative stress.
Publisher: Springer Science and Business Media LLC
Date: 13-10-2016
DOI: 10.1038/NRDP.2016.72
Abstract: Osteoarthritis (OA) is the most common joint disorder, is associated with an increasing socioeconomic impact owing to the ageing population and mainly affects the diarthrodial joints. Primary OA results from a combination of risk factors, with increasing age and obesity being the most prominent. The concept of the pathophysiology is still evolving, from being viewed as cartilage-limited to a multifactorial disease that affects the whole joint. An intricate relationship between local and systemic factors modulates its clinical and structural presentations, leading to a common final pathway of joint destruction. Pharmacological treatments are mostly related to relief of symptoms and there is no disease-modifying OA drug (that is, treatment that will reduce symptoms in addition to slowing or stopping the disease progression) yet approved by the regulatory agencies. Identifying phenotypes of patients will enable the detection of the disease in its early stages as well as distinguish in iduals who are at higher risk of progression, which in turn could be used to guide clinical decision making and allow more effective and specific therapeutic interventions to be designed. This Primer is an update on the progress made in the field of OA epidemiology, quality of life, pathophysiological mechanisms, diagnosis, screening, prevention and disease management.
Publisher: BMJ
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 07-2021
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.1186/AR1835
Publisher: BMJ
Date: 30-11-2007
Abstract: To describe the associations between leptin, body composition, sex and knee cartilage volume/defects in older adults. A cross-sectional s le of 190 randomly selected subjects (mean 63 years, range 52-78, 48% female) were studied. Knee cartilage volume and defects were determined using T1-weighted fat saturation MRI. Serum leptin levels were measured by radioimmunoassay. Fat and lean mass were measured by dual energy x ray absorptiometry (DXA). Body mass index (BMI) was calculated. In multivariable analysis, serum levels of leptin were negatively associated with total cartilage volume (beta: -541 mm3/log transformed unit, 95% CI -861 to -221) but not with prevalent knee cartilage defects. BMI was negatively associated with cartilage volume after adjustment for total lean mass and positively with prevalent knee cartilage defects. However, the association between BMI and cartilage volume disappeared after adjustment for leptin while the association between BMI and cartilage defects remained unchanged. Lastly, sex differences in total cartilage volume decreased substantially after adjustment for leptin (R2 from 51% to 30%). This cross-sectional study suggests cartilage volume loss with obesity and female sex is related to leptin and, thus, is hormonally mediated in older adults. By contrast, obesity related knee focal cartilage defects may be more related to non-hormonal factors.
Publisher: American Physiological Society
Date: 12-2018
DOI: 10.1152/AJPENDO.00234.2018
Abstract: The microcirculation in adipose tissue is markedly impaired in type 2 diabetes (T2D). Resistance training (RT) often increases muscle mass and promotes a favorable metabolic profile in people with T2D, even in the absence of fat loss. Whether the metabolic benefits of RT in T2D are linked to improvements in adipose tissue microvascular blood flow is unknown. Eighteen sedentary people with T2D (7 women/11 men, 52 ± 7 yr) completed 6 wk of RT. Before and after RT, overnight-fasted participants had blood s led for clinical chemistries (glucose, insulin, lipids, HbA1c, and proinflammatory markers) and underwent an oral glucose challenge (OGC 50 g glucose × 2 h) and a DEXA scan to assess body composition. Adipose tissue microvascular blood volume and flow were assessed at rest and 1 h post-OGC using contrast-enhanced ultrasound. RT significantly reduced fasting blood glucose ( P = 0.006), HbA1c ( P = 0.007), 2-h glucose area under the time curve post-OGC ( P = 0.014), and homeostatic model assessment of insulin resistance ( P = 0.005). This was accompanied by a small reduction in total body fat ( P = 0.002), trunk fat ( P = 0.023), and fasting triglyceride levels ( P = 0.029). Lean mass ( P = 0.003), circulating TNF-α ( P = 0.006), and soluble VCAM-1 ( P 0.001) increased post-RT. There were no significant changes in adipose tissue microvascular blood volume or flow following RT however those who did have a higher baseline microvascular blood flow post-RT also had lower fasting triglyceride levels ( r = −0.476, P = 0.045). The anthropometric, glycemic, and insulin-sensitizing benefits of 6 wk of RT in people with T2D are not associated with an improvement in adipose tissue microvascular responses however, there may be an adipose tissue microvascular-linked benefit to fasting triglyceride levels.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.BONE.2018.01.033
Abstract: To estimate the heritability of bone geometry, volumetric bone mineral density (vBMD) and microarchitecture of trabecular (Tb) and cortical (Ct) bone measured by high resolution peripheral quantitative computerised tomography (HRpQCT) at the distal radius and tibia and to investigate the genetic correlations of these measures. Participants were 177 mother-offspring pairs from 162 families (mothers, mean age (SD) = 52.1 (4.7) years offspring, 25.6 (0.73) years). Trabecular and cortical bone measures were obtained by HRpQCT. Multivariable linear regression was used to analyse the association of bone measures between mother and offspring. Sequential Oligogenic Linkage Analysis Routines (SOLAR) software was utilised to conduct quantitative genetic analyses. All maternal bone measures were independently associated with the corresponding bone measures in the offspring before and after adjustment for age, sex, weight and height. Heritability estimates ranged from 24% to 67% at the radius and from 42% to 74% at the tibia. The relationship for most bone geometry measures was significantly stronger in mother-son pairs (n = 107) compared with mother-daughter pairs (n = 70) (p < 0.05). In contrast, the heritability for most vBMD and microarchitecture measures were higher in mother-daughter pairs. Bivariate analyses found moderate to strong genetic correlations across all measures between radius and tibia (R
Publisher: Springer Science and Business Media LLC
Date: 15-05-2014
DOI: 10.1007/S00223-014-9863-6
Abstract: Studies examining the association between muscle size, muscle strength, and bone mineral density (BMD) are limited. Thus, this study aimed to describe the association between hip muscles cross-sectional area (CSA), muscle strength, and BMD of the hip and spine. A total of 321 subjects from the Tasmanian Older Adult Cohort study with a right hip MRI scan conducted between 2004 and 2006 were included. Hip muscles were measured on MR images by OsiriX (Geneva) software measuring maximum muscle CSA (cm(2)) of gluteus maximus, obturator externus, gemelli, quadratus femoris, piriformis, pectineus, sartorius, and iliopsoas. Dual-energy X-ray absorptiometry measured total hip, femoral neck, and spine BMD, and lower limb muscle strength was assessed by dynamometer. Muscle CSA of the hip flexors (pectineus, sartorius, and iliopsoas) and the hip rotators, obturator externus, and quadratus femoris were associated with both total hip and femoral neck BMD (all p < 0.05). The associations between CSA of pectineus and sartorius and BMD were stronger in women (p = 0.01-0.001) compared to men (p = 0.12-0.54). Additionally, only gemelli CSA was associated with BMD of the spine (p = 0.002). Gluteus maximus and piriformis showed no relationship with BMD. CSA of most hip muscles (except gluteus maximus and gemelli) were positively associated with leg strength (p = 0.02 to <0.001). Lastly, leg strength was weakly associated with BMD (p = 0.11-0.007). Hip muscle CSA, and to a lesser extent muscle strength, were positively associated with hip BMD. These data suggest that both higher muscle mass and strength may contribute to the maintenance of bone mass and prevention of disease progression in older adults.
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.JOCA.2015.01.004
Abstract: Genetic factors play an important role in the pathogenesis of knee osteoarthritis (OA), but which knee structural changes mediate this is unclear. This study aimed to describe the differences in knee structural changes over 8-10 years between offspring having at least one parent with total knee replacement (TKR) for severe primary knee OA and controls with no family history of knee OA. 115 offspring (mean age 45 years) with a family history of TKR for severe knee OA were compared with 104 (mean age 46 years) controls. T1 or T2-weighted fat saturated magnetic resonance imaging (MRI) was performed respectively to evaluate knee cartilage defects, bone marrow lesions (BMLs), meniscal extrusion and tears at baseline and 10 years. Multivariate logistic regression model was used to adjust for potential confounders. Offspring had a greater increase in cartilage defect score (1.03 vs 0.52, P = 0.007) and meniscal extrusion score (0.28 vs 0.10, P = 0.027) over 10 years, and a greater increase in meniscal tear score (0.40 vs 0.10, P = 0.012) over 8 years in the medial but not the lateral tibiofemoral compartment. Changes in BMLs over 8-years were not different between the two groups. These associations were independent of potential confounders, and strengthened after further adjustment for each other. With the exception of BMLs, offspring with a family history of knee OA have a greater risk of increases in multiple knee structural abnormalities in the medial tibiofemoral compartment suggesting pleiotropic familial effects.
Publisher: Elsevier BV
Date: 04-2016
Publisher: AMPCo
Date: 04-1991
Publisher: Elsevier BV
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 04-2020
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.EXGER.2018.01.026
Abstract: To describe the longitudinal associations between physiological falls risk, and between-person and within-person effects of 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. Data for 1053 participants (51% women mean age 63 ± 7.4 years) studied at baseline, 2.5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate-to-vigorous PA (MVPA) was measured using accelerometer. Linear mixed-effect regression models, with adjustment for confounders, were used to estimate the association between physiological falls risk and between-person and within-person effects of PA, 25OHD and WOMAC score. Between-person effects showed that 10-year average physiological falls risk was lower in participants who had a higher 10-year average 25OHD (β = -0.005 per nmol/l, 95% CI: -0.008, -0.002), log-MVPA (β = -0.16 per minute, 95% CI: -0.22, -0.10) and lower mean WOMAC score (β = 0.005 per-unit score, 95% CI: 0.003, 0.01). Within-person effects showed that a higher physiological falls risk at any time-point was associated with higher than average WOMAC score (β = 0.002 per-unit score, 95% CI: 0.0003, 0.004) and lower than average log-MVPA (β = -0.15 per minute, 95% CI: -0.24, -0.06), but not 25OHD, at the same time-point. Having higher WOMAC global score above an in idual's average increases the risk of falling, whereas, increasing one's own MVPA level further reduces their risk of falling. The presence of between-person but not within-person associations for 25OHD suggests the former may be confounded by other factors.
Publisher: BMJ
Date: 12-2002
Abstract: Previous studies have suggested a strong genetic component to osteoarthritis (OA), especially that of the hand, and three linkage studies have suggested the existence of susceptibility loci in disparate regions of chromosome 2q. To examine for linkage to 2q in a Tasmanian population of women and men with familial hand OA. Hand OA (distal interphalangeal, carpometacarpal, and Heberden's nodes) was assessed by a combination of hand photographs and radiographs. A non-parametric linkage (NPL) analysis was performed on chromosome 2q of 69 members in 22 families with severe distal interphalangeal joint OA using Genehunter. A quantitative trait linkage analysis of a larger group of 456 members in 68 families was also performed using SOLAR. The maximum non-parametric linkage score was 1.05 (p=0.15) at marker IL1R1, close to the centromere. All components of hand OA scores had significant heritability in this dataset (28%-35%, all p<0.001). Despite this, the quantitative trait analysis (after adjustment for age and, where appropriate, sex) yielded maximum LOD scores of 0.90 for Heberden's nodes (both sexes combined), and 1.19 for carpometacarpal OA score (women only). These results do not provide confirmation of linkage on chromosome 2q in the larger white population with hand OA. They suggest that there are regional variations in the genetic cause of hand OA and that other loci not on 2q may be important in this disease.
Publisher: BMJ
Date: 06-2013
Publisher: BMJ
Date: 23-06-2011
Publisher: Springer Science and Business Media LLC
Date: 15-11-2012
DOI: 10.1007/S00198-012-2211-7
Abstract: The relationship between social disadvantage and bone mineral density (BMD) is complex and remains unclear furthermore, little is known of the relationship with vertebral deformities. We observed social disadvantage to be associated with BMD for females, independent of body mass index (BMI). A lower prevalence of vertebral deformities was observed for disadvantaged males. The relationship between social disadvantage and BMD appears complex and remains unclear, and little is known about the association between social disadvantage and vertebral wedge deformities. We examined the relationship between social disadvantage, BMD and wedge deformities in older adults from the Tasmanian Older Adult Cohort. BMD and wedge deformities were measured by dual-energy X-ray absorptiometry and associations with extreme social disadvantage was examined in 1,074 randomly recruited population-based adults (51 % female). Socioeconomic status was assessed by Socio-economic Indexes for Areas values derived from residential addresses using Australian Bureau of Statistics 2001 census data. Lifestyle variables were collected by self-report. Regression models were adjusted for age, BMI, dietary calcium, serum vitamin D (25(OH)D), smoking, alcohol, physical inactivity, calcium/vitamin D supplements, glucocorticoids and hormone therapy (females only). Compared with other males, socially disadvantaged males were older (65.9 years versus 61.9 years, p = 0.008) and consumed lower dietary calcium and alcohol (both p ≤ 0.03). Socially disadvantaged females had greater BMI (29.9 ± 5.9 versus 27.6 ± 5.3, p = 0.002) and consumed less alcohol (p = 0.003) compared with other females. Socially disadvantaged males had fewer wedge deformities compared with other males (33.3 % versus 45.4 %, p = 0.05). After adjustment, social disadvantage was negatively associated with hip BMD for females (p = 0.02), but not for males (p = 0.70), and showed a trend for fewer wedge deformities for males (p = 0.06) but no association for females (p = 0.85). Social disadvantage appears to be associated with BMD for females, independent of BMI and other osteoporosis risk factors. A lower prevalence of vertebral deformities was observed for males of extreme social disadvantage. Further research is required to elucidate potential mechanisms for these associations.
Publisher: BMJ
Date: 31-07-2013
DOI: 10.1136/ANNRHEUMDIS-2013-203691
Abstract: To investigate cross-sectional and longitudinal associations between systemic bone mineral density (BMD), subchondral BMD (sBMD) and knee cartilage thickness in older adults with or without radiographic osteoarthritis (ROA). A prospective cohort of 158 randomly selected subjects (mean 63 years, 48% women) including 69 non-ROA and 89 ROA subjects were studied at baseline and 2.7 years later. Knee cartilage thickness was semi-automatically determined from T1-weighted fat-suppressed MRI. Knee cartilage volume was measured from MRI. Systemic BMD and sBMD were measured by dual-energy X-ray absorptiometry (DXA). Cross-sectionally, total body, total hip, spine BMD and/or lateral tibial sBMD were significantly and positively associated with femoral, lateral tibial and/or patellar cartilage thickness in subjects with ROA after adjustment for potential confounders. Longitudinally, a high total body BMD was associated with an increase in femoral cartilage thickness (β: 0.33 mm/g/cm(2), 95% CI 0.13 to 0.53) a high spine BMD was associated with increases in femoral and lateral tibial cartilage thickness (β: 0.25 mm/g/cm(2), 95% CI 0.10 to 0.41 and β: 0.18 mm/g/cm(2), 95% CI: 0.01 to 0.34, respectively) and a high medial tibial sBMD was associated with an increase in medial tibial cartilage thickness (β: 0.45 mm/g/cm(2), 95% CI 0.02 to 0.89) in subjects with ROA. In contrast, there were no significant associations between baseline systemic BMD, sBMD and cartilage volume loss, nor were there associations between BMD and cartilage thickness in subjects without ROA. Both systemic and subchondral BMD are positively associated with increased cartilage thickness in subjects with ROA, suggesting BMD may play a protective role against cartilage loss in knee OA.
Publisher: Springer Science and Business Media LLC
Date: 18-07-2018
Publisher: BMJ
Date: 06-06-2013
DOI: 10.1136/ANNRHEUMDIS-2013-203210
Abstract: Meniscal tears are commonly found on MRI and increase the risk for radiographic knee osteoarthritis (OA). While meniscectomy is recommended when knee pain is severe or functionally disabling, it is unclear how to best treat meniscal tears without these symptoms. The aim of this longitudinal study was to examine the effect of weight change on knee cartilage and pain in a cohort of community-based adults with and without meniscal tears detected by MRI. 250 adults with no history of knee OA or knee injury were recruited from the general community and weight-loss clinics. MRI of the knee, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), weight and height were measured at baseline and again at follow-up approximately 2 years later. Medial meniscal tears were present in 36 (18%) of the cohort. In those with medial meniscal tears, after adjustment for confounders, percentage weight change was significantly associated with percentage change in medial tibial cartilage volume (β 0.2% 95% CI 0.08% to 0.3% p=0.002) and knee pain (β 11.6% 95% CI 2.1% to 21.1% p=0.02). That is, for every 1% gain in weight, there was an associated 0.2% increased loss of medial tibial cartilage volume and 11.6% increase in pain. In those with no medial meniscal tear, neither change in medial tibial cartilage volume (β 0.02% 95% CI -0.01% to 0.10% p=0.53) or pain (β 1.9% 95% CI -2.2% to 6.1% p=0.36) were significantly associated with change in weight. This study demonstrated that among adults with medial meniscal tears, weight gain is associated with increased cartilage loss and pain, while weight loss is associated with the converse. This suggests attention to weight is particularly important in the management of people with medial meniscal tears.
Publisher: Massachusetts Medical Society
Date: 21-12-2017
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.1186/AR1962
Publisher: Wiley
Date: 28-07-2011
Publisher: American Medical Association (AMA)
Date: 20-12-1995
Publisher: BMJ
Date: 17-09-1994
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 19-08-2019
DOI: 10.1002/JBMR.3817
Abstract: Musculoskeletal pain is common and typically occurs at multiple sites. Pain has been shown to be associated with falls risk however, whether an increased risk for falls associated with multisite pain (MSP) translates into an increased risk of fractures has not been investigated. This study aimed to examine the association of number of painful sites with prevalent and incident fractures. Data from a longitudinal population-based study of older adults (mean age 63 years) were utilized. Follow-up was performed at 2.6, 5.1, and 10.7 years later, respectively. Presence/absence of pain at the neck, back, hands, shoulders, hips, knees, and feet was assessed by questionnaire at baseline. Participants were classified into three groups according to the total number of painful sites: zero to two, three to four, and five to seven. Fractures were self-reported at each time point. BMD was measured by DXA. Falls risk was calculated based on the Short-Form Physiological Profile Assessment. Log-binomial regression was used for the analyses. There were 450 fractures at baseline and 154 new fractures reported during a mean follow-up period of 10.7 years (range 9.2 to 12.5 years). In multivariable analyses, number of painful sites was associated with prevalent fractures at any and nonvertebral site. Furthermore, participants with five to seven painful sites had an increased risk of incident fractures at any site (RR 1.69 95% CI, 1.13 to 2.53) major site, including the femur, radius, ulnar, vertebral, rib, and humerus (RR 2.17 95% CI 1.12 to 4.22) and vertebral site (RR 6.44, 95% CI, 1.64 to 25.33) compared with those with pain at zero to two sites. These associations remained statistically significant after further adjustment for falls risk and BMD. Pain at multiple sites was associated with incident fracture risk in a dose-response manner, suggesting that widespread pain is an independent contributor to fracture risk. The potential for pain management in fracture prevention warrants further exploration. © 2019 American Society for Bone and Mineral Research.
Publisher: BMJ
Date: 06-2016
Publisher: Informa UK Limited
Date: 09-2011
Abstract: Physical activity has many health benefits however, there has been concern that exercise may increase the risk of the development or progression of osteoarthritis (OA) of the knee. There is little doubt that injury increases the risk of OA, but the role of physical activity independent to injury is uncertain. Recently, magnetic resonance imaging has allowed an in-depth assessment of joints and relevant structural changes-this review covers the recent imaging data relevant to this area. In children and young adults, physical activity appears beneficial for knee cartilage, possibly even in structurally abnormal knees. In addition, there is consistent evidence showing aerobic and strengthening exercise improves OA symptoms later in life. However, there is limited evidence associating exercise with structural changes in later life and this lacks consistency, suggesting little or no effect. In the meantime, it appears safe to prescribe exercise in later life without major concern for structural deterioration, although caution is appropriate in those with bone marrow lesions until more information becomes available.
Publisher: Oxford University Press (OUP)
Date: 06-1997
DOI: 10.1093/PTJ/77.6.619
Abstract: This article reviews and analyzes the role of vision and spatial orientation in maintaining posture and balance. The key issues that relate to the development of postural control across the life span are discussed. Use of vision as a critical source of information that specifies spatial orientation in the environment is considered. We argue that the visual system functions as part of the perception-action cycle as promoted in ecological psychology by James Gibson. We compare and contrast theory and evidence of both standard and ecological accounts of how the visual system perceives the information and the findings relative to the role of the retinal vision in processing and acting on information related to motion. Changes in the ambient optical array (optical flow) as a non-force field are compared with gravity-based perturbations relative to the possible influence of the non-force field to changes in the motor system. Finally, a summary of some of our own work is presented, with comments about implications for further research and possible applications to clinical practice.
Publisher: Informa UK Limited
Date: 07-2012
DOI: 10.2147/BTT.S20659
Publisher: Elsevier BV
Date: 04-2019
Publisher: OMICS Publishing Group
Date: 11-2010
DOI: 10.2217/THY.10.77
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 04-2018
Publisher: Wiley
Date: 23-09-2020
DOI: 10.1111/AJAG.12816
Abstract: To examine associations of education and occupation with handgrip strength (HGS), lower limb strength (LLS) and appendicular lean mass (ALM). Measures of HGS, LLS and ALM (dual‐energy X‐ray absorptiometry) were ascertained at baseline in 1090 adults (50‐80 years, 51% women), ~3 and 5 years. Education and occupation were self‐reported, the latter categorised as high‐skilled white collar (HSWC), low‐skilled white collar (LSWC) or blue collar. Separate general estimating equations were performed. The highest education group had greater HGS than the middle (0.33 psi) and lowest (0.48 psi) education groups, and 0.34 kg greater ALM than the lowest education group. HGS was 0.46 psi greater for HSWC than LSWC groups. Compared to LSWC groups, LLS was 5.38 and 7.08 kg greater in HSWC and blue‐collar groups. Blue‐collar and HSWC groups each had ~ 0.60‐0.80kg greater ALM than LSWC. Progressive muscle loss can be prevented by targeted intervention thus, we suggest clinical attention be directed towards specific social groups.
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/ANNRHEUMDIS-2020-EULAR.2687
Abstract: Knee osteoarthritis (OA) is the most prevalent joint disease worldwide, but no disease-modifying treatments are available. Existing treatments largely focus on relieving symptoms, but they may have substantial adverse effects. Identifying risk factors affecting knee symptoms is important for developing safer prevention strategies of knee OA symptoms. To describe the associations between diet quality in childhood and adulthood and knee symptoms in young adults. Participants were from the Australian Schools Health and Fitness Survey (ASHFS) in 1985, which was conducted to provide benchmark data on the health and fitness of Australian schoolchildren. During 2004-2006, participants were followed up in the Childhood Determinants of Adult Health (CDAH) Study. Dietary measures were collected in ASHFS (aged 10-15 years) and CDAH Study (aged 26-36 years) using food questionnaires. Diet quality was assessed by Dietary Guidelines Index (DGI), reflecting the adherence to Australian Dietary Guidelines. The DGI comprises 9 components and its maximum possible score is 100. A higher score indicated higher diet quality. During 2008-2010, participants (aged 31-41years) were followed up in the CDAH Knee Study. Knee symptoms were collected using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Zero-inflated negative binomial regression analyses were used to assess the associations between diet quality and knee symptoms. Age, sex, body mass index, physical activity, total energy intake, and knee injury history were included as potential confounders based on biological plausibility. A total of 399 participants (48.4% were female) were included in analysis. The average childhood and adult DGI was 46.5 and 55.4, respectively. The prevalence of knee pain, stiffness and dysfunction was 35.1%. 31.6% and 39.9%, respectively. The overall childhood DGI was not associated with adult knee symptoms. However, the limited intake of discretionary foods in childhood was associated with lower pain (Mean ratio (MR): 0.96, 95% confidence interval (CI): 0.92-1.00) and dysfunction (MR: 0.94, 95% CI: 0.90-0.99). The overall adult DGI was not associated with knee symptoms. However, replacing saturated fats with unsaturated fats in adulthood was associated with lower WOMAC (Pain: MR 0.93, 95% CI 0.87-0.99 stiffness: MR 0.93, 95% CI 0.87-0.99 dysfunction: MR 0.91, 95% CI 0.83-0.99), drinking water in adulthood was associated with lower stiffness (MR: 0.90, 95% CI: 0.83-0.99), and fruit intake in adulthood was associated with lower dysfunction (MR: 0.90, 95% CI: 0.81-0.99). Moreover, higher DGI score for dairy in adulthood was associated with higher WOMAC (Pain: MR 1.07, 95% CI 1.00-1.13 stiffness: MR 1.13, 95% CI 1.05-1.21 dysfunction: MR 1.11, 95% CI 1.02-1.21). The overall score change of DGI from childhood to adulthood was not associated with adult knee symptoms. However, the score change of replacing saturated fats with unsaturated fats from childhood to adulthood was associated with lower stiffness (MR 0.89, 95% CI 0.80-0.98), and the score change of fruit intake was associated with lower dysfunction (MR 0.92, 95% CI 0.86-0.99). Several DGI component scores in childhood and adulthood and some changes of DGI component score from childhood to adulthood were associated with knee symptoms in young adults. The results suggested that early-life diet quality may affect knee symptoms in young adults. None declared
Publisher: Elsevier BV
Date: 05-2009
DOI: 10.1016/J.BONE.2008.11.009
Abstract: It has been hypothesized that bone density tracks but long term studies in children are lacking. As such, the aim of this study was to describe tracking of dual X-ray absorptiometry measures from age 8 to age 16 years, whether this was independent of change in body size and whether deviation from tracking could be predicted. 116 males and 67 females had anthropometric (height and weight), questionnaire (medication use, sports, breastfeeding), fitness (PWC(170)) and DXA measures (bone free lean mass [LM], fat mass [FM] and bone mass) at baseline and follow-up. BMC and aBMD were assessed at the spine and hip and total body and bone mineral apparent density (BMAD) at the spine and hip. We found all DXA measures tracked significantly after adjustment for change in height and change in weight (males: R(2): BMC 24-62% aBMD 41-48% BMAD 30-37%, females: R(2): BMC 45-72% aBMD 36-56% BMAD 30-48%). Factors that predicted subjects would deviate positively, that is improve in tertile or remain in the highest tertile of spine and hip aBMD included having been breastfed, increase in LM, PWC(170) at age 8 and sport participation in males. LM at age 8 was beneficial in males while in females FM at age 8 predicted subjects would deviate positively. Boys who gained absolute and percent FM and girls who gained percent FM, were more likely to deviate negatively, that is, decrease in tertile or remain in the lowest tertile of spine and hip aBMD. ICS use at age 8 also predicted subjects, particularly males would not improve in bone mass relative to their peers. In conclusion, DXA measures track moderately to strongly from childhood to adolescence. This was independent of linear growth and sex indicating bone development and physical growth are under largely separate mechanistic control. Body composition was the main predictor of altered tracking but environmental factors also appear important.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 04-2019
Publisher: Research Square Platform LLC
Date: 13-11-2019
Abstract: Background: Knee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at modifying structures visible on imaging have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic inflammation and could be used for targeting inflammatory mechanisms of OA. Methods: 260 patients with clinical knee OA, significant knee pain and effusion-synovitis present on MRI will be recruited in 5 Australian cities (Hobart, Melbourne, Sydney, Adelaide and Perth). They will be randomly allocated to the two arms of the study, receiving 2g/day krill oil or inert placebo daily for 6 months. MRI of the study knee will be performed at screening, and after 6 months. Knee symptoms, function and MRI structural abnormalities will be assessed using validated methods. Safety data will be recorded. Primary outcomes are absolute change in knee pain (assessed by visual analog score) and change in size of knee effusion-synovitis over 24 weeks. Secondary outcomes include improvement in knee pain over 4, 8, 12, 16 and 20 weeks. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per protocol analyses adjusting for missing data and for treatment compliance will be performed as the secondary analyses. Discussion: This study will provide high-quality evidence to assess whether krill oil 2g/day reduces pain and effusion-synovitis size in older adults with clinical knee OA and knee effusion-synovitis. If krill oil is effective and confirmed to be safe, we will provide compelling evidence that krill oil improves pain and function, changes disease trajectory and slows disease progression in OA. Given the lack of approved therapies for slowing disease progression in OA, and moderate cost of krill oil, these findings will be readily translated into clinical practice.
Publisher: Elsevier BV
Date: 04-2013
Publisher: Research Square Platform LLC
Date: 03-08-2019
Abstract: Background: Knee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at structural modification have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic inflammation and could be used for targeting inflammatory mechanisms of OA. Methods: 260 patients with clinical knee OA, significant knee pain and effusion-synovitis present on MRI will be recruited in 5 Australian cities (Hobart, Melbourne, Sydney, Adelaide and Perth). They will be randomly allocated to the two arms of the study, receiving 2g/day krill oil or inert placebo daily for 6 months. MRI of the study knee will be performed at screening, and after 6 months. Knee symptoms, function and MRI structural abnormalities will be assessed using validated methods. Safety data will be recorded. Primary outcomes are absolute change in knee pain (assessed by visual analog score) and change in size of knee effusion-synovitis over 24 weeks. Secondary outcomes include improvement in knee pain over 4, 8, 12, 16 and 20 weeks. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per protocol analyses adjusting for missing data and for treatment compliance will be performed as the secondary analyses. Discussion: This study will provide high-quality evidence to assess whether krill oil 2g/day reduces pain and effusion-synovitis size in older adults with clinical knee OA and knee effusion-synovitis. If krill oil is effective and confirmed to be safe, we will provide compelling evidence that krill oil improves pain and function, changes disease trajectory and slows disease progression in OA. Given the lack of approved therapies for slowing disease progression in OA, and moderate cost of krill oil, these findings will be readily translated into clinical practice.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Elsevier BV
Date: 04-2021
Publisher: Research Square Platform LLC
Date: 09-10-2019
Abstract: Background : Knee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at modifying structures visible on imaging have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic inflammation and could be used for targeting inflammatory mechanisms of OA. Methods : 260 patients with clinical knee OA, significant knee pain and effusion-synovitis present on MRI will be recruited in 5 Australian cities (Hobart, Melbourne, Sydney, Adelaide and Perth). They will be randomly allocated to the two arms of the study, receiving 2g/day krill oil or inert placebo daily for 6 months. MRI of the study knee will be performed at screening, and after 6 months. Knee symptoms, function and MRI structural abnormalities will be assessed using validated methods. Safety data will be recorded. Primary outcomes are absolute change in knee pain (assessed by visual analog score) and change in size of knee effusion-synovitis over 24 weeks. Secondary outcomes include improvement in knee pain over 4, 8, 12, 16 and 20 weeks. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per protocol analyses adjusting for missing data and for treatment compliance will be performed as the secondary analyses. Discussion : This study will provide high-quality evidence to assess whether krill oil 2g/day reduces pain and effusion-synovitis size in older adults with clinical knee OA and knee effusion-synovitis. If krill oil is effective and confirmed to be safe, we will provide compelling evidence that krill oil improves pain and function, changes disease trajectory and slows disease progression in OA. Given the lack of approved therapies for slowing disease progression in OA, and moderate cost of krill oil, these findings will be readily translated into clinical practice.
Publisher: Humana Press
Date: 11-2011
Publisher: Elsevier BV
Date: 04-2019
Publisher: Springer Science and Business Media LLC
Date: 05-01-2016
Publisher: Springer Science and Business Media LLC
Date: 09-2004
DOI: 10.1007/S11914-004-0014-2
Abstract: Fractures in childhood have long been considered an unavoidable consequence of growth. Studies in recent years have documented the epidemiology of these very common fractures and have also documented considerable variation by fracture type and from country to country. There have also been a number of studies aimed at identifying risk factors particularly for the most common distal forearm fracture. These studies have consistently associated bone mineral density with these fractures. Other possible risk factors include obesity, physical inactivity, sports, cola beverages, calcium intake, risk taking, and coordination. While prospective studies are required to confirm these risk factors, accumulating evidence now suggests that a substantial proportion of fractures in children are preventable.
Publisher: BMJ
Date: 23-06-2010
Abstract: Riding thoroughbred racehorses is a hazardous occupation. In this study, we investigated risk factors associated with falls by licensed thoroughbred racing jockeys participating in flat races conducted in Australia. Data on race-day falls were extracted from stewards' reports. Denominator data were provided by Racing Information Services Australia on races conducted in Australia from August 2002 until July 2006. Incidence rate ratios (IRRs) were estimated using Poisson regression. Analyses were stratified by race grade (maiden, class, open/restricted). In multivariable analyses, factors associated with falls were female sex of jockey (IRR 1.11 95% CI 1.00 to 1.23), being an apprentice jockey (IRR 1.51 95% CI 1.39 to 1.63), being an amateur jockey (IRR 1.44 95% CI 1.11 to 1.86), drier tracks (p<0.001), younger horse age (p<0.001), shorter race distance (p<0.001), lower field size (p=0.013) and lower race grade (p<0.001). The IRRs for five factors associated with falls differed by category of race grade: those for apprentice jockey (interaction p=0.003), higher prize money (interaction p<0.001) and shorter race distance (interaction p=0.041) were greater in lower race grades, while those for fewer previous rides this meeting (interaction p=0.027) and drier track rating (interaction p=0.035) were greater in higher race grades. Female jockeys had a significantly higher incidence of falls when riding horses under 4 years of age in open and restricted races (interaction p=0.038), and the effects of lower field size in maiden races, and of shorter races, were more pronounced for falls occurring before the race. We identified a range of factors associated with falls to thoroughbred racing jockeys riding in flat races that adds to the evidence base for formulating strategies to improve occupational health and safety standards in the thoroughbred racing industry.
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 02-2005
DOI: 10.1016/J.BONE.2004.11.001
Abstract: The aim of this population-based case-control study was to describe the association among skeletal age deviation (SAD), bone density, and upper limb fracture risk in male and female children aged 9-16 years. A total of 321 fracture cases and 321 randomly selected in idually matched controls were studied. Skeletal age was assessed by standard atlas. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) and metacarpal index (MI). There were no significant differences in mean skeletal age or chronological age between fracture cases and controls. However, SAD was associated with total, hand, and female fracture risk (all P<0.05). The fracture associations became nonsignificant after adjustment for BMD and MI in all subgroups with the exception of hand fractures (OR, 0.67/year 95% CI, 0.47-0.96). SAD was also positively associated with BMD at all sites (r=0.33-0.35, all P<0.05) and MI (r=0.20, P<0.05). The strength of association reduced but remained significant at most sites after adjustment for body size, maturity, age, and sex. In conclusion, SAD is positively associated with measures of bone strength and negatively associated with upper limb fracture risk (especially those of the hand) in children. SAD is simple to measure and gives additional information regarding bone health and fracture risk in children.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JSAMS.2018.10.008
Abstract: To describe the cross-sectional association between musculoskeletal pain at multiple sites and physical work capacity (PWC) and objectively measured physical activity (PA). Observational study. Data from a subs le of the UK Biobank were utilised (n=9856 mean age 58.5 years, mean body mass index 30.2kg/m Increase in number of painful sites was associated with lower PWC, moderate and vigorous PA and increased low intensity PA in a dose-response relationship (all p-values for trend ≤0.001) before and after adjustment for confounders. In site specific analyses, hip pain was associated with an increased low intensity PA (β 52.8min/week, 95% CI 2.3-103.2) and reduced moderate PA (β -50.1min/week, 95% CI -98.5 to -1.8). Knee pain was only associated with vigorous PA (β -5.7min/week, 95% CI -10.0 to -1.3). Pain at neck/shoulder pain and back were not independently associated with PWC and PA. Greater number of painful sites is consistently associated with poorer PWC, increased low intensity PA and reduced moderate to vigorous PA. Clinicians should address the critical role of being physically active in managing chronic musculoskeletal pain and interventions targeting musculoskeletal pain may be needed to increase PA levels.
Publisher: Elsevier BV
Date: 11-2010
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JAMDA.2019.07.001
Abstract: Resistin acts as an endogenous ligand of Toll-like receptor (TLR)-4 that triggers major inflammatory pathways and mediates inflammatory processes. The role of resistin in osteoarthritis (OA) pathogenesis is unclear. The aim of this study is to describe the longitudinal associations of serum levels of resistin with knee synovitis measures and structural abnormalities in patients with knee OA. A prospective cohort study. Patients (n = 200) with symptomatic knee OA (mean age 63.1 years, range 49-79 female 46.5%) participated. All measures were performed at baseline and 2 years later. Serum resistin was measured using enzyme-linked immunosorbent assay. Infrapatellar fat pad (IPFP) high signal intensity alteration and effusion synovitis were measured from magnetic resonance imaging (MRI). Knee structures including cartilage volume, cartilage defects, and bone marrow lesions (BMLs) were also assessed by MRI semiquantitatively or quantitatively. Linear or logistic mixed effects regression analyses were used in longitudinal analyses. Serum resistin was positively associated with high signal intensity alteration measures of IPFP as well as the presence [relative risk = 1.06, 95% confidence interval (CI) 1.02, 1.10] and volume (β = 0.77, 95% CI 0.01, 1.53) of effusion synovitis in multivariable analyses. Serum levels of resistin were also positively associated with higher tibiofemoral cartilage defect (β = 1.98, 95% CI 0.34, 3.57) and BML scores (β = 3.18, 95% CI 0.99, 5.37) after adjustment for covariates. Higher serum levels of resistin are associated with knee synovitis surrogate measures and structural abnormalities, suggesting that obesity may promote OA not only by increasing weight loading on joints but also by triggering 1 or more inflammatory pathways.
Publisher: The Endocrine Society
Date: 09-1995
DOI: 10.1210/JCEM.80.9.7673413
Abstract: The risk of osteoporotic fracture is related to peak bone mass achieved at skeletal maturity and subsequent bone loss. Although premature menopause is a risk factor for osteoporosis, the effect of exposure to endogenous estrogen during a woman's reproductive years is poorly characterized. We analyzed the relationship between reproductive factors and estrogen exposure on bone mineral density (BMD) and incidence of atraumatic fracture in data from 1091 women (age: 70 +/- 7.2 yr mean +/- SD) participating in the Dubbo Osteoporosis Epidemiology Study. Age- and weight-adjusted BMD among women who had used estrogen replacement therapy (ERT) for more than 5 yr was higher at the lumbar spine and femoral neck by 13.7% and 10.2% (P < 0.001), respectively, compared with women who had used ERT for less than 5 yr or nonusers. Duration of exposure to estrogen (years of menstruation plus postmenopausal ERT use) was associated with higher BMD, such that BMD increased by 2-3% for every 10-yr increase in years of estrogen exposure thus women who menstruated for more than 40 yr had a 6-8% higher BMD than did women who menstruated for less than 30 yr. Higher BMD was also significantly associated with high parity, such that nulliparous women had 5-6% lower BMD than did their peers of the same age and weight. The incidence of atraumatic fractures among non-ERT users was higher than that of ERT-users [odds ratio (OR): 1.06 95% confidence interval (CI): 0.94-1.16] and was significantly lower among parous women than among nulliparous women (OR 0.94 95% CI: 0.84-0.98) in univariate analysis. Longer duration of menstruation was associated with lower fracture incidence (OR for 1 SD = 6.6 yr: 0.93 95% CI: 0.86-1.02). Moreover, when all of these factors were considered simultaneously, parity remained a significant determinant of fracture as well as femoral neck BMD. We conclude that high parity and longer duration of exposure to estrogen, either through natural menstruation or postmenopausal ERT, have protective effects on BMD and are associated with a reduced incidence of atraumatic fracture in a population-based study.
Publisher: SAGE Publications
Date: 10-2018
Abstract: Rheumatoid arthritis is a leading musculoskeletal cause of disability in Western society. Therapeutic options have expanded rapidly with the advent of biological agents as treatment options. One of these, tocilizumab, targets the interleukin-6 receptor and has been approved since the late 2000s in many jurisdictions. This approval was based on 6–12 month trials. It is now appropriate to look at longer-term studies and what new insights they have provided into this agent. Data are based largely on observational studies with their well-known limitations as well as some further randomized trials and provide a number of important observations regarding both efficacy and safety. In conclusion, the longer-term data suggest tocilizumab efficacy increases over time for both signs and symptoms and radiographic change. It is also corticosteroid sparing. The safety data are consistent with the shorter-term trials and are largely reassuring but some questions still remain over cardiovascular safety and cancer risk.
Publisher: BMJ
Date: 06-2016
Publisher: Elsevier BV
Date: 12-2021
Publisher: Informa UK Limited
Date: 03-2010
DOI: 10.1586/ECI.10.2
Abstract: Recent years have seen many exciting developments in the treatment of inflammatory arthritis. Tocilizumab (TCZ) is a compound that inhibits the IL-6 receptor. Following initial studies in Japan, it has been extensively studied in five multicenter clinical trials. This report concentrates on the Actemra Versus Methotrexate Double-blind Investigative Trial in Monotherapy (AMBITION), which compared TCZ monotherapy (8 mg/kg every 4 weeks) with methotrexate monotherapy over 24 weeks. TCZ was shown to be the first biologic agent that is superior to methotrexate across a whole range of clinical outcomes measures with a rapid onset of effect. Significant liver toxicity was less common in the TCZ group. However, increases in lipids and decreases in neutrophils and skin infections were more common in the TCZ arm. Long-term efficacy and safety follow-up is ongoing. This trial supports the use of TCZ as monotherapy and suggests it should be regarded as a first-line biologic therapy.
Publisher: Springer Science and Business Media LLC
Date: 24-08-2005
DOI: 10.1007/S00198-005-1960-Y
Abstract: Effective therapies for the treatment of osteoporosis and fracture have been available for a number of years. Despite this, there are numerous reports indicating very low uptake rates in those admitted to hospital with fracture. The aim of this retrospective audit was to assess the impact of a fracture protocol on inpatient prescriptions of osteoporosis therapy. A fracture protocol was arrived at by consensus and was based on recommendations from the Australian Fracture Prevention Summit, which included specific advice on the commencement in hospital of calcium, vitamin D, synthetic estrogen receptor modulators (SERMs) and bisphosphonates. We studied subjects who were treated for fractured neck of the femur at Royal Hobart Hospital from March 2002 to March 2004 and included 161 prior to the start of the protocol and 93 after. As compared to the baseline period, subjects after the introduction of the protocol had higher rates of in-hospital prescription for any treatment (58 vs. 36%, P <0.01), calcium (51 vs. 26%, P <0.01), vitamin D (48 vs. 29%, P <0.01) and oral bisphosphonates (24 vs. 5%, P <0.01), but not SERMs as expected (1 vs. 1%, P =0.70). Additional factors affecting the decision to start any treatment included in-hospital death (OR 0.16, 95% CI 0.05-0.49), dementia (OR 0.39, 95% CI 0.21-0.74), a trend for female sex (OR 1.79, 95%CI 0.96-3.36), but not age. In conclusion, a structural approach to changing hospital policy from the top down is effective at substantially increasing the usage of effective therapy after fractured neck of the femur.
Publisher: Bentham Science Publishers Ltd.
Date: 11-2010
DOI: 10.2174/157339710793205648
Abstract: Knee osteoarthritis (OA) is a common and significant cause of disability. Until recently, the major investigation to help establish a diagnosis of knee OA was the joint radiograph. This imaging modality offers only a two-dimensional image of a three-dimensional structure, and can only crudely identify major joint abnormalities at the later stage of disease. Moreover, joint radiographs cannot fully characterise subtle changes in intra and extraarticular structures, such as cartilage and bone marrow abnormalities that are now considered to be part of a whole-organ disease process. The recent advent of Magnetic Resonance Imaging (MRI) has enabled a three-dimensional assessment of the entire joint, thus providing new insights into the natural history of joint arthropathies. It is likely that morphological changes in articular structures caused by the OA process have their origins in the apparently healthy asymptomatic knee joint. MRI has therefore enabled the opportunity to better examine and understand pre-clinical and very subtle early aberrations in joint morphology, prior to the onset of radiographic disease. This discussion seeks to explore knee OA as a disease entity that can be recognised before any radiographic change. This may pose new, yet exciting challenges for the identification and classification of disease, and provide a better understand of the pathogenesis of knee OA.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2022
DOI: 10.1186/S13395-022-00286-9
Abstract: Skeletal muscles are essential components of the neuromuscular skeletal system that have an integral role in the structure and function of the synovial joints which are often affected by osteoarthritis (OA). The aim of this study was to identify the baseline metabolomic signatures for the longitudinal reduction of muscle strength over 10 years in the well-established community-based Tasmanian Older Adult Cohort (TASOAC). Study participants were 50–79 year old in iduals from the TASOAC. Hand grip, knee extension, and leg strength were measured at baseline, 2.6-, 5-, and 10-year follow-up points. Fasting serum s les were collected at 2.6-year follow-up point, and metabolomic profiling was performed using the TMIC Prime Metabolomics Profiling Assay. Generalized linear mixed effects model was used to identify metabolites that were associated with the reduction in muscle strength over 10 years after controlling for age, sex, and BMI. Significance level was defined at α =0.0004 after correction of multiple testing of 129 metabolites with Bonferroni method. Further, a genome-wide association study (GWAS) analysis was performed to explore if genetic factors account for the association between the identified metabolomic markers and the longitudinal reduction of muscle strength over 10 years. A total of 409 older adults (50% of them females) were included. The mean age was 60.93±6.50 years, and mean BMI was 27.12±4.18 kg/m 2 at baseline. Muscle strength declined by 0.09 psi, 0.02 kg, and 2.57 kg per year for hand grip, knee extension, and leg strength, respectively. Among the 143 metabolites measured, 129 passed the quality checks and were included in the analysis. We found that the elevated blood level of asymmetric dimethylarginine (ADMA) was associated with the reduction in hand grip ( p =0.0003) and knee extension strength ( p =0.008) over 10 years. GWAS analysis found that a SNP rs1125718 adjacent to WISP1 gene was associated with ADMA levels ( p =4.39*10 -8 ). Further, we found that the increased serum concentration of uric acid was significantly associated with the decline in leg strength over 10 years ( p =0.0001). Our results demonstrated that elevated serum ADMA and uric acid at baseline were associated with age-dependent muscle strength reduction. They might be novel targets to prevent muscle strength loss over time.
Publisher: Springer Science and Business Media LLC
Date: 04-2002
Abstract: There are limited data describing urban-rural differences in fracture incidence and the overall effect remains controversial. The aim of this study was to compare symptomatic fracture incidence occurring in geographically defined rural (n = 34619) and urban (n = 194974) populations of Southern Tasmania from July 1, 1997 to June 30, 1999. Fractures were ascertained by reviewing reports from all the radiology providers within the area. In the 2-year study time frame there were 3644 fractures in males and 2657 fractures in females. Fracture incidence was significantly higher in urban compared with rural populations in both sexes (male: RR 1.60, 95% CI 1.47-1.75 female: RR 1.77, 95% CI 1.58-1.98). This higher urban fracture incidence was present across all age groups and all fracture types with the exception of knee and pelvis fractures in males (although not all were statistically significant). In addition, urban men >50 years old had a higher fracture incidence than rural women >50 years old (RR 1.25, 95% CI 1.05-1.50), suggesting that in later life the factors responsible for the urban-rural difference are able to offset completely the effect of gender. While some of the reduced fracture incidence in the rural population may be explained by urban drift and underreporting of minor fractures such as foot fractures, the overall pattern of higher fracture risk was very consistent, suggesting a real difference in whole-of-life symptomatic fracture incidence. Further research at an in idual level is required to determine what factors account for these large urban-rural differences, as they imply a substantial potential for fracture prevention.
Publisher: Elsevier BV
Date: 06-2022
Publisher: The Endocrine Society
Date: 02-2015
DOI: 10.1210/JC.2014-3519
Abstract: High vitamin D and physical activity (PA) levels are independently associated with improved body composition and muscle function in older adults. The objective of this study was to investigate the interaction of 25-hydroxyvitamin D (25OHD) and PA status in maintenance of body composition and muscle function in older adults. This was a 5-year prospective population-based study of Australian community-dwelling older adults. Participants in the study included 615 community-dwelling volunteers aged 50 years old or older [61.4 ± 6.9 (mean ± SD) y 48% female] randomly selected from electoral rolls and categorized according to baseline serum 25OHD (≥ or & nmol/L) and PA (≥ or & 000 pedometer determined steps/d) levels as follows: high 25OHD and high PA (VitD+PA+) high 25OHD and low PA (VitD+PA−) low 25OHD and high PA (VitD-PA+) and low 25OHD and low PA (VitD-PA−). A subset of 518 participants completed accelerometer assessments during follow-up. Changes in dual-energy X-ray absorptiometry-assessed body composition and lower-limb muscle function were measured. VitD+PA+ had significantly smaller increases in body fat over 5 years compared with other groups (all P & .05). Higher baseline pedometer-determined PA resulted in declines in total body fat (β = −.23 kg per 100 steps/d, P = .001) over 5 years for participants with high 25OHD but not those with low 25OHD (P & .05). Among participants with accelerometer data, these associations were generally mediated by higher levels of moderate/vigorous PA. High vitamin D status appears to enhance PA-related declines in body fat during aging, but the mechanism may be greater amounts of outdoor moderate/vigorous PA rather than a direct effect of 25OHD.
Publisher: Wiley
Date: 19-07-2013
Publisher: Springer Science and Business Media LLC
Date: 21-10-2020
Publisher: SERDI
Date: 2023
Publisher: Wiley
Date: 09-1999
DOI: 10.1359/JBMR.1999.14.9.1628
Abstract: The objective of this cross-sectional study was to describe the relationship between cigarette smoking, effect modifiers, and bone density in premenopausal parous women. We studied a s le of 276 women (mean age 33 years) from Southern Tasmania. The study factors were cigarette smoking, body mass index (BMI), sports participation, and breastfeeding history. Bone mineral density was measured utilizing an Hologic QDR 2000 densitometer and converted to Z scores using the group mean and variance. There were 118 current smokers and 158 nonsmokers. Smokers had lower bone mass at all sites (femoral neck, -0.32 SD, 95% confidence interval [CI] -0.60 to -0. 04 lumbar spine, -0.49 SD, 95% CI -0.76 to -0.22 total body, -0.40 SD, 95% CI -0.66 to -0.14). Stratifying by BMI revealed that this association was only present, but greater in magnitude, for those with a BMI <25 kg/m2. Smokers who had breastfed at least one child had an additional deficit in bone mass (femoral neck, -0.48 SD, 95% CI -0.89 to -0.07 lumbar spine, -0.39 SD, 95% CI -0.80 to 0.02 total body, -0.37 SD, 95% CI -0.77 to 0.06) while smokers who took part in competitive sport had significant increments in bone mass (femoral neck, 0.74 SD, 95% CI 0.31 to 1.17 lumbar spine, 0.48 SD, 95% CI 0.03 to 0.93 total body, 0.42 SD, 95% CI 0.00 to 0.84). Neither of these two associations were present in nonsmokers. In conclusion, current smoking was associated with substantial deficits in bone mass in our s le of women, particularly those with a BMI <25 kg/m2. In addition, smoking may prevent the usual postweaning recovery phase of bone after breastfeeding while sports participation may offset the negative effect of smoking on bone mass. These observations need to be confirmed in longitudinal studies but they imply that past studies of smoking in this age group may have missed important associations as they did not consider possible effect modifiers.
Publisher: Springer Science and Business Media LLC
Date: 12-10-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2007
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.CLNU.2019.02.031
Abstract: Aging is characterized by progressive decline in physiologic reserves and functions as well as prolonged inflammation, increasing susceptibility to disease. Diet plays an important role in maintaining health, and reducing morbidity and mortality, especially in older populations. This study was designed to determine prospective associations between dietary inflammatory index (DII®) scores and bone health, sarcopenia-related outcomes, falls risk and incident fractures in community-dwelling Australian older adults. A total of 1098 [51% male age (mean ± SD) 63.0 ± 7.5 years] non-institutionalized older adults who participated in the Tasmanian Older Adult Cohort Study (TASOAC) at baseline, 768 at 5 years, and 566 at 10 years follow-up were included in this analysis. Baseline energy-adjusted DII (E-DII) scores were calculated using a validated Food Frequency Questionnaire. Changes in bone mineral density (BMD) and appendicular lean mass (ALM) were measured over ten years using dual-energy x-ray absorptiometry. Ten-year changes in hand grip, knee extensor and whole lower-limb muscle strength and quality were assessed by dynamometers and change in falls risk score using the Physical Profile Assessment (PPA). Incident fractures at any site and non-vertebral fractures over 10 years were self-reported. The E-DII range was -3.48 to +3.23 in men and -3.80 to +2.74 in women. Higher E-DII score (indicating a more pro-inflammatory diet) was associated with lower total hip (B: -0.009 95% CI: -0.017, 0.000) and lumbar spine BMD (B: -0.013 95% CI: -0.024, -0.002), and higher falls risk score (B: 0.040 95% CI: 0.002, 0.078) over 10 years in men. Women with higher E-DII scores had higher whole lower-limb muscle quality over 10 years (B: 0.109 95% CI: 0.002, 0.215). For every unit increase in E-DII score, incident fracture rates increased by 9.0% in men (IRR: 1.090 95% CI: 1.011, 1.175) and decreased by 12.2% in women (IRR: 0.878 95% CI: 0.800, 0.964) in a fully adjusted model. Higher E-DII scores were associated with lower bone density, higher falls risk, and increased incidence of fractures in community-dwelling older men, but decreased fracture incidence in women, over 10 years. This suggests pro-inflammatory diets may be more detrimental to musculoskeletal health in older men than in women. Additional studies are warranted to elucidate these sex differences.
Publisher: Springer Science and Business Media LLC
Date: 06-2018
DOI: 10.1007/S00198-018-4568-8
Abstract: Greater skin pigmentation reduces dose equivalent cutaneous vitamin D3 production, potentially impacting lifetime vitamin D status and fracture risk. We show that melanin density was positively associated with 25-hydroxyvitamin D and total body bone mineral density. These relationships were partially explained by greater sun exposure due to more permissive skin phenotype. Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, osteoporotic risk factors and potential intermediaries in a cohort of exclusively older Caucasian adults. One thousand seventy-two community-dwelling adults aged 50-80 years had constitutive melanin density quantified using spectrophotometry. Sun exposure, skin phenotype, non-melanoma skin cancer (NMSC) prevalence and smoking status were assessed by questionnaire. Bone mineral density (BMD), falls risk, physical activity and 25-hydroxyvitamin D were measured using DXA, the short form Physiological Profile Assessment, pedometer and radioimmunoassay, respectively. Higher melanin density was independently associated with greater ability to tan (RR = 1.27, p < 0.001), less propensity to sunburn (RR = 0.92, p < 0.001), fewer lifetime sunburns (RR = 0.94, p = 0.01), current smoking (RR = 1.41, p < 0.001), female sex (RR = 1.24, p < 0.001) and less photodamage (RR = 0.98, p = 0.01). The associations between melanin density and sun exposure (RR = 1.05-1.11, p < 0.001-0.01), sun protection behaviours (RR = 0.89, p < 0.001) and NMSC prevalence (RR = 0.75, p = 0.001) were no longer significant after taking into account skin phenotype and sun exposure, respectively. 25-Hydroxyvitamin D was strongly associated with higher melanin density (β = 1.71-2.05, p = 0.001). The association between melanin density and total body BMD (β = 0.007, p = 0.04) became non-significant after adjustment for 25-hydroxyvitamin D. There was no association between melanin density and physical activity, falls risk or BMD at other sites. Our data support a model of higher constitutive melanin density underpinning a less photosensitive skin phenotype, permitting greater sun exposure with fewer sequelae and yielding higher 25-hydroxyvitamin D and, potentially, total body BMD.
Publisher: Springer Science and Business Media LLC
Date: 04-06-2010
Publisher: Wiley
Date: 29-01-2019
DOI: 10.1002/ACR.23596
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JOCA.2018.12.023
Abstract: To investigate the longitudinal association between objectively measured ambulatory activity (AA) and knee MRI-detected osteophytes (OPs), and to test whether this relationship was modified by common risk factors for OA including sex, obesity, disease severity and knee injury history. 408 community-dwelling adults aged 51-81 years were assessed at baseline and 2.7 years. T1-weighted fat-suppressed MRI was used to evaluate knee OPs at both time points. AA was assessed at baseline by pedometers and categorized as: less active (≤7499 steps per day), moderately active (7500-9999 steps per day) and highly active (≥10,000 steps per day). Statistically significant interactions were detected between knee OA risk factors and AA on increases in MRI-detected OPs (all P < 0.05). In stratified analyses, being moderately active, compared to being less active, was protective against an increase in MRI-detected OPs (score change of ≥1) in females (relative risk (RR) = 0.42, 95%CI, 0.25-0.70, P < 0.01), those who were obese (RR = 0.50, 95%CI, 0.30-0.83, P < 0.01), those with radiographic OA (ROA) (RR = 0.68, 95%CI, 0.47-0.97, P = 0.02) and those with a history of knee injury (RR = 0.27, 95%CI, 0.08-0.88, P = 0.02) in almost every knee compartment, after adjustment for confounders. No statistically significant associations were found in males, non-obese, non-ROA or non-injury groups. Being moderately active is protective against an increase in MRI-detected OPs in females, those with ROA, those who are obese and those with a history of knee injury. These findings suggest that being moderately active is beneficial for in iduals who are at higher risk of knee OA.
Publisher: Elsevier BV
Date: 04-2017
Publisher: BMJ
Date: 10-2003
Publisher: Springer Science and Business Media LLC
Date: 26-02-2016
DOI: 10.1007/S00198-016-3545-3
Abstract: This was the first study investigating both linear associations between lower limb muscle strength and balance in middle-aged women and the potential for thresholds for the associations. There was strong evidence that even in middle-aged women, poorer LMS was associated with reduced balance. However, no evidence was found for thresholds. Decline in balance begins in middle age, yet, the role of muscle strength in balance is rarely examined in this age group. We aimed to determine the association between lower limb muscle strength (LMS) and balance in middle-aged women and investigate whether cut-points of LMS exist that might identify women at risk of poorer balance. Cross-sectional analysis of 345 women aged 36-57 years was done. Associations between LMS and balance tests (timed up and go (TUG), step test (ST), functional reach test (FRT), and lateral reach test (LRT)) were assessed using linear regression. Nonlinear associations were explored using locally weighted regression smoothing (LOWESS) and potential cut-points identified using nonlinear least-squares estimation. Segmented regression was used to estimate associations above and below the identified cut-points. Weaker LMS was associated with poorer performance on the TUG (β -0.008 (95 % CI: -0.010, -0.005) second/kg), ST (β 0.031 (0.011, 0.051) step/kg), FRT (β 0.071 (0.047, 0.096) cm/kg), and LRT (β 0.028 (0.011, 0.044) cm/kg), independent of confounders. Potential nonlinear associations were evident from LOWESS results significant cut-points of LMS were identified for all balance tests (29-50 kg). However, excepting ST, cut-points did not persist after excluding potentially influential data points. In middle-aged women, poorer LMS is associated with reduced balance. Therefore, improving muscle strength in middle-age may be a useful strategy to improve balance and reduce falls risk in later life. Middle-aged women with low muscle strength may be an effective target group for future randomized controlled trials. Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.JOCA.2018.02.899
Abstract: To assess the efficacy of adalimumab in patients with erosive hand osteoarthritis (OA). Patients >50 years old, meeting the American College of Rheumatology (ACR) criteria for hand OA, with pain >50 on 100 mm visual analogue scale (VAS), morning stiffness >30 min and ≥1 erosive joint on X-ray with synovitis present on magnetic resonance imaging (MRI) were included in a randomised double-blind placebo-controlled crossover trial. Patients were randomised to adalimumab (40 mg subcutaneous injections every other week) or identical placebo injections for 12 weeks followed by an 8-week washout and then crossed over treatment groups for another 12 weeks. The primary outcome was change in VAS hand pain over 12 weeks. Secondary outcomes included change in Australian/Canadian Hand OA Index (AUSCAN) pain, function and stiffness subscales from baseline to 4, 8 and 12 weeks, change in MRI-detected synovitis and bone marrow lesions (BMLs) from baseline to 12 weeks and change in VAS from baseline to 4 and 8 weeks. We recruited 51 patients and 43 were randomised to either Group 1 (N = 18, active then placebo) or Group 2 (N = 25, placebo then active). At 12 weeks there was no difference between the groups on the primary outcome measure (mean decrease in VAS pain of 3.2 mm standard deviation (SD 16.7) for adalimumab vs 0.8 mm (SD 29.6) for placebo). The adjusted treatment effect was -0.7 mm (95% confidence interval (CI) -9.3 to 8.0), P = 0.87. No statistically significant differences were found for any secondary outcomes. Adalimumab did not show any effect on pain, synovitis or BMLs in patients with erosive hand OA with MRI-detected synovitis as compared to placebo after 12 weeks. ACTRN12612000791831.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 04-2022
Publisher: Elsevier BV
Date: 04-2019
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: Elsevier BV
Date: 09-2018
Publisher: Elsevier BV
Date: 04-2012
Publisher: Springer Science and Business Media LLC
Date: 16-09-2010
Abstract: Fetal life may be a critical period for the development and/or programming of metabolic systems, including the skeleton. However, it is unclear on the association between maternal nutrition during pregnancy and bone mass in their offspring at adolescence. This was a birth cohort study of 216 adolescents (16.2+/-0.4 years). Dietary intake was measured by food frequency questionnaire. Bone densitometry was measured at the femoral neck, lumbar spine and total body by DXA. After adjustment for confounders, bone mineral density (BMD) of the femoral neck was positively associated with magnesium density and negatively associated with fat density (all P-values <0.05). BMD of the lumbar spine was positively associated with calcium, magnesium and phosphorus density and negatively associated with fat density (all P-values <0.05). Maternal milk intake was significantly positively associated with lumbar spine BMD. After considering all significant nutrients in the same model, fat density remained significant negatively for the femoral neck and lumbar spine, whereas magnesium density remained significant positively for the femoral neck. No nutrient was significant for the total body. Maternal intake of milk, fat and magnesium during the third trimester of pregnancy is predictive of BMD at age 16, suggesting that in utero diet influences peak bone mass possibly through programming bone responses.
Publisher: Springer Science and Business Media LLC
Date: 28-04-2020
Publisher: Springer Science and Business Media LLC
Date: 07-08-2019
DOI: 10.1038/S41430-018-0264-1
Abstract: We aimed to examine dietary patterns and their longitudinal associations with socio-demographic and lifestyle factors in older adults. A cohort of 1098 participants aged 50-80 years were followed for 5 years. Dietary intake was assessed at baseline, 2.6 and 5 years using a validated food frequency questionnaire. Dietary patterns were identified at baseline using exploratory factor analysis and pattern scores for each calculated using the weighted sum score method. Associations of dietary pattern scores with participants' characteristics were assessed using linear mixed-effects models. The three dietary patterns identified and the food groups of which they were predominantly composed were as follows: a healthy dietary pattern (vegetables, fruits, nuts, and whole grains) a western dietary pattern (pizza, hamburgers, chips, and potatoes) and a meat and vegetable dietary pattern (red meat, fish, poultry, vegetables, potatoes, and legumes). Being a man, unemployed, a current smoker, less educated, and residing in a socially disadvantaged area were associated with lower healthy dietary pattern scores, but these differences lessened over time, except in current smokers (p < 0.03 for interactions with time). Being a man was associated with higher, but being a current smoker with lower western dietary pattern scores (β = 8.0, 95% CI: 5.3,10.7 and - 6.7: - 10.1,- 3.3, respectively). For the meat and vegetable dietary pattern, being a man and a current smoker were associated with lower scores (β = - 24.9, 95% CI: - 44.9,- 4.9 and - 66.8: - 98.3,- 35.3, respectively), while being unemployed was associated with higher scores but this difference lessened over time (p = 0.018 for interaction with time). In older adults, men, smokers, and those experiencing social disadvantage could be target groups for interventions to improve diets.
Publisher: Oxford University Press (OUP)
Date: 18-05-2023
DOI: 10.1093/RHEUMATOLOGY/KEAD227
Abstract: To describe associations between MRI markers with knee symptoms in young adults. Knee symptoms were assessed using the WOMAC scale during the Childhood Determinants of Adult Health Knee Cartilage study (CDAH-knee 2008–2010) and at the 6- to 9-year follow-up (CDAH-3 2014–2019). Knee MRI scans obtained at baseline were assessed for morphological markers (cartilage volume, cartilage thickness, subchondral bone area) and structural abnormalities [cartilage defects and bone marrow lesions (BMLs)]. Univariable and multivariable (age, sex, BMI adjusted) zero-inflated Poisson (ZIP) regression models were used for analysis. The participants’ mean age in CDAH-knee and CDAH-3 were 34.95 (s.d. 2.72) and 43.27 (s.d. 3.28) years, with 49% and 48% females, respectively. Cross-sectionally, there was a weak but significant negative association between medial femorotibial compartment (MFTC) [ratio of the mean (RoM) 0.99971084 (95% CI 0.9995525, 0.99986921), P & 0.001], lateral femorotibial compartment (LFTC) [RoM 0.99982602 (95% CI 0.99969915, 0.9999529), P = 0.007] and patellar cartilage volume [RoM 0.99981722 (95% CI 0.99965326, 0.9999811), P = 0.029] with knee symptoms. Similarly, there was a negative association between patellar cartilage volume [RoM 0.99975523 (95% CI 0.99961427, 0.99989621), P = 0.014], MFTC cartilage thickness [RoM 0.72090775 (95% CI 0.59481806, 0.87372596), P = 0.001] and knee symptoms assessed after 6–9 years. The total bone area was negatively associated with knee symptoms at baseline [RoM 0.9210485 (95% CI 0.8939677, 0.9489496), P & 0.001] and 6–9 years [RoM 0.9588811 (95% CI 0.9313379, 0.9872388), P = 0.005]. The cartilage defects and BMLs were associated with greater knee symptoms at baseline and 6–9 years. BMLs and cartilage defects were positively associated with knee symptoms, whereas cartilage volume and thickness at MFTC and total bone area were weakly and negatively associated with knee symptoms. These results suggest that the quantitative and semiquantitative MRI markers can be explored as a marker of clinical progression of OA in young adults.
Publisher: Elsevier BV
Date: 04-2019
Publisher: MDPI AG
Date: 10-06-2022
DOI: 10.3390/LIFE12060869
Abstract: Osteoarthritis (OA) is the most prevalent joint disorder characterized by joint structural pathological changes with the loss of articular cartilage as its hallmark. Tools that can predict cartilage loss would help identify people at high risk, thus preventing OA development. The recent advance of the metabolomics provides a new avenue to systematically investigate metabolic alterations in disease and identify biomarkers for early diagnosis. Using a metabolomics approach, the current study aimed to identify serum metabolomic signatures for predicting knee cartilage volume loss over 10 years in the Tasmania Older Adult Cohort (TASOAC). Cartilage volume was measured in the medial, lateral, and patellar compartments of the knee by MRI at baseline and follow-up. Changes in cartilage volume over 10 years were calculated as percentage change per year. Fasting serum s les collected at 2.6-year follow-up were metabolomically profiled using the TMIC Prime Metabolomics Profiling Assay and pairwise metabolite ratios as the proxies of enzymatic reaction were calculated. Linear regression was used to identify metabolite ratio(s) associated with change in cartilage volume in each of the knee compartments with adjustment for age, sex, and BMI. The significance level was defined at α = 3.0 × 10−6 to control multiple testing. A total of 344 participants (51% females) were included in the study. The mean age was 62.83 ± 6.13 years and the mean BMI was 27.48 ± 4.41 kg/m2 at baseline. The average follow-up time was 10.84 ± 0.66 years. Cartilage volume was reduced by 1.34 ± 0.72%, 1.06 ± 0.58%, and 0.98 ± 0.46% per year in the medial, lateral, and patellar compartments, respectively. Our data showed that the increased ratios of hexadecenoylcarnitine (C16:1) to tetradecanoylcarnitine (C14) and C16:1 to dodecanoylcarnitine (C12) were associated with 0.12 ± 0.02% reduction per year in patellar cartilage volume (both p 3.03 × 10−6). In conclusion, our data suggested that alteration of long chain fatty acid β-oxidation was involved in patellar cartilage loss. While confirmation is needed, the ratios of C16:1 to C14 and C12 might be used to predict long-term cartilage loss.
Publisher: Elsevier BV
Date: 09-2011
Publisher: AMPCo
Date: 04-1991
Publisher: BMJ
Date: 06-2014
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.JOCA.2018.05.008
Abstract: To describe the associations between childhood adiposity measures and adulthood knee cartilage defects and bone marrow lesions (BMLs) measured 25 years later. 327 participants from the Australian Schools Health and Fitness Survey (ASHFS) of 1985 (aged 7-15 years) were followed up 25 years later (aged 31-41 years). Childhood measures (weight, height and skinfolds) were collected in 1985. Body mass index (BMI), overweight status and fat mass were calculated. Participants underwent 1.5 T knee magnetic resonance imaging (MRI) during 2008-2010, and cartilage defects and BMLs were scored from knee MRI scans. Log binomial regressions were used to examine the associations. Among 327 participants (47.1% females), 21 (6.4%) were overweight in childhood. Childhood adiposity measures were associated with the increased risk of adulthood patellar cartilage defects (Weight relative risk (RR) 1.05/kg, 95% confidence interval (CI) 1.01-1.09 BMI 1.10/kg/m Childhood adiposity measures were associated with the increased risk of adulthood patellar cartilage defects and, to a lesser extent, BMLs, independent of adulthood adiposity measures. These results suggest that adiposity in childhood has long-term effects on patellar structural abnormalities in young adults.
Publisher: Oxford University Press (OUP)
Date: 16-11-2010
DOI: 10.1093/RHEUMATOLOGY/KEQ341
Abstract: Although there is a well-established sex difference in the prevalence and severity of OA, the mechanism for this is not clear. The aim of this study was to examine the potential role of BMD and BMC in explaining gender differences in knee cartilage volume. A total of 153 subjects aged 25-60 years, 81% female, were recruited. MRI was performed of the dominant knee. Cartilage volume was measured using validated methods. Total body BMD and content was measured using DXA. Total body BMC and BMD was significantly associated with medial cartilage volume in both sexes. However, the associations were stronger in men for BMC (B = 0.52 95% CI 0.21, 0.83 P for difference = 0.001) and BMD (B = 2242 95% CI 443, 4041 P for difference = 0.05). Similar results were obtained in the lateral tibial compartment. No significant association was obtained between total body BMD and BMC and patella cartilage volume in either men or women. In this relatively healthy population, we found a positive relationship between total body BMD and BMC and tibial cartilage volume in the medial and lateral compartments. These relationships were stronger in men than women. Thus, the results of this study may provide some insight into the sex differences in knee cartilage volume, which may in turn facilitate our understanding of the pathogenesis of OA.
Publisher: Elsevier BV
Date: 04-2001
Abstract: Our understanding of the role of nutrients in bone development in children is limited. We examined the associations between urinary potassium, urinary sodium, usual dietary intake, and bone mineral density (BMD) in prepubertal children. This was a cross-sectional study of 330 boys and girls aged 8 y. Urinary measures were assessed in a single, timed, overnight urine specimen. Usual diet was assessed with a food-frequency questionnaire completed by a parent or guardian. BMD at the femoral neck, lumbar spine, and total body was measured by dual-energy X-ray absorptiometry. Urinary potassium correlated significantly with BMD at all sites (femoral neck: r = 0.20, P < 0.001 lumbar spine: r = 0.19, P = 0.001 total body: r = 0.24, P < 0.001). After adjustment for confounders (primarily lean body mass), this association was lower in magnitude but remained significant at 2 sites with a consistent trend at the third (femoral neck: P = 0.15 lumbar spine: P = 0.046 total body: P = 0.028). Urinary sodium was not associated with BMD at any site. No nutrient or food intake estimate was associated with BMD, although urinary potassium correlated significantly with potassium intake (r = 0.14, P = 0.016) and fruit and vegetable intake (r = 0.12, P = 0.033). Urinary potassium was associated with both dietary intake and BMD independent of lean body mass in these well-nourished, calcium-replete young children. These findings should be confirmed in further longitudinal studies. Nevertheless, this association is likely to represent dietary intake of potassium and suggests that measurement of urinary potassium is superior to food-frequency questionnaires for assessing potassium intake in this age group.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.JOCA.2018.11.009
Abstract: To describe associations between presence of patellar tendon enthesis (PTE) abnormalities and symptoms, structural abnormalities, and total knee replacement (TKR) in older adult cohort. PTE abnormalities (presence of abnormal bone signal and/or bone erosion), were measured on T2-weighted magnetic resonance (MR) images at baseline in 961 community-dwelling older adults. Knee pain and function limitation were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Bone marrow lesions (BMLs), cartilage volume and defects score, and infrapatellar fat pad (IPFP) area were measured using validated methods. Incidence of TKR was determined by data linkage. Participants with abnormal PTE bone signal and/or erosion was 20%. Cross-sectionally, presence of PTE abnormalities was associated with greater pain intensity while going up and down stairs (β = 0.22 (95% confidence interval (CI) 0.03, 0.41)), greater risk of femoral BMLs (RR = 1.46 (1.12, 1.90)) and worse tibial cartilage defects score (RR = 1.70 (1.16, 2.47), and smaller IPFP area (β = -0.27 (-0.47, -0.06) cm PTE abnormalities are common in older adults. Presence of cross-sectional but not longitudinal associations suggests they are commonly co-exist with other knee structural abnormalities but may not play a major role in symptom development or structural change, excepting tibial BMLs.
Publisher: Research Square Platform LLC
Date: 22-06-2020
Abstract: Background: Hip osteoarthritis (OA) commonly affects older adults and leads to high morbidity. There is no preventative treatment available and total hip replacement (THR) is offered for end stage disease. Known predictors of THR include pain and radiographic OA. Hip structure has also been shown to worsen hip OA and predict THR. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. The purpose of this study is to describe predictors of THR in community dwelling older adults. Methods: At baseline, participants had assessment of radiographic OA and cam morphology (from pelvic radiographs), shape mode scores (from dual energy X-ray absorptiometry (DXA)) and hip bone mineral density (BMD) (from DXA). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression. Results: Incidence of THR for OA over 14 years was 5.0% (40 / 802). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.57 per SD 95% CI 1.01-2.46), shape mode 4 score (non-spherical femoral head) (RR 0.65/SD 95% CI 0.44-0.97), cam morphology (α °) (RR 2.66/SD 95% CI 1.38-5.13), neck of femur BMD (RR 1.85/SD, 95% CI 1.4-2.44) and bone marrow lesions (BMLs) increased risk of THR (RR 5.62/unit 95% CI 1.1 – 28.81). Conclusion: In addition to hip pain and radiographic hip OA, measures of hip shape, cam morphology, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.
Publisher: Wiley
Date: 02-2005
DOI: 10.1038/OBY.2005.47
Abstract: To describe the associations among BMI, knee cartilage morphology, and bone size in adults. A cross-sectional convenience s le of 372 male and female subjects (mean age, 45 years range, 26 to 61 years) was studied. Knee articular cartilage defect score (0 to 4) and prevalence (defect score of >/=2), volume, and thickness, as well as bone surface area and/or volume, were determined at the patellar, tibial, and femoral sites using T1-weighted fat-saturation magnetic resonance imaging. Height, weight, BMI, and radiographic osteoarthritis were measured by standard protocols. In multivariate analysis in the whole group, BMI was significantly associated with knee cartilage defect scores (beta: +0.016/kg/m(2) to +0.083/kg/m(2), all p < 0.05) and prevalence (odds ratio: 1.05 to 1.12/kg/m(2), all p < 0.05 except for the lateral tibiofemoral compartment). In addition, BMI was negatively associated with patellar cartilage thickness only (beta = -0.021 mm/kg/m(2) p = 0.039) and was positively associated with tibial bone area (medial: beta = +7.1 mm(2)/kg/m(2), p = 0.001 lateral: beta = +3.2 mm(2)/kg/m(2), p = 0.037). Those who were obese also had higher knee cartilage defect severity and prevalence and larger medial tibial bone area but no significant change in cartilage volume or thickness compared with those of normal weight. This study suggests that knee cartilage defects and tibial bone enlargement are the main structural changes associated with increasing BMI particularly in women. Preventing these changes may prevent knee osteoarthritis in overweight and obese subjects.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Springer Science and Business Media LLC
Date: 07-05-2015
Publisher: Research Square Platform LLC
Date: 20-12-2019
Abstract: Background Hip osteoarthritis (OA) commonly affects older adults and leads to high morbidity. There is no preventative treatment available and total hip replacement (THR) is offered for end stage disease. Known predictors of THR include pain and radiographic OA. Hip structure has also been shown to worsen hip OA and predict THR. A better understanding of predictors of THR can aid in triaging patients and researching preventative strategies. The purpose of this study is to describe predictors of THR in community dwelling older adults.Methods At baseline, participants had assessment of radiographicOA and cam impingement (from pelvic radiographs), shape mode scores (from dual energy X-ray absorptiometry (DXA)) and hip bone mineral density (BMD) (from DXA). After 2.6 and 5 years, participants reported hip pain using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and had hip structural changes assessed using magnetic resonance imaging (MRI). Risk of THR was analysed using mixed-effect Poisson regression.Results Incidence of THR for OA over 14 years was 5.0% (40 / 802). As expected, WOMAC hip pain and hip radiographic OA both predicted risk of THR. Additionally, shape mode 2 score (decreasing acetabular coverage) (RR 1.57 per SD 95% CI 1.01-2.46), shape mode 4 score (non-spherical femoral head) (RR 0.65/SD 95% CI 0.44-0.97), cam impingement (α °) (RR 2.66/SD 95% CI 1.38-5.13), neck of femur BMD (RR 1.85/SD, 95% CI 1.4-2.44) and bone marrow lesions (BMLs) increased risk of THR (RR 5.62/unit 95% CI 1.1 – 28.81). There was a trend for hip effusions to increase the risk of THR (RR 1.88/SD 95% CI 0.24 to 14.78).Conclusion In addition to hip pain and radiographic hip OA, measures of hip shape, cam impingement, BMD and BMLs independently predict risk of THR. This supports the role of hip bone geometry and structure in the pathogenesis of end stage hip OA and has identified factors that can be used to improve prediction models for THR.
Publisher: Elsevier BV
Date: 03-2023
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: BMJ
Date: 23-05-2022
DOI: 10.1136/ANNRHEUMDIS-2022-EULAR.4149
Abstract: In rheumatoid arthritis (RA) persistence on disease modifying anti-rheumatic drugs (DMARDs) can be interpreted as a composite measure of effectiveness, safety, and tolerability. There is limited data available on real-life use of the newest class of drugs, the Janus Kinase (JAK) inhibitors. JAK inhibitors are small-molecule treatments which are administered orally on a daily basis and offer a long-term option in RA treatment. To compare drug persistence on JAK inhibitors tofacitinib, baricitinib and upadacitinib to tumor necrosis factor-α (TNF) inhibitors and other DMARDs in RA patients in Australia. A retrospective observational study was conducted among RA patients in the Australian Medicare Database (from January 2006 till October 2021), aged ≥18 and for whom a JAK inhibitor or biologic DMARDs were dispensed. Data were provided by the Australian Department of Health and Aging through PROSPECTION, an Australian healthcare consulting company. A deidentified 10% s le of the database was taken as a random representation of RA patients in Australia. Kaplan-Meier analysis was used to calculate drug persistence rates, defined as the time from treatment initiation until the date of the last dose when there had not been a script dispensed for 6 months except for rituximab, where a 12-month gap was applied. Data from 5,455 patients were analysed. For all patients the 12-month persistence rates were 61% for JAK inhibitors (baricitinib, tofacitinib, upadacitinib), 62% for tocilizumab, 52% for TNF inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab), and 51% for abatacept. The JAK inhibitors baricitinib (64%) and upadacitinib (78%) were superior to tofacitinib (54%). Median treatment persistence for upadacitinib was not reached (n = 430) was 27.1 months for baricitinib and 15.2 months for tofacitinib. For TNF inhibitors, treatment persistence was 15.1 months for adalimumab, 14.1 months for certolizumab, 14.0 months for etanercept, 11.1 months for golimumab and 4.5 months for infliximab. Persistence rates on first-line JAK inhibitors were 70% for baricitinib and 57% for tofacitinib persistence rates dropped to 63% for baricitinib and 47% for tofacitinib in the second-line setting. First-line persistence rates were 54% for TNF inhibitors and 65% for tocilizumab, rates were sustained for tocilizumab, but dropped to 48% for TNF inhibitors in the second-line setting. This real-world data highlights that in an Australian clinical practice setting treatment persistence rates on 12 months on JAK inhibitors, in particular baricitinib and upadacitinib, were superior to TNF inhibitors, but not to tocilizumab. Suggesting that persistence rates might differ according to biologics mode of action and line of treatment. Table 1. Persistence rates at 12 months post treatment initiation All patients First line Second line JAK inhibitors Overall 61% (2155) 60% (616) 60% (554) Baricitinib 64% (537) 70% (158) 63% (124) Tofacitinib 54% (1188) 57% (441) 47% (294) Upadacitinib 78% (430) 28% (17) 84% (136) TNF inhibitors Overall 52% (6339) 54% (4227) 48% (1561) Adalimumab 55% (2710) 56% (2030) 48% (590) Certolizumab 51% (593) 54% (251) 47% (147) Etanercept 52% (2079) 55% (1354) 47% (623) Golimumab 49% (814) 49% (506) 47% (174) Infliximab 35% (143) 23% (86) 53% (27) Other DMARDs Abatacept 51% (952) 56% (263) 46% (310) Rituximab 49% (284) 41% (70) 65% (79) Tocilizumab 62% (1156) 65% (279) 65% (351) In brackets are number of patients. [1]Hetland, M.L., et al., Direct comparison of treatment responses, remission rates, and drug adherence in patients with rheumatoid arthritis treated with adalimumab, etanercept, or infliximab: results from eight years of surveillance of clinical practice in the nationwide Danish DANBIO registry. Arthritis Rheum, 2010 [2]Jones, G., et al., A retrospective review of the persistence on bDMARDs prescribed for the treatment of rheumatoid arthritis in the Australian population. Int J Rheum Dis, 2018 L. Scheepers receives funding from The Farrell Family Foundation. Lieke Scheepers Grant/research support from: received the Competitive Grant Program Inflammation ASPIRE 2020 Rheumatology International Developed Markets from Pfizer, Employee of: worked as an Associate Director Epidemiology at the Medical Evidence Observational Research Department at AstraZeneca., Graeme Jones Speakers bureau: Received payment for a speakers bureau from Novartis
Publisher: Springer Science and Business Media LLC
Date: 28-01-2021
Publisher: Elsevier BV
Date: 2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
Publisher: Elsevier BV
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 16-11-2021
Publisher: Elsevier BV
Date: 04-2016
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Date: 09-2021
Publisher: Elsevier BV
Date: 04-2018
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 12-08-2014
Publisher: Elsevier BV
Date: 04-2018
Publisher: Oxford University Press (OUP)
Date: 10-07-2019
DOI: 10.1093/RHEUMATOLOGY/KEZ266
Abstract: To examine the association of metabolic syndrome (MetS) and its components with knee cartilage volume loss and bone marrow lesion (BML) change. Longitudinal data on 435 participants from a population-based cohort study were analysed. Blood pressure, glucose, triglycerides and high-density lipoprotein (HDL) were collected. MetS was defined based on the National Cholesterol Education Program–Adult Treatment Panel III criteria. MRI of the right knee was performed to measure cartilage volume and BML. Radiographic knee OA was assessed by X-ray and graded using the Altman atlas for osteophytes and joint space narrowing. Thirty-two percent of participants had MetS and 60% had radiographic knee OA. In multivariable analysis, the following were independently associated with medial tibial cartilage volume loss: MetS, β = −0.30% central obesity, β = −0.26% and low HDL, β = −0.25% per annum. MetS, hypertriglyceridaemia and low HDL were also associated with higher risk of BML size increase in the medial compartment (MetS: relative risk 1.72, 95% CI 1.22, 2.43 hypertriglyceridaemia: relative risk 1.43, 95% CI 1.01, 2.02 low HDL: relative risk 1.67, 95% CI 1.18, 2.36). After further adjustment for central obesity or BMI, MetS and low HDL remained statistically significant for medial tibial cartilage volume loss and BML size increase. The number of components of MetS correlated with greater cartilage volume loss and BML size increase (both P for trend .05). There were no statistically significant associations in the lateral compartment. MetS and low HDL are associated with medial compartment cartilage volume loss and BML size increase, suggesting that targeting these factors has the potential to prevent or slow knee structural change.
Publisher: Oxford University Press (OUP)
Date: 20-09-2018
DOI: 10.1093/RHEUMATOLOGY/KEY299
Abstract: To identify and validate knee pain phenotypes in an older population across different pain-related domains over 10.7 years. A total of 963 participants (mean age 63 years) from a population-based older adult cohort study were studied at baseline and followed up at 2.6 (n = 875), 5.1 (n = 768) and 10.7 years (n = 563). Baseline demographic, psychological, lifestyle and comorbidities data were obtained and MRI was performed to measure knee structural pathology. WOMAC pain and pain at multiple sites were assessed by questionnaires at each time-point. Latent class analysis was used to identify knee pain phenotypes, considering sex, BMI, emotional problems, education level, comorbidities, number of painful sites and knee structural pathology. Three pain phenotypes were identified: Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%) Class 2: high prevalence of structural damage and low prevalence of emotional problems (20%) Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%). Participants within Class 1 and 2 had greater BMI, more comorbidities, a higher prevalence of radiographic knee OA and knee structural pathology compared with Class 3. Furthermore, compared with Class 2 and 3, WOMAC pain and number of painful sites were consistently greater at each time-point over 10.7 years in Class 1. Results were similar when the analyses were restricted to participants with radiographic knee OA. Psychological and structural factors interact with each other to exacerbate pain perception, suggesting that tailored treatment approaches for older people with knee pain in clinical practice are needed.
Publisher: Elsevier BV
Date: 10-2010
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.EXGER.2014.04.006
Abstract: The aim of this study was to describe the relationship between accelerometer-determined physical activity (PA) and adiposity in community-dwelling older adults. In addition, we were interested in comparing the extent of correlation between questionnaire and accelerometer determined PA. 636 community-dwelling older adults (66±7years) were studied. Adiposity was measured using dual-energy X-ray absorptiometry and BMI was calculated. We measured minutes/day spent in sedentary, light, moderate and vigorous intensity activity using both questionnaires and Actigraph GT1M accelerometers. Participants spent a median of 583(IQR 522-646), 225(176-271), 27(12-45) and 0(0-0) minutes in sedentary, light, moderate and vigorous activities respectively. There was a non linear dose-response inverse relationship between activity intensity and adiposity. After adjusting for age, sex and other levels of PA, for every 10minute increase in activity, total body fat decreased by 169g(95% CI 61-277), 905g(632-1178), and 2208g(759-3657) for light, moderate and vigorous activities respectively. There was an interaction between age and activity as age increased, the magnitude of the effects of light and moderate activities on adiposity decreased. Sedentary minutes were not associated with adiposity after adjusting for time spent at other PA intensities. Questionnaire measures of PA were weakly correlated with body fat measures when compared to accelerometer determined PA. Both the amount and intensity of PA, but not sedentary time, have an independent dose-response association with adiposity. The association is much stronger using objective assessment compared to questionnaire. The magnitude of these associations decrease with age suggesting that physical activity programmes may need to be modified with increasing age.
Publisher: Wiley
Date: 29-04-2009
DOI: 10.1002/ART.24486
Abstract: To determine the associations between serum levels of vitamin D, sunlight exposure, and knee cartilage loss cross-sectionally and longitudinally in older adults. A total of 880 randomly selected subjects (mean age 61 years [range 51-79 years], 50% women) were studied at baseline, and 353 of these subjects were studied 2.9 years later. Serum levels of 25-hydroxyvitamin D (25[OH]D) were assessed by radioimmunoassay, and sunlight exposure was assessed by questionnaire. T1-weighted fat-suppressed magnetic resonance imaging (MRI) of the right knee was performed to determine knee cartilage volume and defects. Knee radiographic osteoarthritis (OA) and knee pain were also assessed. The mean 25(OH)D serum level was 52.8 nmoles/liter at baseline (range 13-119 nmoles/liter). Winter sunlight exposure and serum 25(OH)D level were both positively associated with medial and lateral tibial cartilage volume, and a serum 25(OH)D level<50 nmoles/liter was associated with increased medial tibiofemoral joint space narrowing (all P<0.05). Longitudinally, baseline serum 25(OH)D level predicted change in both medial and lateral tibial cartilage volume (beta=+0.04% per annum per nmole/liter for both P<0.05), and change in serum 25(OH)D level was positively associated with change in medial tibial cartilage volume. These associations were consistent in subjects with radiographic OA and knee pain and/or in women, but not in men or in subjects without radiographic OA or knee pain. Sunlight exposure and serum 25(OH)D levels are both associated with decreased knee cartilage loss (assessed by radiograph or MRI). This is best observed using the whole range of 25(OH)D levels rather than predefined cut points and implies that achieving vitamin D sufficiency may prevent and/or retard cartilage loss in knee OA.
Publisher: Wiley
Date: 11-2003
DOI: 10.1359/JBMR.2003.18.11.1970
Abstract: The effect of physical activity on upper limb fractures was examined in this population-based case control study with 321 age- and gender-matched pairs. Sports participation increased fracture risk in boys and decreased risk in girls. Television viewing had a deleterious dose response association with wrist and forearm fractures while light physical activity was protective. The aim of this population-based case control study was to examine the association between television, computer, and video viewing types and levels of physical activity and upper limb fractures in children 9-16 years of age. A total of 321 fracture cases and 321 randomly selected in idually matched controls were studied. Television, computer, and video viewing and types and levels of physical activity were determined by interview-administered questionnaire. Bone strength was assessed by DXA and metacarpal morphometry. In general, sports participation increased total upper limb fracture risk in boys and decreased risk in girls. Gender-specific risk estimates were significantly different for total, contact, noncontact, and high-risk sports participation as well as four in idual sports (soccer, cricket, surfing, and swimming). In multivariate analysis, time spent television, computer, and video viewing in both sexes was positively associated with wrist and forearm fracture risk (OR 1.6/category, 95% CI: 1.1-2.2), whereas days involved in light physical activity participation decreased fracture risk (OR 0.8/category, 95% CI: 0.7-1.0). Sports participation increased hand (OR 1.5/sport, 95% CI: 1.1-2.0) and upper arm (OR 29.8/sport, 95% CI: 1.7-535) fracture risk in boys only and decreased wrist and forearm fracture risk in girls only (OR 0.5/sport, 95% CI: 0.3-0.9). Adjustment for bone density and metacarpal morphometry did not alter these associations. There is gender discordance with regard to sports participation and fracture risk in children, which may reflect different approaches to sport. Importantly, television, computer, and video viewing has a dose-dependent association with wrist and forearm fractures, whereas light physical activity is protective. The mechanism is unclear but may involve bone-independent factors, or less likely, changes in bone quality not detected by DXA or metacarpal morphometry.
Publisher: American Diabetes Association
Date: 07-07-2017
DOI: 10.2337/DC16-2750
Abstract: Insulin increases glucose disposal in part by enhancing microvascular blood flow (MBF) and substrate delivery to myocytes. Insulin’s microvascular action is impaired with insulin resistance and type 2 diabetes. Resistance training (RT) improves glycemic control and insulin sensitivity, but whether this improvement is linked to augmented skeletal muscle microvascular responses in type 2 diabetes is unknown. Seventeen (11 male and 6 female 52 ± 2 years old) sedentary patients with type 2 diabetes underwent 6 weeks of whole-body RT. Before and after RT, participants who fasted overnight had clinical chemistries measured (lipids, glucose, HbA1c, insulin, and advanced glycation end products) and underwent an oral glucose challenge (OGC) (50 g × 2 h). Forearm muscle MBF was assessed by contrast-enhanced ultrasound, skin MBF by laser Doppler flowmetry, and brachial artery flow by Doppler ultrasound at baseline and 60 min post-OGC. A whole-body DEXA scan before and after RT assessed body composition. After RT, muscle MBF response to the OGC increased, while skin microvascular responses were unchanged. These microvascular adaptations were accompanied by improved glycemic control (fasting blood glucose, HbA1c, and glucose area under the curve [AUC] during OGC) and increased lean body mass and reductions in fasting plasma triglyceride, total cholesterol, advanced glycation end products, and total body fat. Changes in muscle MBF response after RT significantly correlated with reductions in fasting blood glucose, HbA1c, and OGC AUC with adjustment for age, sex, % body fat, and % lean mass. RT improves OGC-stimulated muscle MBF and glycemic control concomitantly, suggesting that MBF plays a role in improved glycemic control from RT.
Publisher: BMJ
Date: 06-2014
Publisher: Wiley
Date: 11-07-2023
Abstract: There is increasing use of complementary and alternative medicines (CAMs) alone or as an adjuvant therapy to conventional medicines in osteoarthritis (OA) patients. This study aimed to describe the prevalence and correlates of the use of CAMs among community‐dwelling older adults. Data from the Tasmania Older Adult Cohort Study (TASOAC, n = 1099) were used to describe the prevalence of CAM use. Correlates of CAM use were assessed by comparing CAM users and non‐users. To further assess correlates of CAM use, participants with at least one joint with pain were classified into four categories: CAM‐only, analgesics‐only, co‐therapy, and “neither CAMs nor analgesics” (NCNA). In all, 385 (35.0%) of our participants reported use of CAM s, among which vitamins/minerals were used most (22.6%, n = 232). Compared with CAM non‐users, CAM users were more likely to be female, were less likely to be overweight, were better educated, had more joints with OA , had fewer WOMAC scores, and did more steps per day. Among participants with any joint pain, the CAM‐only group were less likely to be overweight, consumed more alcohol, had higher quality of life, had more steps per day, and had fewer pain‐related symptoms compared with the analgesic‐only group. Complementary and alternative medicines were commonly used among Tasmanian older adults, with 35% of the population using CAMs either alone or in combination with conventional analgesics. CAM users were more likely to be female, be better educated, have more joints with OA, and had healthier lifestyles, including lower body mass index and higher number of steps per day.
Publisher: Cambridge University Press (CUP)
Date: 09-10-2017
DOI: 10.1017/S0007114517002483
Abstract: Influences of dietary patterns on musculoskeletal health are poorly understood in middle-aged women. This cross-sectional analysis from a cohort of 347 women (aged 36–57 years) aimed to examine associations between dietary patterns and musculoskeletal health outcomes in middle-aged women. Diet was measured by the Cancer Council of Victoria FFQ. Total body bone mineral content (TB BMC), femoral neck and lumbar spine bone density (dual-energy X-ray absorptiometry), lower limbs muscle strength (LMS) and balance tests (timed up and go test, step test, functional reach test (FRT) and lateral reach test) were also measured. Exploratory factor analysis was used to identify dietary patterns and scores for each pattern generated using factor loadings with absolute values ≥0·20. Associations between food pattern scores and musculoskeletal outcomes were assessed using multivariable linear regression. Three dietary patterns were identified: ‘Healthy’ (high consumption of a plant-based diet – vegetables, legumes, fruit, tomatoes, nuts, snacks, garlic, whole grains and low intake of high-fat dairy products), ‘high protein, high fat’ (red meats, poultry, processed meats, potatoes, cruciferous and dark-yellow vegetables, fish, chips, spirits and high-fat dairy products) and ‘Processed foods’ (high intakes of meat pies, hamburgers, beer, sweets, fruit juice, processed meats, snacks, spirits, pizza and low intake of cruciferous vegetables). After adjustment for confounders, Healthy pattern was positively associated with LMS, whereas Processed foods pattern was inversely associated with TB BMC and FRT. The associations were not significant after accounting for multiple comparisons. There were no associations with any other outcomes. These results suggest that maintaining a healthy diet could contribute to bone acquisition, muscle strength and balance in adult life. However, while they provide some support for further investigating dietary strategies for prevention of age-related loss of muscle and deterioration in balance, the exploratory nature of the analyses means that confirmation in longitudinal studies and/or trials with pre-specified hypotheses is needed.
Publisher: Springer Science and Business Media LLC
Date: 05-02-2015
DOI: 10.1007/S40264-015-0266-Z
Abstract: Osteoarthritis (OA) is the leading musculoskeletal cause of disability. Despite this, there is no consensus on the precise definition of OA and what is the best treatment to improve symptoms and slow disease progression. Current pharmacological treatments include analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase (COX) inhibitors. None of those treatments are disease-modifying agents that target the core pathological processes in OA. Diacerein, a semi-synthetic anthraquinone derivative, inhibits the interleukin-1-beta (IL-1β) cytokine which, according to animal studies, plays a key role in the pathogenesis of OA. Diacerein was synthesized in 1980 and licensed in some European Union and Asian countries for up to 20 years. It has shown modest efficacy and acceptable tolerability in a number of trials of low to moderate quality. Early this year, the European Medicines Agency (EMA) conducted a review and restricted the use of diacerein-containing medicines. This was because of major concerns about the frequency and severity of diarrhoea and liver disorders in OA patients. In addition, the EMA's Pharmacovigilance Risk Assessment Committee (PRAC) questioned the limited clinical benefits of diacerein, which, in their view, did not outweigh its risks. The aim of this review is to provide a benefit-risk assessment of diacerein in the treatment of OA, based on asystematic evaluation of the published efficacy and safety data. Overall, there is evidence that diacerein is modestly effective for symptoms and possibly for radiographic changes, but this needs to be balanced against higher rates of gastrointestinal toxicity.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Environmental Health Perspectives
Date: 08-2007
DOI: 10.1289/EHP.9937
Publisher: Springer Science and Business Media LLC
Date: 16-02-2011
DOI: 10.1038/EJCN.2011.9
Abstract: There is inconsistent evidence regarding the association between moderate alcohol consumption and bone mineral density (BMD). The aim of this study was to describe the associations between total and beverage-specific alcohol intake and bone loss in older men and women. A total of 862 randomly selected subjects (mean age 63 years, range 51-81, 51% men) were studied at baseline and 2 years later. BMD was assessed by dual-energy X-ray absorptiometry. Beverage specific and total alcohol intake was assessed by food-frequency questionnaire. Falls risk was determined using the short form Physiological Profile Assessment. Incident fractures were ascertained by questionnaire. Total alcohol intake in men positively predicted change in BMD at the lumbar spine and hip (β=0.008% and 0.006% per year per gram, P<0.05) after adjustment for confounders, but there was no significant association between alcohol intake and change in BMD in women. Lumbar spine BMD at baseline was negatively associated with frequency of spirits/liquor drinking in men (β=-0.01 g/cm(2) per category, P=0.045) and was positively associated with frequency of beer drinking (low alcohol) in women (β=0.034 g/cm(2) per category, P=0.002). Change in lumbar spine BMD was positively associated with the frequency of red wine drinking in men (β=0.08% per year per class, P=0.046). Neither beverage-specific nor total alcohol intake was associated with falls risk or fracture. Alcohol intake especially red wine might prevent bone loss in older men but not women, whereas low-alcohol beer may be protective in women and spirits/liquor may be deleterious in men.
Publisher: John Wiley & Sons, Ltd
Date: 23-01-2008
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1385/JCD:8:1:095
Abstract: In this 2-yr randomized controlled trial, we examined the effect of bone mineral density feedback and two different educational interventions (an osteoporosis information leaflet and group-based behavioral education [OPSMC]) on osteoporosis knowledge and self-efficacy in 470 women aged 25-44 yr. Osteoporosis knowledge increased across all intervention groups. Women receiving the OPSMC had a greater increase in both short (beta = +1.33, 95% confidence interval [CI] = 0.72-1.94) and long-term (beta = +0.64, 95% CI = 0.0034-1.25) osteoporosis knowledge, compared to those receiving the leaflet. In contrast, a low T-score was associated with a significant increase in long-term (beta = +0.66, 95% CI = 0.0034-1.25) but not short-term (beta = +0.57, 95% CI = -0.036 to 1.17) osteoporosis knowledge, compared to a normal T-score. Changes in osteoporosis self-efficacy were not associated with either low bone mineral density or receiving the OPSMC but were negatively associated with number of children (beta = -0.9, 95% CI = - 1.4 to -0.3) and working more than 20 h per week (beta = -2.7, 95% CI = -4.6 to -0.8). In conclusion, both the OPSMC and bone density feedback increased osteoporosis knowledge but not self-efficacy over 2 yr. Women with children or who worked full time have decreased osteoporosis self-efficacy, suggesting that this group should be a specific target for future interventional strategies.
Publisher: Springer Science and Business Media LLC
Date: 10-2000
Abstract: To describe the association between maternal diet during the third trimester of pregnancy and bone mass in 8 y-old male and female children. Longitudinal study. Southern Tasmania between 1988 and 1996. One-hundred and seventy-three 8-y-old male and female children with adequate maternal dietary information taking part in a study of bone mineralization. After adjustment for confounders, femoral neck bone mineral density (BMD) was positively associated with magnesium and phosphorus density of the maternal diet lumbar spine BMD was positively associated with magnesium, phosphorus and potassium and negatively associated with fat density while total body BMD was positively associated with magnesium, potassium and protein and negatively associated with fat density (all P<0.05). After further adjustment for other significant dietary factors, the only significant remaining associations observed were for phosphorus and fat at the lumbar spine, although the adjusted goodness of fit of the models improved compared to those including one dietary variable. A child in the 'optimal' levels of dietary exposures had significantly higher adjusted BMD at all sites (femoral neck, +5.5%, lumbar spine, +12%, total body, +6.8%). Calcium intake was not associated with BMD at any site, possibly due to a high average intake. This study reports a substantial association between in utero diet in a well-nourished population and later bone mass in their children. However, it does not allow identification of the dietary components of greatest importance, indicating that these results should be regarded as hypothesis-generating. Further longitudinal studies in other populations are required to confirm that dietary manipulation during pregnancy has a role to play in the early life prevention of osteoporosis.
Publisher: Wiley
Date: 10-2002
DOI: 10.1046/J.1440-1754.2002.00037.X
Abstract: The aim of this study was to investigate the association of clinical risk factors and bone density with prevalent fractures in prepubertal children. Bone mineral density (BMD) in lumbar spine, femoral neck and total body bone was assessed by dual-energy X-ray absorptiometry. Clinical data on risk factors were collected by measurement and questionnaires. Of 324 children, 32 (10%) had a prevalent fracture (upper limb 69%). Most fractures were due to low-energy falls at home (69%). Children with fractures were older (P = 0.04), had higher levels of sports participation (P = 0.03), lower levels of breastfeeding (P = 0.05) and tended towards higher usage of inhaled corticosteroids in the previous year (P = 0.05). However, both BMD and apparent BMD did not differ between those with and without prevalent fracture. No differences were observed in the proportion of maternal fractures, maternal smoking during pregnancy, asthma history and oral prednisolone in last year (all P > 0.05). A final model incorporating age, weight, height, breastfeeding history, sports participation and inhaled corticosteroid usage accounted for 10% of the variability in the odds of fracture (P = 0.03). These results suggest that BMD may be less important than clinical risk factors for total fracture risk in prepubertal children. However, s le size limitations mean that further investigation in larger populations with less heterogeneity in fracture types is warranted.
Publisher: Elsevier BV
Date: 04-2019
Publisher: The Journal of Rheumatology
Date: 06-2016
Abstract: Knee cartilage defects are a key feature of osteoarthritis (OA) but correlates of hip defects remain unexplored. The aims of this cross-sectional study were to describe the correlates of hip cartilage defects. The study included 194 subjects from the Tasmanian Older Adult Cohort who had right hip short-tau inversion recovery magnetic resonance imaging (MRI). Hip cartilage defects were assessed and categorized as grade 0 = no defects, grade 1 = focal blistering or irregularities on cartilage or partial thickness defect, and grade 2 = full thickness defect. Hip pain was determined by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Hip structural changes were measured on MRI, and hip radiographic OA (ROA) was assessed. Leg strength and physical activity were assessed using dynamometer and pedometers, respectively. Data were analyzed using log binomial and linear regression. Of 194 subjects, 24% (n = 48) had no defects, 34% (n = 66) had grade 1, and 41% (n = 80) had grade 2. In multivariable analyses, any hip defects were associated with greater hip pain [prevalence ratio (PR) 1.20, 95% CI 1.02–1.35] and lower mean leg strength (men mean ratio 0.83, 95% CI 0.67–0.98). Grade 1 defects were associated with hip bone marrow lesions (BML PR 1.42, 95% CI 1.03–1.96) and high cartilage signal (men PR 1.84, 95% CI 1.27–2.70), but not with hip pain or other structural findings. Grade 2 defects were associated with greater hip pain (PR 1.40, 95% CI 1.09–1.80), hip BML (PR 1.45, 95% CI 1.15–1.85), hip effusion cross-sectional area (PR 1.14, 95% CI 1.01–1.30), hip ROA (men PR 1.60, 95% CI 1.13–2.25), and steps/day (PR 0.97, 95% CI 0.96–0.99). Grade 2 defects in both sexes and grade 1 defects (mostly in men) are associated with clinical, demographic, and structural factors relevant for OA. Damage to the hip cartilage could be one of the major causes of rapid disease progression and pathophysiology of hip defects. The topic needs further study.
Publisher: BMJ
Date: 11-02-2014
DOI: 10.1136/ANNRHEUMDIS-2013-204488
Abstract: There is a paucity of data examining the effects of weight change on knee joint structures and symptoms. This study examined the effect of weight change on change in knee cartilage volume and symptoms in an obese cohort. 112 obese subjects (Body Mass Index ≥30 kg/m 2 ) were recruited from various community sources to examine the effect of obesity on musculoskeletal health. Tibial cartilage volume, determined by MRI, and knee symptoms, determined by the Western Ontario and McMaster Osteoarthritis Index (WOMAC) were collected at baseline and an average of 2.3 years later. Percentage weight change was associated with change in medial tibial cartilage volume (β −1.2 mm 3 , 95% CI −2.3 to −0.1 mm 3 , p=0.03) that was consistent throughout the spectrum of weight loss through to mild weight gain. Percentage weight change was not associated with change in the lateral tibial (p=0.93) or patella (p=0.32) cartilage volumes. Percentage weight change was associated with change in all WOMAC subscales (all p≤0.01): pain (β −1.8 mm, 95% CI −3.2 to −0.4 mm), stiffness (β −1.6 mm, 95% CI −2.5 to −0.7 mm) and function (β −6.9 mm, 95% CI −11.6 to −2.1 mm). The linearity of effect implies that weight loss is associated with reduced medial cartilage volume loss and improved knee symptoms, while weight gain is associated with increased medial cartilage volume loss and worse knee symptoms. These results suggest that in obese people, small amounts of weight change may have the potential for a disease modifying effect on both knee joint structure and symptoms. While weight loss is an important primary management strategy in obese in iduals, avoidance of further weight gain should also be a clinical goal.
Publisher: Elsevier BV
Date: 09-2011
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/J.JOCA.2004.11.007
Abstract: To generate hypotheses regarding the associations between knee cartilage defects and knee radiographic osteoarthritis (ROA), cartilage volume, bone size and type II collagen breakdown in adults. A cross-sectional convenience s le of 372 male and female subjects (mean age 45 years, range 26-61) was studied. Knee cartilage defect score (0-4) and prevalence (a defect score of > or =2), cartilage volume, and bone surface area were determined using T1-weighted fat saturation MRI. Urinary levels of C-terminal crosslinking telopeptide of type II collagen (U-CTX-II) were measured by enzyme-linked immunosorbent assay. Height, weight and ROA were measured by standard protocols. In multivariate analysis, the severity and prevalence of knee cartilage defects were significantly and independently associated with tibiofemoral osteophytes (regression coefficient (beta): +0.86 to +1.31/unit, odds ratio (OR): 2.97-3.68/unit, all P<0.05 with the exception of OR in lateral tibiofemoral compartment) and tibial bone area (beta: +0.11 to +0.25/cm2 OR: 1.33-1.58/cm2, all P<0.01). Knee cartilage defects were inconsistently associated with joint space narrowing after adjustment for osteophytes but consistently with knee cartilage volume (beta: -0.27 to -0.70/ml OR: 0.16-0.56/ml, all P<0.01 except for OR at lateral tibial cartilage site P=0.06). Lastly, knee cartilage defect severity was significantly associated with U-CTX-II (Partial r=+0.18, P<0.001 for total cartilage defect score). Osteophytes and increasing knee bone size may be causally related to knee cartilage defects. Furthermore, knee cartilage defects may result in increased cartilage breakdown leading to decreased cartilage volume and joint space narrowing suggesting an important role for knee cartilage defects in early knee OA.
Publisher: Wiley
Date: 15-10-2015
DOI: 10.1002/JCSM.12065
Publisher: BMJ
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 26-10-2015
Publisher: Wiley
Date: 25-04-2019
DOI: 10.1002/ACR.23713
Abstract: To describe the cross-sectional and longitudinal associations between quantitative measures of infrapatellar fat pad (IPFP) signal-intensity alteration and knee structural abnormalities in patients with symptomatic knee osteoarthritis (OA). A total of 261 patients (mean ± SD age 63.0 ± 7.2 years) with symptomatic knee OA were selected from a randomized controlled trial with a follow-up of 2 years. IPFP signal-intensity alterations at baseline were quantitatively measured on T2-weighted fat-saturated magnetic resonance imaging using MATLAB. These quantitative measures included the SD of whole IPFP signal intensity measurement, the upper quartile value of high signal intensity (UQ Higher baseline SD of the IPFP, UQ Quantitative measures of increased signal intensity in the IPFP were associated with knee structural abnormalities in the tibiofemoral compartment, suggesting that these measurements could be used as an additional entry criterion to enrich studies for faster progressors of knee OA.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 22-04-2004
Publisher: Springer Science and Business Media LLC
Date: 19-02-2016
Publisher: BMJ
Date: 19-05-2021
DOI: 10.1136/ANNRHEUMDIS-2021-EULAR.98
Abstract: Serum levels of cartilage and joint-specific biochemical markers such as cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) are associated with cartilage degradation, joint tissue degradation, and synovitis in patients with OA. Change in these biomarkers may precede the morphological and clinical manifestations of OA and therefore have been explored as predictive markers in OA. However, few studies have evaluated the association of OA-related biomarkers with knee symptoms in general population-based middle-aged adults To describe the associations between OA-related biomarkers and knee symptoms in middle-aged adults followed up over 10-13 years Blood s les were collected during the Childhood Determinants of Adult Health (CDAH)-1 study at baseline (year: 2004-06, age: 26–36 years) and 10-13 year follow-up (CDAH-3 year: 2014–2019, age: 36–49 years). Serum s les from baseline (n=156) and follow-up (n= 167) were analyzed for three OA-related biomarkers – namely COMP, MMP-3, and HA– using ELISA. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the WOMAC scale during the CDAH-3 phase. Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) zero-inflated Poisson regression models with random effects were used to describe the above associations The prevalence of knee pain was 46%. In the multivariable model, adjusted for age, sex, and BMI, there was a significant positive association between COMP (ɞ=1.156, 95%CI: 0.989,1.324 p=0.04), MMP-3 (ɞ=1.013, 95%CI: 1.001,1.025 p=0.02), and HA (ɞ=1.008, 95%CI: 1.002,1.015, p=0.01) with knee pain and WOMAC-total score (Table 1) in middle-aged adults. The increase in knee pain per ng/ml increase in COMP, MMP-3, and HA was 15.7%, 1.3%, and 0.8%, respectively. The overall mean biomarker levels decreased over 10-13 years however, the mean WOMAC-total scores were higher in participants whose COMP and HA levels increased (COMP: 24 (27.31), HA: 14.20 (22.60)) compared to those in whom it decreased or remained stable (COMP: 9.84 (16.83), and HA: 8.28 (13.22)) during this period. There was a significant positive association between COMP (ɞ=1.026, 95%CI: 1.002,1.050, p=0.03) and MMP-3 (ɞ=1.020, 95%CI: 1.009,1.030, p .01) measured at baseline and knee pain assessed after 10-13 year in the middle-aged adults (Table 1) Table 1. Cross-sectional and longitudinal association between WOMAC symptoms and OA-related biomarkers Variables Longitudinal Biomarker at CDAH-1, knee symptom at CDAH-3 Cross-sectional Biomarker at CDAH-3, knee symptom at CDAH-3 Adjusted. Coef. (95%CI) p-value Adjusted. Coef. (95%CI) p-value COMP (Predictor) WOMAC-total 1.047 (1.035, 1.060) 1.088 (1.017, 1.159) p .01 p=0.01 Stiffness 1.019 (0.988, 1.051) 0.877 (0.708, 1.057) p=0.23 p=0.12 Dysfunction 1.045 (1.030, 1.061) 1.040 (0.949, 1.130) p .01 p=0.38 MMP3 (Predictor) WOMAC-total 1.026 (1.020, 1.031) 1.017 (1.010, 1.023) p .01 p .01 Pain 1.020 (1.009, 1.030) 1.013 (1.001, 1.025) p .01 p=0.03 Stiffness 1.020 (1.004, 1.035) 1.004 (.987, 1.021) p=0.01 p=0.66 Dysfunction 1.029 (1.022, 1.037) 1.019 (1.010, 1.026) p .01 p .01 HA (Predictor) WOMAC-total 0.995 (0.991, 0.999) 1.007 (1.003, 1.010) p=0.01 p .01 Pain 0.999 (0.991, 1.006) 1.008 (1.002, 1.015) p=0.75 p=0.01 Stiffness 0.989 (0.980, 0.998) 0.997 (0.989, 1.007) p=0.03 p=0.65 Dysfunction 1.003 (0.998, 1.009) 1.015 (1.010, 1.020) p= 0.22 p .01 Bold denotes statistically significant. Model adjusted for age, sex, and BMI OA-related biochemical markers such as COMP and MMP-3 were positively associated with knee pain in population-based middle-aged adults. These results suggest biochemical markers measured in middle-aged adults may be used as a marker of joint pain AS is supported by International Graduate Research Scholarship, University of Tasmania. Ambrish Singh Employee of: Has worked in the past for Abbott and Eli Lilly and Company, Leigh Blizzard: None declared, Alison Venn: None declared, Graeme Jones: None declared, John Burgess: None declared, Venkat Parameswaran: None declared, Changhai Ding: None declared, Benny Antony: None declared
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.JOCA.2018.08.002
Abstract: To identify distinct pain trajectories over 10.7 years and to examine predictors of identified pain trajectories in an older population and those with radiographic knee osteoarthritis (ROA). 963 participants (aged 50-80 years) from a population-based cohort had baseline demographic, psychological, lifestyle and comorbidities data collected. T1-and T2-weighted magnetic resonance imaging (MRI) of the right knee was performed to measure knee structural pathology-cartilage defects, bone marrow lesions (BMLs) and effusion-synovitis. Group-based trajectory modelling (GBTM) was applied to identify trajectories of knee pain over 10.7 years measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Three distinct pain trajectories were defined: 'Minimal pain' (n = 501, 52%), 'Mild pain' (n = 329, 34%) and 'Moderate pain' (n = 165, 14%). In multivariable analysis, having cartilage defects, BMLs and effusion-synovitis were associated with an increased risk of being in the 'Mild pain' (relative risk [RR]: 1.40 to 1.92) and 'Moderate pain' trajectory (RR: 1.72 to 2.26), compared with the 'Minimal pain' trajectory. Being obese and having more painful sites were associated with 'Mild pain' and 'Moderate pain' trajectories, while unemployment, lower education level and presence of emotional problems were associated with 'Moderate pain' trajectory group. Similar results were found for those with ROA. Distinct pain trajectories identified suggest that homogeneous subgroups exist, which might be useful for phenotypic assessment for pain management, particularly in knee osteoarthritis. Structural pathology was associated with worse pain trajectories, suggesting that peripheral stimuli are critical for the development and maintenance of pain severity. Environmental and psychological factors may exacerbate pain perception.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2019
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2019
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2019
Publisher: Springer Science and Business Media LLC
Date: 2004
DOI: 10.1007/S00198-003-1503-3
Abstract: Definitions of adherence, also termed compliance, with use of hip protectors have varied in published studies, making interpretation of results difficult. This paper proposes standard definitions of adherence with the use of hip protectors. Adherence is the wearing of hip protectors in accordance with the recommendations of the study protocol, and is measured as the amount of time hip protectors are worn. When reporting use of hip protectors in clinical trials investigators should indicate the specific definition of adherence used, explicitly state the recommendation that was made for use of hip protectors during the study, and describe the methods of recording adherence.
Publisher: OMICS Publishing Group
Date: 09-2011
DOI: 10.4155/CLI.11.103
Publisher: Springer Science and Business Media LLC
Date: 07-01-2019
Publisher: BMJ
Date: 17-03-2009
Abstract: The anti-interleukin (IL) 6 receptor antibody tocilizumab inhibits signalling of IL6, a key cytokine in rheumatoid arthritis (RA) pathogenesis. To evaluate through the AMBITION study the efficacy and safety of tocilizumab monotherapy versus methotrexate in patients with active RA for whom previous treatment with methotrexate/biological agents had not failed. This 24-week, double-blind, double-dummy, parallel-group study, randomised 673 patients to either tocilizumab 8 mg/kg every 4 weeks, or methotrexate, starting at 7.5 mg/week and titrated to 20 mg/week within 8 weeks, or placebo for 8 weeks followed by tocilizumab 8 mg/kg. The primary end point was the proportion of patients achieving American College of Rheumatology (ACR) 20 response at week 24. The intention-to-treat analysis demonstrated that tocilizumab was better than methotrexate treatment with a higher ACR20 response (69.9 vs 52.5% p .001), and 28-joint Disease Activity Score (DAS28) .6 rate (33.6 vs 12.1%) at week 24. Mean high-sensitivity C-reactive protein was within the normal range from week 12 with tocilizumab, whereas levels remained elevated with methotrexate. The incidence of serious adverse events with tocilizumab was 3.8% versus 2.8% with methotrexate (p = 0.50), and of serious infections, 1.4% versus 0.7%, respectively. There was a higher incidence of reversible grade 3 neutropenia (3.1% vs 0.4%) and increased total cholesterol ⩾240 mg/dl (13.2% vs 0.4%), and a lower incidence of alanine aminotransferase elevations ×– × upper limit of normal (1.0% vs 2.5%), respectively. Tocilizumab monotherapy is better than methotrexate monotherapy, with rapid improvement in RA signs and symptoms, and a favourable benefit–risk, in patients for whom treatment with methotrexate or biological agents has not previously failed. NCT00109408
Publisher: Elsevier BV
Date: 09-2014
Publisher: The Endocrine Society
Date: 09-1995
DOI: 10.1210/JC.80.9.2709
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: BMJ
Date: 09-2010
Publisher: Springer Science and Business Media LLC
Date: 12-12-2022
Publisher: Springer Science and Business Media LLC
Date: 04-05-2016
Abstract: Ankylosing spondylitis (AS) is a common chronic immune-mediated arthropathy affecting primarily the spine and pelvis. The condition is strongly associated with HLA-B*27 as well as other human leukocyte antigen variants and at least 47 in idual non-MHC-associated variants. However, substantial additional heritability remains as yet unexplained. To identify further genetic variants associated with the disease, we undertook an association study of AS in 5,040 patients and 21,133 healthy controls using the Illumina Exomechip microarray. A novel association achieving genome-wide significance was noted at CDKAL1 . Suggestive associations were demonstrated with common variants in FAM118A , C7orf72 and FAM114A1 and with a low-frequency variant in PNPLA1. Two of the variants have been previously associated with inflammatory bowel disease (IBD CDKAL1 and C7orf72 ). These findings further increase the evidence for the marked similarity of genetic risk factors for IBD and AS, consistent with the two diseases having similar aetiopathogenesis.
Publisher: BMJ
Date: 15-05-2014
DOI: 10.1136/ANNRHEUMDIS-2013-205108
Abstract: The infrapatellar fat pad (IPFP) is of uncertain significance for knee osteoarthritis. The aim of this study was to describe the longitudinal associations between baseline IPFP maximal area and changes in knee pain, knee cartilage volume and cartilage defects in older adults. 356 community-dwelling male and female adults aged 50-80 years were measured at baseline and approximately 2.6 years later. T1-weighted or T2-weighted fat-suppressed MRI was used to assess maximal IPFP area, cartilage volume and cartilage defects at baseline and/or follow-up. Knee pain was assessed by the self-administered Western Ontario McMaster Osteoarthritis Index questionnaire. After adjustment for confounders, IPFP maximal area in women was significantly and negatively associated with changes in knee pain (β: -0.18 to -0.86 for total knee pain, pain at night while in bed, pain when sitting/lying and pain when standing upright, all p<0.05) but not with other knee pain subscales. IPFP maximal area in women was beneficially associated with change in tibial cartilage volume per annum (β: +1.56% per cm(2) at medial site +0.86% per cm(2) at lateral site, both p<0.05), but not with change in patellar cartilage volume. Further, it was significantly associated with reduced risks of increases in medial cartilage defects (relative risk: 0·46 at tibial site, relative risk: 0.59 at femoral site both p<0.05) but not with increases at other sites in women. No significant associations were found in men. While the associations are not fully consistent, IPFP maximal area appears to have a protective role for knee symptoms and cartilage damage in older female adults.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 04-2022
Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 12-2012
Publisher: The Endocrine Society
Date: 05-2008
DOI: 10.1210/JC.2007-2325
Abstract: Context: IL-1, IL-6, and TNF-α play an important role in the pathogenesis of osteoporosis in animals however, evidence that these play a similar role in bone loss in human studies is limited. Objective: Our objective was to determine the associations between serum markers of inflammation and changes in bone mineral density (BMD) and urinary pyridinoline (PYR) to creatinine (Cr) ratio over 2.9 yr in older adults. Methods: A total of 168 randomly selected subjects (mean 63 yr, range 52–78, 48% female) was studied. BMD was measured by dual-energy x-ray absorptiometry at baseline (mean T score: −0.18 to −0.61) and 2.9 yr later. Serum high-sensitivity (hs) C-reactive protein (CRP), IL-6, TNF-α, and the urinary PYR/Cr ratio were measured on both occasions. Results: The mean annual loss of BMD was 0.15, 0.15, and 0.34% at total body, spine, and hip, respectively. Change in total body BMD was associated with baseline hs-CRP, IL-6, and TNF-α, as well as change in hs-CRP (β: −0.41%/U, 95% confidence interval −0.68%, −0.15%) and IL-6 (β: −0.62%/U, 95% confidence interval −1.01%, −0.23%). If these markers were put in the same predictive model, only IL-6 remained largely unchanged. Changes in other BMD sites were significantly predicted by IL-6 (hip and spine) and TNF-α (spine only). Finally, change in the PYR/Cr ratio was positively associated baseline IL-6, hs-CRP, and their changes (all P & 0.05) in women, but not men. Conclusions: Variation within the low levels of inflammatory markers observed in this study, especially IL-6, predicts bone loss and resorption, suggesting that targeted antiinflammatory therapy has potential for the prevention of osteoporosis.
Publisher: BMJ
Date: 20-12-2013
DOI: 10.1136/ANNRHEUMDIS-2013-204494
Abstract: There is emerging evidence that the development and progression of osteoarthritis (OA) is associated with inflammation. C reactive protein (CRP), a systemic marker for inflammation, may be elevated in OA patients but the evidence is conflicting. To systematically review the literature for the relationship between serum CRP levels measured by a high sensitivity method (high sensitive CRP (hs-CRP)) and OA, as well as the correlation between circulating CRP levels and OA phenotypes. MEDLINE, EMBASE and CINAHL databases were systematically searched from January 1992 to December 2012. Studies were included when they met the inclusion criteria and data from studies were extracted. Two independent reviewers assessed study quality using a modified Newcastle-Ottawa Quality Assessment Scale. Meta-analyses were performed to pool available data from included studies. 32 studies met the inclusion criteria. Serum hs-CRP levels in OA were modestly but statistically significantly higher than controls (mean difference=1.19 mg/L, 95% CI 0.64 to 1.73, p<0.001) with significant heterogeneity between studies. Levels were significantly associated with pain (r=0.14, 95% CI 0.09 to 0.20, p<0.001) and decreased physical function (r=0.25, 95% CI 0.13 to 0.39, p<0.001). No significant associations were found between hs-CRP levels and radiographic OA. Low-grade systemic inflammation may play a greater role in symptoms rather than radiographic changes in OA.
Publisher: Elsevier BV
Date: 04-2015
Publisher: S. Karger AG
Date: 2016
DOI: 10.1159/000452742
Abstract: There is a plausible physiological theory, supported by many observational studies, that vitamin D supplementation should be effective for improving cardiovascular end points, such as blood pressure (BP), large artery stiffness, atherosclerosis, endothelial function and clinical events. However, results from randomised controlled trials (RCTs) have been inconsistent. In this review, we evaluated the evidence regarding the effectiveness of vitamin D supplementation for cardiovascular surrogate and hard clinical end points. RCTs were assessed in terms of s le size, duration of supplementation, baseline vitamin D level inclusion criteria (i.e., absence of vitamin D deficiency), dosage of vitamin D and population under investigation. Forty-five RCTs were identified. Eight RCTs with BP and 6 RCTs with large artery stiffness as the end points were found to comply with guidelines for the optimal design of clinical trials evaluating nutrient effects. Only 2 of the RCTs with an optimal design were effective in decreasing BP with vitamin D supplementation, although these were of moderate s le size ( ) and very short duration (8 weeks for both), whilst no RCT was effective in reducing large artery stiffness. Similar results were observed for atherosclerotic and endothelial function markers as end points. Only 1 RCT reported cardiovascular events as an end point and found neither increased nor decreased incident cardiovascular events over 7 years of follow-up. In conclusion, results from published RCTs indicate that vitamin D supplementation is ineffective in improving cardiovascular health among various patient populations, including in the presence or absence of vitamin D deficiency.
Publisher: Elsevier BV
Date: 10-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2011
Publisher: Springer Science and Business Media LLC
Date: 20-05-2011
Publisher: Wiley
Date: 06-10-2010
Publisher: Elsevier BV
Date: 10-2000
Publisher: Elsevier BV
Date: 11-2019
Publisher: Springer Science and Business Media LLC
Date: 26-06-2014
DOI: 10.1007/S00198-013-2431-5
Abstract: Sarcopenia may be diagnosed in the clinic using operational definitions based on low muscle mass or function. This prospective, population-based study revealed that sex-specific associations may exist between operational definitions of sarcopenia and falls in community-dwelling middle-aged and older adults. The objective of this study is to verify associations between sarcopenia and falls risk and to determine changes in sarcopenia prevalence over 5 years in middle-aged and older men and women according to different anthropometric and performance-based operational definitions. N = 681 volunteers (48% female mean ± SD age 61.4 ± 7.0 years) participated in baseline and follow-up assessments (mean 5.1 ± 0.5 years later). Appendicular lean mass (ALM) was assessed by dual-energy X-ray absorptiometry, hand grip (HGS) and lower-limb (LLS) strength were assessed by dynamometry, and falls risk was determined using the physiological profile assessment. Anthropometric definitions (ALM/height squared [ALM-H], ALM/weight × 100 and a residuals method [ALM-R]) and performance-based definitions (HGS, LLS and upper- and lower-limb muscle quality [LMQ]) of sarcopenia were examined. The lowest 20% of the sex-specific distribution for each definition at baseline was classified as sarcopenia. Sarcopenia prevalence increased after 5 years for all operational definitions except ALM-H (men: -4.0% women: -5.5%). Men classified with sarcopenia according to anthropometric definitions, and women classified with sarcopenia according to performance-based definitions, had significant increases in falls risk over 5 years (all P < 0.05) compared to in iduals without sarcopenia. Significant sex interactions were observed for ALM-R, LLS and LMQ (all P < 0.05) definitions. Sarcopenia prevalence generally increases at a higher rate when assessed using performance-based definitions. Sarcopenia is associated with increases in falls risk over 5 years in community-dwelling middle-aged and older adults, but sex-specific differences may exist according to different anthropometric or performance-based definitions.
Publisher: BMJ
Date: 06-2016
Publisher: Wiley
Date: 2004
DOI: 10.1002/ART.20108
Abstract: To estimate the heritability of muscle strength, knee pain, cartilage volume, bone size, and radiographic osteoarthritis (ROA), and to assess whether heritability of the knee structural components is independent of ROA. A sibpair design was utilized. Sagittal T1-weighted fat-suppressed magnetic resonance imaging (MRI) of the right knee was performed to determine cartilage volume and bone size. Standing semiflexed radiographs of the same knee were obtained to assess the presence of ROA. Knee pain was assessed by questionnaire and muscle strength by dynamometry. Heritability was estimated using the genetic analysis program SOLAR. A total of 128 subjects (61 men, 67 women mean age 45 years) from 51 families representing 115 sibpairs were studied. Lower limb muscle strength had high heritability (42% P = 0.02), as did knee pain (44% P = 0.07). Heritability estimates for cartilage volume were 65% for medial tibial cartilage, 77% for lateral tibial cartilage, and 84% for patellar cartilage, and heritability estimates for bone size were 85% for medial tibial bone area, 57% for lateral tibial bone area, and 70% for patella bone volume (all P < or = 0.004). For ROA, heritability was 61% for presence (with a large standard error) (P = 0.16) and 61% for severity (P = 0.02). The estimates for tibial bone areas were the only ones markedly reduced after adjustment for body size, while all estimates with the exception of knee pain were independent of ROA. Cartilage and, to a lesser extent, bone sites investigated by MRI were largely under independent genetic control, with a lesser shared genetic component. With the exception of prevalent ROA, all knee modalities assessed had high heritability, most likely reflecting a strong genetic component. Cartilage volume, bone size, and muscle strength all have the potential to be studied in quantitative trait linkage analyses, but their exact relevance with regard to OA remains uncertain at this time.
Publisher: BMJ
Date: 06-2016
Publisher: Elsevier BV
Date: 10-2011
Publisher: Springer Science and Business Media LLC
Date: 04-01-2012
Publisher: BMJ
Date: 06-2016
Publisher: Elsevier BV
Date: 07-2018
Publisher: Elsevier BV
Date: 09-2009
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.MATURITAS.2015.04.015
Abstract: Aspirin, widely used in the prevention of cardiovascular disease, in low dose, has anti-inflammatory and vasculoprotective effects: both of these processes contribute to the pathogenesis of osteoarthritis. We examined whether use of low dose aspirin affects change in knee cartilage volume in osteoarthritis. Participants from the Melbourne osteoarthritis cohort were classified as users and non-users of aspirin, according to baseline use (≤300 mg/day). Their knees were imaged twice over 2 years. Tibial cartilage volumes were measured and change calculated. Twenty one (18%) of 117 eligible participants were aspirin users. Annual change in medial tibial cartilage volume was -43 mm(3) (95% confidence intervals (CI) -93, 10) in aspirin users and -101 mm(3) (95% CI -125, -77) in non-users (p=0.043 for difference) after adjusting for age, gender, BMI and radiographic severity. Similar results were seen for annual percentage loss (1.9% vs 5.4%, p=0.034). No difference was observed for lateral tibial cartilage change and annual change (p=0.98, 0.87 respectively) Low dose aspirin use was associated with reduced medial tibial cartilage loss over 2 years in people with knee osteoarthritis. This data is hypothesis generating and clinical trials are required to confirm efficacy. If this hypothesis is confirmed, low dose aspirin may be used to reduce the progression of knee osteoarthritis.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2013
Publisher: Springer Science and Business Media LLC
Date: 26-01-2016
Publisher: Springer Science and Business Media LLC
Date: 20-11-2010
DOI: 10.1007/S11914-010-0037-9
Abstract: Sex hormones play a key role in bone homeostasis, and oral contraceptive (OC) use may affect bone mass in women. However, the nature of the association between OC use and bone remains controversial. This paper critically reviews studies on OC use and bone published between January 2009 and August 2010. Studies of OC use and bone mass mainly focus on adolescents or young adults and showed mixed results. Weak evidence suggests that OC use has no effect or a beneficial effect on bone mass, except in women commencing OCs shortly after menarche, and a consistently negative effect on bone turnover markers. A limited number of studies have examined the effect of ultra-low-dose OC (20 μg ethinyl estradiol) on bone mass in adolescents or young adults, and present conflicting results. The lack of randomized trials indicates that further high-quality prospective studies are required to investigate the effect of OC use on bone mass, particularly the optimal dose and timing of initiation of OC use in adolescents requiring contraception.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.JOCA.2007.08.009
Abstract: To identify factors associated with change in femoral cartilage volume over 2 years in a cohort largely without knee radiographic osteoarthritis. A total of 252 subjects (mean 45 years, range 28-60) were used for this study. T1-weighted fat saturation magnetic resonance imaging was performed at baseline and approximately 2 years later. Knee femoral condyle cartilage volume, femoral cartilage defect (0-4 scale) and tibial bone size were determined. The total femoral cartilage volume loss was 6.3% for the 2.3-year period. Factors associated with this annual change were female gender (females vs males: -1.69%, P<0.01), age (over vs under 40 years: -0.96%, P=0.01), smoking (beta: -0.04% per pack-years, P<0.01), as well as lower limb muscle strength (r: +0.32, P<0.01) and its change (beta: +0.34% per quartile, P<0.05). Structural factors associated with change included baseline femoral cartilage volume (beta: -0.36% per ml, P<0.01), femoral cartilage defects (beta: +1.07% per grade, P<0.01), tibial bone area (beta: +0.13% per cm(2), P<0.05), lateral osteophytes (beta: -1.91% per grade, P<0.01) and change in femoral cartilage defects (beta: -0.8% per grade, P<0.001). This study provides evidence confirming that significant risk factors are associated with femoral cartilage loss and these include gender (female), age, smoking, and severity of lower limb muscle weakness. It also supports the hypothesis that femoral cartilage swelling reflected by an increased baseline cartilage volume could be a predictor of disease progression. Our findings also provide interesting clues to implement preventive measures that can possibly prevent or reduce knee cartilage loss.
Publisher: Springer Science and Business Media LLC
Date: 03-05-2021
Publisher: Elsevier BV
Date: 04-2022
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.JOCA.2017.02.804
Abstract: To develop a measure of knee joint effusion-synovitis volume and to examine the effect of vitamin D supplementation on effusion-synovitis in people with knee osteoarthritis (OA) and low vitamin D levels over 24 months. Symptomatic knee OA patients with low 25-(OH)D levels (12.5-60 nmol/l) were recruited for a multi-centre, randomised, placebo-controlled and double-blind trial. Participants (age 63 ± 7 years, 208 females) were allocated to either 50,000 IU monthly vitamin D The reproducibilities of effusion-synovitis volume measurement were high with ICCs ranging from 0.93 to 0.99. Over 24 months, effusion-synovitis volume remained stable in the vitamin D group but increased in placebos with a significant between-group difference (-1.94 ml, 95% confidence interval (CI): -3.54, -0.33). This effect was evident in those with baseline effusion-synovitis and with suprapatellar effusion-synovitis. The proportion with an increase in effusion-synovitis volume was lower in the vitamin D group than placebo (risk ratio (RR): 0.87, 95% CI: 0.77, 0.97). This highly reproducible effusion-synovitis volume measurement could be a promising outcome measure in OA trials. Vitamin D supplementation could retard the progression of effusion-synovitis which can potentially benefit people with an inflammatory OA phenotype.
Publisher: MDPI AG
Date: 07-04-2022
Abstract: Obesity is a global pandemic, but there is yet no effective measure to control it. Recent metabolomics studies have identified a signature of altered amino acid profiles to be associated with obesity, but it is unclear whether these findings have actionable clinical potential. The aims of this study were to reveal the metabolic alterations of obesity and to explore potential strategies to mitigate obesity. We performed targeted metabolomic profiling of the plasma/serum s les collected from six independent cohorts and conducted an in idual data meta-analysis of metabolomics for body mass index (BMI) and obesity. Based on the findings, we hypothesized that restriction of branched-chain amino acids (BCAAs), phenylalanine, or tryptophan may prevent obesity and tested our hypothesis in a dietary restriction trial with eight groups of 4-week-old male C57BL/6J mice (n = 5/group) on eight different types of diets, respectively, for 16 weeks. A total of 3397 in iduals were included in the meta-analysis. The mean BMI was 30.7 ± 6.1 kg/m2, and 49% of participants were obese. Fifty-eight metabolites were associated with BMI and obesity (all p ≤ 2.58 × 10−4), linked to alterations of the BCAA, phenylalanine, tryptophan, and phospholipid metabolic pathways. The restriction of BCAAs within a high-fat diet (HFD) maintained the mice’s weight, fat and lean volume, subcutaneous and visceral adipose tissue weight, and serum glucose and insulin at levels similar to those in the standard chow group, and prevented obesity, adipocyte hypertrophy, adipose inflammation, and insulin resistance induced by HFD. Our data suggest that four metabolic pathways, BCAA, phenylalanine, tryptophan, and phospholipid metabolic pathways, are altered in obesity and restriction of BCAAs within a HFD can prevent the development of obesity and insulin resistance in mice, providing a promising strategy to potentially mitigate diet-induced obesity.
Publisher: BMJ
Date: 19-05-2021
DOI: 10.1136/ANNRHEUMDIS-2021-EULAR.375
Abstract: There is growing evidence that inflammation plays a critical role in osteoarthritis (OA) progression and its symptoms evolution. OA pain is heterogeneous and there are distinct subgroups within OA pain patients. Recently, we identified three homogeneous subgroups following distinct pain trajectories in which metabolic mechanism may be involved. Whether circulating inflammatory markers are associated with long-term knee structural changes on MRI, and whether the association between inflammatory markers and the trajectories we identified differs remain to be clarified. To examine whether inflammatory markers are associated with 10.7-year knee structural changes including knee cartilage volume (CV) and bone marrow lesions (BMLs), and to assess the associations between inflammatory markers and different pain trajectories. This study was conducted as part of a population-based older adult (mean age 63 years, 51% of females) cohort study with 1,099, 875, 768 and 563 participants attending at baseline, and 2.6-, 5.1- and 10.7-year follow-ups. Circulating levels of interleukin (IL)-6, tumour necrosis factor alpha (TNF-α) and high sensitivity C-reactive protein (CRP) were measured at baseline in 193 randomly selected participants. T1-weighted or T2-weighted MRI of the right knee was performed to measure CV and BMLs at baseline and 10.7-year. X-ray was performed to assess radiographic knee osteoarthritis (ROA). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain questionnaire was used to measure knee pain at all four visits. Data on demographic, psychological, lifestyle and comorbidities were also collected. Pain trajectories was previously identified using the group-based trajectory modelling. Linear, log-binomial and multi-nominal logistic regression modellings were used for the analyses. IL-6 was associated with both medial and lateral tibial CV loss (Medial: β=-0.51% per log pg/ml, 95%CI -0.88 to -0.15 Lateral: β=-0.34% per log pg/ml, 95%CI -0.64 to -0.04) after adjusting for age, sex, body mass index, physical activity, comorbidities, and ROA. TNF-α was not associated with either medial or lateral CV loss, but CRP was positively associated with medial tibial CV loss (Medial: β=0.27% per log mg/L, 95%CI 0.04 to 0.49), not lateral CV loss. No inflammatory markers were found to associate with medial and lateral BML size increase. Of 169 participants who had complete data at baseline, 54%, 35% and 11% of participants fell into ‘Minimal pain’, ‘Mild pain’ and ‘Moderate pain’ trajectory group, respectively. In multivariable analysis, IL-6 was associated with an increased risk of being a ‘Moderate pain’ trajectory (relative risk ratio [RRR]: 4.03, 95%CI 1.34 to 12.13) in comparison with ‘Minimal pain’ trajectory group. There was no significant association of TNF-α and CRP with trajectory groups. IL-6 was associated with both medial and lateral tibial CV loss (Medial: β=-0.51% per log ml g, 95%CI -0.88 to -0.15 Lateral: β=-0.34% per log ml g, 95%CI -0.64 to -0.04) after adjusting for age, sex, body mass index, physical activity, comorbidities, and ROA. TNF-α was not associated with either medial or lateral CV loss, but CRP was positively associated with medial tibial CV loss (Medial: β=0.27% per log ml g, 95%CI 0.04 to 0.49), not lateral CV loss. No inflammatory markers were found to associate with medial and lateral BML size increase. Of 169 participants who had complete data at baseline, 54%, 35% and 11% of participants fell into ‘Minimal pain’, ‘Mild pain’ and ‘Moderate pain’ trajectory group, respectively. In multivariable analysis, IL-6 was associated with an increased risk of being a ‘Moderate pain’ trajectory (relative risk ratio [RRR]: 4.03, 95%CI 1.34 to 12.13) in comparison with ‘Minimal pain’ trajectory group. There was no significant association of TNF-α and CRP with trajectory groups. None declared
Publisher: Wiley
Date: 10-03-2022
DOI: 10.1002/ART.42001
Abstract: The effect of physical activity on the risk of developing knee osteoarthritis (OA) is unclear. We undertook this study to examine the relationship between recreational physical activity and incident knee OA outcomes using comparable physical activity and OA definitions. Data were acquired from 6 global, community‐based cohorts of participants with and those without knee OA. Eligible participants had no evidence of knee OA or rheumatoid arthritis at baseline. Participants were followed up for 5–12 years for incident outcomes including the following: 1) radiographic knee OA (Kellgren‐Lawrence [K/L] grade ≥2), 2) painful radiographic knee OA (radiographic OA with knee pain), and 3) OA‐related knee pain. Self‐reported recreational physical activity included sports and walking/cycling activities and was quantified at baseline as metabolic equivalents of task (METs) in days per week. Risk ratios (RRs) were calculated and pooled using in idual participant data meta‐analysis. Secondary analysis assessed the association between physical activity, defined as time (hours per week) spent in recreational physical activity and incident knee OA outcomes. Based on a total of 5,065 participants, pooled RR estimates for the association of MET days per week with painful radiographic OA (RR 1.02 [95% confidence interval (95% CI) 0.93–1.12]), radiographic OA (RR 1.00 [95% CI 0.94–1.07]), and OA‐related knee pain (RR 1.00 [95% CI 0.96–1.04]) were not significant. Similarly, the analysis of hours per week spent in physical activity also showed no significant associations with all outcomes. Our findings suggest that whole‐body, physiologic energy expenditure during recreational activities and time spent in physical activity were not associated with incident knee OA outcomes.
Publisher: Elsevier BV
Date: 04-2015
Publisher: Oxford University Press (OUP)
Date: 30-11-2020
DOI: 10.1093/RHEUMATOLOGY/KEAA716
Abstract: To describe the association between change in subchondral bone marrow lesions (BMLs) and change in tibiofemoral cartilage volume and knee symptoms in patients with symptomatic knee OA. In total, 251 participants (mean 61.7 years, 51% female) were included. Tibiofemoral cartilage volume was measured at baseline and 24 months, and BML size at baseline, 6 and 24 months. Knee pain and function scores were evaluated at baseline, 6 and 24 months. Change in total and compartment-specific BML size was categorized according to the Least Significance Criterion. Linear mixed-effects models were used to evaluate the associations of change in BMLs over 6 and 24 months with change in cartilage volume over 24 months and knee symptoms over 6 and 24 months. Total BML size enlarged in 26% of participants, regressed in 31% and remained stable in 43% over 24 months. Compared with stable BMLs in the same compartment, enlarging BMLs over 24 months were associated with greater cartilage loss (difference: −53.0mm3, 95% CI: −100.0, −6.0), and regressing BMLs were not significantly associated with reduced cartilage loss (difference: 32.4mm3, 95% CI: −8.6, 73.3) over 24 months. Neither enlargement nor regression of total BML size over 6 and 24 months was associated with change in knee pain and function over the same time intervals. In subjects with symptomatic knee osteoarthritis and BMLs, enlarging BMLs may lead to greater cartilage loss but regressing lesions are not associated with reduced cartilage loss while neither is associated with change in knee symptoms.
Publisher: Oxford University Press (OUP)
Date: 2199
DOI: 10.1093/RHEUMATOLOGY/36.1.95
Abstract: The objective of this study was to use the technique of meta-analysis to undertake a systematic review of published and unpublished randomized controlled trials of pharmacological agents to determine their relative efficacy and toxicity in the treatment of psoriatic arthritis. The main outcome measure was the change in pooled disease index with component variables derived from OMERACT. Nineteen randomized trials were identified, of which 12 were included in the quantitative analysis with data from 792 subjects. Although all agents were better than placebo, parenteral high-dose methotrexate, salazopyrin, azathioprine and etretinate were the agents that achieved statistical significance (although it should be noted that only one component variable was available for azathioprine and only one trial with a high dropout rate was available for etretinate suggesting some caution is necessary in interpreting these results). In all trials, the placebo group improved over baseline (pooled improvement 0.43 disease index (DI) units, 95% CI 0.28-0.59). There were insufficient data to examine toxicity. In conclusion, parenteral high-dose methotrexate and salazopyrin are the only two agents with well-demonstrated published efficacy in psoriatic arthritis. The magnitude of the effect seen with etretinate, oral low-dose methotrexate, azathioprine and perhaps colchicine suggests that they may be effective, but that further multicentre clinical trials are required to establish their efficacy. Furthermore, the magnitude of the improvement observed in the placebo group strongly suggests that uncontrolled trials should not be used to guide management decisions in this condition.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2009
Publisher: Cambridge University Press (CUP)
Date: 15-11-2018
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.ARCHGER.2019.01.015
Abstract: To determine whether older adults with low muscle mass (sarcopenia) and strength (dynapenia), in the presence of osteoporosis/osteopenia, have an increased risk of fracture and mortality over 10 years, compared to those with low muscle or low bone mass alone or with neither condition. 1032 participants (52% women mean age 62.9 ± 7.4 years) were prospectively followed for 10 years. Mortality was ascertained from the death registry and fractures were self-reported. Baseline appendicular lean mass (ALM) was assessed using dual-energy X-ray absorptiometry and normalised to body mass index (BMI). Hand grip strength (HGS) was assessed by dynamometer. Osteosarcopenia and osteodynapenia were defined as having T-scores of the total hip and/or lumbar spine bone mineral density (BMD) < -1 combined with being in the lowest 20% of the sex-specific distribution for ALM/BMI or HGS respectively. Incident fracture risk was significantly higher in participants who were osteodynapenic (RR = 2.07, 95% CI: 1.26-3.39), dynapenic alone (RR = 1.74, 95% CI: 1.05-2.87), and osteopenic alone (RR = 1.63, 95% CI: 1.15-2.31), compared to those without dynapenia or osteopenia. Mortality risk was significantly higher only in participants with osteosarcopenia (RR = 1.49, 95% CI: 1.01-2.21) compared to those without sarcopenia or osteopenia. However, osteosarcopenia and osteodynapenia did not lead to a significantly greater fracture or mortality risk compared to having these conditions on their own. These findings suggest that the combined effect of osteopenia and sarcopenia or dynapenia on fracture and mortality risk, respectively, may not be greater than that of each in idual condition.
Publisher: BMJ
Date: 06-2016
Publisher: Elsevier BV
Date: 10-2000
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.JOCA.2007.10.018
Abstract: Meniscal tears detected using magnetic resonance imaging (MRI) have been identified as a risk factor for the development and progression of Osteoarthritis, however the prevalence and significance of meniscal tears in healthy, asymptomatic adults remains to be studied. We investigated the prevalence of meniscal tears in a healthy pain free population of post-menopausal women and whether meniscal tears in this population are associated with changes in cartilage volume and defects and tibial plateau bone area over 2 years. Fifty-seven post-menopausal women underwent MRI of their dominant knee at baseline line and approximately 2 years later to assess meniscal tears, cartilage volume, cartilage defects and tibial plateau bone area. Forty-six percent of women had a meniscal tear in either the medial and/or lateral compartment. Women who had a tear were older (P=0.01) and had more lateral cartilage defects (P=0.02). Medial meniscal tear was associated with 103 mm(2) greater tibial plateau bone area within the medial [95% confidence of interval (CI) 6.2, 200.3 P=0.04] and a lateral meniscal tear with a 120 mm(2) greater area within the lateral compartment (95% CI 45.5, 195.2 P=0.002). This study demonstrates that meniscal tears are common in asymptomatic post-menopausal women and that they become more common with age. Meniscal tears were also associated with greater tibial plateau bone area but not cartilage volume, providing support to the hypothesis that tibial plateau bone changes occur before significant pathological changes in cartilage. Whether increased tibial plateau bone area predisposes to an increased risk of degenerative meniscal tears or whether it is a consequence of altered biomechanical forces in relation to meniscal tear will need to be determined.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2018
DOI: 10.1161/CIRCIMAGING.117.007074
Abstract: In obesity and type 2 diabetes mellitus (T2D), adipose tissue expansion (because of larger adipocytes) results in reduced microvascular density which is thought to lead to adipocyte hypoxia, inflammation, and reduced nutrient delivery to the adipocyte. Adipose tissue microvascular responses in humans with T2D have not been extensively characterized. Furthermore, it has not been determined whether impaired microvascular responses in human adipose tissue are most closely associated with adiposity, inflammation, or altered metabolism. Overnight-fasted healthy controls (n=24, 9 females/15 males) and people with T2D (n=21, 8 females/13 males) underwent a body composition scan (dual-energy X-ray absorptiometry), an oral glucose challenge (50 g glucose) and blood analysis of clinical chemistries and inflammatory markers. Abdominal subcutaneous adipose tissue microvascular responses were measured by contrast-enhanced ultrasound at baseline and 1-hour post-oral glucose challenge. Adipose tissue microvascular blood volume was significantly elevated in healthy subjects 1-hour post-oral glucose challenge however, this effect was absent in T2D. Adipose tissue microvascular blood flow was lower in people with T2D at baseline and was significantly blunted post-oral glucose challenge compared with controls. Adipose tissue microvascular blood flow was negatively associated with truncal fat (%), glucoregulatory function, fasting triglyceride and nonesterified fatty acid levels, and positively associated with insulin sensitivity. Truncal fat (%), systolic blood pressure, and insulin sensitivity were the only correlates with microvascular blood volume. Systemic inflammation was not associated with adipose tissue microvascular responses. Impaired microvascular function in adipose tissue during T2D is not conditionally linked to systemic inflammation but is associated with other characteristics of the metabolic syndrome (obesity, insulin resistance, hyperglycemia, and dyslipidemia).
Publisher: Springer Science and Business Media LLC
Date: 2014
Publisher: Wiley
Date: 27-03-2019
DOI: 10.1111/JPC.14428
Abstract: Targeted screening by a salivary cytomegalovirus (CMV) polymerase chain reaction (PCR) of infants who 'refer' on their newborn hearing screen has been suggested as an easy, reliable and cost-effective approach to identify and treat babies with congenital CMV (cCMV) to improve hearing outcomes. This study aimed to investigate the feasibility and cost-effectiveness of introducing targeted salivary cCMV testing into a newborn hearing screening programme. The study included three tertiary maternity hospitals in Queensland, Australia between August 2014 and April 2016. Infants who 'referred' on the newborn hearing screen were offered a salivary swab for CMV PCR at the point of referral to audiology. Swabs were routinely processed and tested for CMV DNA by real-time quantitative PCR. Parents of babies with a positive CMV PCR were notified, and the babies were medically assessed and, where appropriate, were offered treatment (oral valganciclovir). Of eligible infants, the parents of 83.0% (234/283) consented to the cCMV screen. Of these, 96.6% returned a negative result (226/234), and 3.4% (8/234) returned a positive result (three true positive five false positive). The prevalence of cCMV for infants with confirmed hearing loss was 3.64% (P = 2/55 confidence interval = 0.44-12.53%). The cost comparison suggests the cost implementation of cCMV screening (and subsequent potential treatment benefits and management over time), compared to non-screening (and subsequent management), to be negligible. Incorporating cCMV testing into Universal Newborn Hearing Screening within Queensland is realistic and achievable, both practically and financially.
Publisher: Oxford University Press (OUP)
Date: 24-07-2009
DOI: 10.1093/QJMED/HCP093
Abstract: Statin therapy can cause myopathy, however it is unclear whether this exacerbates age-related muscle function declines. To describe differences between statin users and non-users in muscle mass, muscle function and falls risk in a group of community-dwelling older adults. A prospective, population-based cohort study with a mean follow-up of 2.6 years. Total 774 older adults [48% female mean (standard deviation) age = 62 (7) years] were examined at baseline and follow-up. Differences in percentage appendicular lean mass (%ALM), leg strength, leg muscle quality (LMQ specific force) and falls risk were compared for statin users and non-users. There were 147 (19%) statin users at baseline and 179 (23%) at follow-up. Longitudinal analyses revealed statin use at baseline predicted increased falls risk scores over 2.6 years (0.14, 95% CI 0.01 to 0.27) and a trend towards increased %ALM (0.45%, 95% CI -0.01 to 0.92). Statin users at both time points demonstrated decreased leg strength (-5.02 kg, 95% CI -9.65 to -0.40) and LMQ (-0.30 kg/kg, 95% CI -0.59 to -0.01), and trended towards increased falls risk (0.13, 95% CI -0.01 to 0.26) compared to controls. Finally, statin users at both baseline and follow-up demonstrated decreased leg strength (-16.17 kg, 95% CI -30.19 to -2.15) and LMQ (-1.13 kg/kg, 95% CI -2.02 to -0.24) compared to those who had ceased statin use at follow-up. Statin use may exacerbate muscle performance declines and falls risk associated with aging without a concomitant decrease in muscle mass, and this effect may be reversible with cessation.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Springer Science and Business Media LLC
Date: 06-02-2020
DOI: 10.1186/S12891-020-3074-2
Abstract: To evaluate the effects of the updated version of an evidence-based osteoarthritis (OA) resource and consumer hub, ‘My Joint Pain’ website, on health education and quality of care over 12 months. Using a classic quasi-experimental design, participants with symptomatic hip or knee OA were recruited across Australia to evaluate the ‘My Joint Pain’ website, compared to a control group of non-users from 12 to 24 months. Outcome measures included the Health Education Impact Questionnaire (HEIQ) and the OA Quality Indicator (OAQI) questionnaire. The changes from 12 to 24 months in the HEIQ were evaluated using a generalised linear model. The differences between users and non-users in the OAQI were evaluated using a chi-square test. A total of 277 eligible participants with symptomatic hip or knee OA were recruited at baseline, and 122 participants completed the 24-month surveys (users: n = 35, non-users: n = 87). There was no significant difference between users and non-users for the HEIQ scores at 24 months after adjustments for age, sex and body mass index (BMI). Users had higher emotional distress scores than non-users in univariable analysis. When compared with non-users in the OAQI, users showed favourable changes in receiving information about “self-management” and “acetaminophen” and “non-steroidal anti-inflammatory drugs (NSAIDs)” from 12 to 24 months. The evaluation of the updated ‘My Joint Pain’ website didn’t find significant improvements in terms of health education, but it may help delivering useful information about self-management and appropriate use of pharmacological treatments. More strategies are needed to facilitate the uptake of evidence-based self-management and education online resources for OA consumers.
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.JOCA.2010.08.016
Abstract: The role of inflammation in osteoarthritis (OA) pathogenesis is unclear, and the associations between inflammatory cytokines and cartilage loss have not been reported. We determined the associations between serum levels of interleukin (IL)-6 and tumor necrosis factor-α (TNF-α), knee radiographic OA (ROA) and cartilage loss over 2.9 years in older adults. A total of 172 randomly selected subjects (mean 63 years, range 52-78, 47% female) were studied at baseline and approximately 3 (range 2.6-3.3) years later. IL-6 and TNF-α were assessed by radioimmunoassay. T1-weighted fat-suppressed magnetic resonance imaging of the right knee was performed at baseline and follow-up to determine knee cartilage volume. Knee ROA of both knees was assessed at baseline. At baseline, quartiles of IL-6 and TNF-α were associated with increased prevalence of medial tibiofemoral joint space narrowing (OARSI grade ≥ 1) in multivariate analyses [odds ratio (OR): 1.42 and 1.47 per quartile, respectively, both P<0.05]. Longitudinally, baseline IL-6 predicted loss of both medial and lateral tibial cartilage volume (β: -1.19% and -1.35% per annum per quartile, P<0.05 and P<0.01, respectively), independently of TNF-α. Change in IL-6 was associated with increased loss of medial and lateral tibial cartilage volume (β: -1.18% and -1.06% per annum per quartile, both P<0.05) and change in TNF-α was also negatively associated with change in medial cartilage volume (β: -1.27% per annum per quartile, P<0.05). Serum levels of IL-6 and TNF-α are associated with knee cartilage loss in older people suggesting low level inflammation plays a role in the pathogenesis of knee OA.
Publisher: Oxford University Press (OUP)
Date: 28-07-2006
DOI: 10.1093/RHEUMATOLOGY/KEL243
Abstract: To describe the association between sex, age and rate of change in knee cartilage volume in adults. A total of 325 subjects (mean age 45 yrs, range 26-61) was measured at baseline and approximately 2 yrs later. Knee cartilage volume and bone size were determined using T1-weighted fat saturation magnetic resonance imaging (MRI). Height, weight, body mass index and radiographic osteoarthritis (ROA) were measured by standard protocols. Knee cartilage volume decreased by 1.5-4.2% per annum. In multivariable analysis, females had higher rates of change per annum in knee cartilage volume than males (medial tibia: -3.5%, P < 0.001 lateral tibia: -2.6%, P < 0.001 and patella: -0.8%, P = 0.053). The sex difference first appeared at age 40 and became more marked with increasing age at the medial tibial site only (P = 0.039). Age was significantly associated with annual change in knee cartilage volume at all three sites (beta = -0.06 to -0.12%/yr, all P < 0.05), and these associations were stronger in females. With the exception of the medial site (beta = -0.05/yr, P = 0.117 for ROA exclusion, and beta = -0.06%/yr, P = 0.056 for ROA adjustment), the association with age did not change when subjects with ROA were excluded from analyses or after further adjustment for ROA. Within the age range we studied, knee cartilage volume declines at a faster rate with increasing age. This is partly mediated by ROA at the medial tibial site only. Furthermore, women have substantially higher knee cartilage loss than men, and these sex differences first appear at age 40 and become more marked with increasing age, which has implications for prevention of cartilage loss from middle age.
Publisher: Informa UK Limited
Date: 28-01-2016
Publisher: Springer Science and Business Media LLC
Date: 09-09-2017
DOI: 10.1007/S00198-016-3754-9
Abstract: This was the first study examining optimal vitamin D status for musculoskeletal health in middle-aged women. A 25-hydroxyvitamin D level of at least 29 to 33 nmol/L appears required for optimal musculoskeletal health, but the current cut-off of 50 nmol/L may be warranted. This study aimed to determine whether cut-points exist for associations between serum 25-hydroxyvitamin D (25OHD) and musculoskeletal health outcomes in middle-aged women, below which greater 25OHD levels are associated with musculoskeletal health benefits and above which no such associations exist. This is a cross-sectional study of 344 women aged 36-57 years. Cut-points for associations of serum 25OHD with lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD), lower limb muscle strength (LMS), timed up and go test (TUG), functional reach test (FRT), lateral reach test (LRT), and step test (ST) were explored using locally weighted regression smoothing and nonlinear least-squares estimation, and associations above and below the identified cut-points were estimated using segmented regression. The prevalence of low 25OHD was 28 % (<50 nmol/L). Significant cut-points (nmol/L) were identified for FN BMD 31 (95 % confidence interval (CI): 18, 43), LS BMD 31 (17, 45), TUG 30 (24, 36), ST 33 (24, 31), FRT 31 (18, 43), and LMS 29 (8, 49) but not LRT (42 (-8, 93). Below these cut-points, there were beneficial associations between higher 25OHD level and each outcome, while above the cut-points, there were no beneficial associations. In middle-aged women, there are thresholds for associations between serum 25OHD concentrations and bone density and most balance measures, suggesting that 25OHD levels of at least 29 to 33 nmol/L are required for optimal musculoskeletal health in this population. The current cut-off of 50 nmol/L may be higher than needed for some outcomes but appears warranted overall.
Publisher: Elsevier BV
Date: 05-2007
DOI: 10.1016/J.JOCA.2007.01.003
Abstract: Unlike knee plain radiography which can only detect joint space narrowing and osteophytes, magnetic resonance imaging can directly visualize and analyse the whole knee structure, including bone size, cartilage defects and loss of cartilage volume. Tibial subchondral bone area expansion may be primary and is associated with risk factors such as age, body mass index (BMI), genetics and/or limb malalignment. It can lead to the development of knee defects, which may also be caused by demographic, anthropometric and environmental factors such as age, female sex, BMI and smoking as well as structural changes such as osteophytes, bone marrow lesions, meniscal tears, meniscal extrusion and ligament abnormalities. Once knee cartilage defects develop, they have a variable natural history but are associated with subsequent cartilage loss in a dose-response manner. Both tibial subchondral bone area and knee cartilage defects are quantitatively related to the severity of knee osteoarthritis (OA), and predictive of the need for knee joint replacement in subjects with knee OA independent of radiographic change. Taken as a whole, these studies suggest that tibial subchondral bone expansion and cartilage defect development represent important targets for the prevention of cartilage loss and joint replacement.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.JOCD.2014.01.004
Abstract: The ISCD 2007 Pediatric Official Positions define osteoporosis in children on the basis of fracture history and low bone density, adjusted as appropriate for age, gender, and body size. The task force on fracture prediction and osteoporosis definition has reviewed these positions and suggests modifications with respect to vertebral fracture and the definition of a significant fracture history and draws attention to the need to consider degree of trauma as a factor that may modify fracture risk prediction.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/AR2428
Publisher: BMJ
Date: 25-01-2011
DOI: 10.1136/BMJ.C7254
Publisher: Springer Science and Business Media LLC
Date: 2014
DOI: 10.1186/AR4607
Publisher: BMJ
Date: 08-2011
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.JOCA.2013.06.002
Abstract: To describe the cross-sectional and longitudinal association between hip Bone marrow lesions (BMLs) and bone density. 198 subjects with a right hip MRI and dual-energy X-ray absorptiometry (DXA) scans conducted at two time points, approximately 2.6 years apart were included. MR images were used to assess hip BML presence and size (cm(2)) while DXA scans were used to determine bone mineral density (BMD) of the total hip, spine and femoral neck. Fifty-five subjects (28%) had either a femoral and/or acetabular BML. Cross-sectionally, acetabular BMLs were associated with 5-6% lower total hip [P = 0.01] and femoral neck BMD [P < 0.001]. Resolving acetabular BMLs were associated with a 1-2% increase in BMD at hip [P = 0.05] and femoral neck [P = 0.01]. In contrast, resolving femoral BMLs were associated with a 4% lower and incident femoral BMLs with 3% higher femoral neck BMD [P = 0.04, P < 0.001 resp.]. Finally, each 1 cm(2) change femoral BMLs was associated with increase in femoral neck BMD: +0.03 g/cm(2), 95% confidence intervals (CI): +0.00, +0.05, and enlarging acetabular BMLs was associated with decrease in hip: -0.01 g/cm(2), 95% CI: -0.03, -0.00 and femoral neck BMD: -0.01 g/cm(2), 95% CI: -0.03, -0.001. Hip BMLs were associated with local BMD (hip and femoral neck) but not with spine BMD and these associations vary according to site. BML prevalence and change was low in this study, hence these findings need confirmation. However, we hypothesize that these associations represent a combination of changes related directly to the BML pathology or changes adjacent to the disease process.
Publisher: Wiley
Date: 02-1991
DOI: 10.1111/J.1445-5994.1991.TB03010.X
Abstract: Patients with functional gastrointestinal disorders may have visceral sensory dysfunction so that physiological stimuli induce their symptoms. The clinical significance of altered perception-that is, its relation to clinical symptoms-remains unclear. Data indicate that sensory dysfunction is associated with altered reflex activity. Hence evidence of combined sensory-reflex dysfunction as a common pathophysiological mechanism in various functional gastrointestinal disorders would suggest that they are different forms of the same process. Altered reflex activity and altered conscious perception of gastrointestinal stimuli may combine to differing degrees, and their interaction may produce clinical symptoms.
Publisher: Elsevier BV
Date: 02-2004
DOI: 10.1016/J.JOCA.2003.08.010
Abstract: To describe the association between early radiographic osteoarthritis of the knee (ROA), knee cartilage volume and tibial bone surface area. Cross-sectional convenience s le of 372 male and female subjects (mean age 45 years, range 26-61). Articular cartilage volume, bone area and volume were determined at the patella, medial tibial and lateral tibial compartments by processing images acquired in the sagittal plane using T1-weighted fat saturation MRI. ROA was assessed with a standing semiflexed radiograph and the OARSI atlas for joint space narrowing and osteophytosis. Both radiographs and MRIs were performed in the right knee and read by different observers. ROA (predominantly grade 1) was present in 17% of subjects of which medial joint space narrowing was most common (14%) followed by medial osteophytes (6%). Grade one medial joint space narrowing was associated with substantial reductions in cartilage volume at both the medial and lateral tibial and patellar sites within the knee (adjusted mean difference 11-13%, all P<0.001) while grade one osteophytosis was associated with substantial increases in both lateral and medial tibial joint surface area (adjusted mean difference 10-16%, all P 0.05). Early medial compartment ROA is associated with substantial reductions in cartilage volume and increases in bone area. These large changes, when combined with similar measurement error for MRI and radiographs, suggest that MRI may be superior at detecting and hence understanding early osteoarthritis of the knee in humans.
Publisher: Wiley
Date: 10-2016
DOI: 10.1002/ACR.22871
Abstract: To describe the natural history of patellofemoral (PF) joint bone marrow lesions (BMLs) over 2.6 years and associations between changes in PF joint BMLs, knee pain, and knee cartilage morphology in older adults over 5 years. A prospective population-based cohort study of men and women ages 50-80 years (mean age 63 years, n = 406) was performed. PF joint BMLs, knee cartilage volume, and cartilage defect scores (range 0-4) were measured using the Whole-Organ Magnetic Resonance Imaging Score system at baseline and at 2.6 years. Knee pain was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline and at 5 years. At baseline, 27% (n = 109) had PF joint BMLs 24% of these increased (WOMAC score change of ≥1) at followup, 44% persisted, 32% decreased, and 21% resolved completely. Of those without PF joint BMLs at baseline, 20% of participants developed PF joint BMLs over 2.6 years. In multivariable analyses, a change in PF joint BMLs was deleteriously associated with a change in total knee pain (β = 0.67, 95% confidence interval [95% CI] 0.03, 1.31) and knee pain when going up/down stairs (β = 0.24, 95% CI 0.04, 0.44) over 5 years. Baseline PF joint and tibiofemoral joint cartilage volume were protective for PF joint BMLs (relative risk [RR] 0.69, 95% CI 0.52, 0.90 for PF joint), while baseline PF joint cartilage defects were associated with an increase in PF joint BMLs (RR 1.73, 95% CI 1.38, 2.17) over 2.6 years. TF joint cartilage defects were not associated with increases in PF joint BMLs. PF joint BMLs are not static, and change is clinically relevant. PF joint cartilage morphology predicts increases in PF joint BMLs.
Publisher: Bentham Science Publishers Ltd.
Date: 09-2006
DOI: 10.2174/157488706778250168
Abstract: Tocilizumab (namely MRA), a humanized anti-interleukin (IL)-6 receptor monoclonal antibody, is under development by Roche for the treatment of inflammatory autoimmune diseases such as rheumatoid arthritis (RA), systemic onset juvenile idiopathic arthritis (JIA), adult-onset Still's disease, Castleman's disease and Crohn's disease. Tocilizumab has a long plasma half-life, so it can be administered intravenously biweekly or monthly. Phase I and II clinical trials showed that tocilizumab (2, 4, 5, 8 or 10 mg/kg) reduced disease activity significantly in a dose-dependent manner. Tocilizumab not only improved signs and symptoms, but also normalized inflammatory markers such as C-reactive protein, erythrocyte sedimentation rate (ESR), fibrinogen and serum amyloid A, and reversed joint damage of RA. The efficacy of tocilizumab in the treatment of RA was at least as good as methotrexate. Tocilizumab was generally safe and well tolerated. Some adverse events such as significant rises in total cholesterol and triglyceride levels, liver function disorders, decreases in white blood cell counts, diarrhoea and infection were observed. In summary, preliminary clinical results suggest that tocilizumab is effective and generally well tolerated in the treatment of IL-6-related inflammatory autoimmune diseases. Like other anti-cytokine immunotherapies, caution and close monitoring for the adverse events, especially infection, are necessary in subsequent clinical trials.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.JOCA.2008.04.012
Abstract: To describe the reproducibility and validity of six different measurement techniques for knee subchondral bone mineral density (sBMD). A consecutive s le of 50 male and female participants from a population-based longitudinal study had sBMD assessed using dual energy X-ray absorptiometry scans. Anthropometric, knee pain, cartilage and bone measures by magnetic resonance imaging and radiographic osteoarthritis (OA) were assessed. The six methods were defined as: (1) the midpoint of one intercondylar spine, across the tibial surface and descending 10mm from the midpoint of the two intercondylar spines (2) the top of the spine descending 20mm, (3) 10-20mm beneath the top of the spine from the tibial surface descending, (4) 10mm, (5) 15 mm, and (6) 20mm. All six methods had excellent reproducibility (intra-class correlation coefficient 0.98-1.00). sBMD was higher in males (methods 2-4) and higher in those with medial tibial osteophytes (methods 1, 3 and 4). Medial tibial cartilage defects and overall cartilage defects correlated with sBMD (methods 3 and 4). Method 2, which includes the intercondylar spine, correlated with medial tibial bone size. Measuring sBMD using methods 3 and 4 produced the greatest number of associations with joint features of OA. These preliminary results need confirmation in larger longitudinal s les but suggest that sBMD can be accurately measured and plays a role in knee OA. Methods 3 and 4 had the best concurrent validity however, method 2 adds additional information on tibial bone size, suggesting that two measures are necessary in clinical studies.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.EXGER.2019.01.008
Abstract: This study aims to describe the associations of low muscle mass, handgrip (HGS) and lower-limb muscle strength (LMS) with health-related quality of life (HRQoL) over 10 years in community-dwelling older adults. Participants (N = 1002 51% women mean age 63 ± 7.4 years) were prospectively followed for 10 years. HRQoL was measured using the validated assessment of quality of life (AQoL) instrument. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry and normalized to body mass index (BMI). HGS and LMS were assessed using dynamometers. Low ALM/BMI (ALM/BMI Participants with LMS Lower-limb muscle strength and handgrip strength (in women only), which can be easily measured in clinical practice, appear more important than muscle mass for HRQoL.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.JOCD.2014.07.008
Abstract: This is 12-yr follow-up of a randomized controlled trial aimed to evaluate the long-term effects of bone density feedback and osteoporosis education on osteoporosis knowledge and self-efficacy. We examined the effects of feedback of bone density-defined fracture risk (high [T-score <0] vs normal [T-score ≥0] risk) and 2 different educational interventions (the group-based Osteoporosis Prevention and Self-Management Course [OPSMC] vs an osteoporosis leaflet) on osteoporosis knowledge and self-efficacy in women aged 25-44. Seventy-four percent (N = 347) of 470 participants at baseline participated at 12 yr. Overall, the scores were higher for osteoporosis knowledge but lower for self-efficacy at 12 yr. However, neither intervention had an effect on the change in knowledge (T-score, β = 0.4, 95% confidence interval [CI] = -0.3 to 1.1 OPSMC, β = 0.2, 95% CI = -0.5 to 0.9) or self-efficacy (T-score, β = -1.1, 95% CI = -2.5 to 0.4 OPSMC, β = -0.2, 95% CI = -1.6 to 1.3). Women in households with an unemployed main financial provider had a decrease in knowledge at 12 yr compared with those in households with an employed main financial provider in whom knowledge increased (β = -1.95, 95% CI = -3.40 to -0.50), but there were no other predictors of change identified for knowledge or self-efficacy. In conclusion, beneficial effects of both OPSMC and feedback of high fracture risk on osteoporosis knowledge seen previously at 2 yr were not sustained after 12 yr although overall knowledge was still significantly higher than at baseline. Neither intervention improved osteoporosis self-efficacy. More frequent osteoporosis education and bone density feedback may be required to maintain knowledge, and other approaches to improve self-efficacy are necessary.
Publisher: Elsevier BV
Date: 09-2011
Publisher: Elsevier BV
Date: 04-2015
Publisher: The Journal of Rheumatology
Date: 15-11-2015
Abstract: To describe the cross-sectional and longitudinal associations between knee regional effusion synovitis and knee pain in older adults. Data from a population-based random s le (n = 880, mean age 62 yrs, 50% women) were used. Baseline knee joint effusion synovitis was graded (0–3) using T2-weighted magnetic resonance imaging (MRI) in the suprapatellar pouch, central portion, posterior femoral recess, and subpopliteal recess. Effusion synovitis of the whole joint was defined as a score of ≥ 2 in any subregion. Other knee structural (including cartilage, bone marrow, and menisci) lesions were assessed by MRI at baseline. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire at baseline and 2.6 years later. Multivariable analyses were performed after adjustment for age, sex, body mass index, and other structural lesions. The prevalence of effusion synovitis was 67%. Suprapatellar pouch effusion synovitis was significantly and independently associated with increased total and nonweight-bearing knee pain in both cross-sectional and longitudinal analyses (for an increase in total knee pain of ≥ 5, RR 1.26 per grade, 95% CI 1.04–1.52), and increased weight-bearing knee pain in longitudinal analysis only. Effusion synovitis in posterior femoral recess and central portion were independently associated with increases in nonweight-bearing pain (RR 1.63 per grade, 95% CI 1.32–2.01 and RR 1.29 per grade, 95% CI 1.01–1.65, respectively) in longitudinal analyses only. Knee joint effusion synovitis has independent associations with knee pain in older adults. Suprapatellar pouch effusion synovitis is associated with nonweight-bearing and weight-bearing knee pain, while posterior femoral recess and central portion effusion synovitis are only associated with nonweight-bearing pain.
Publisher: BMJ
Date: 17-12-2013
DOI: 10.1136/ANNRHEUMDIS-2013-204161
Abstract: To describe the associations between overweight measures in childhood and knee pain, stiffness and dysfunction among adults 25 years later. Subjects broadly representative of the Australian population (n=449, aged 31-41 years, female 48%) were selected from the Australian Schools Health and Fitness Survey of 1985. Height, weight and knee injury were recorded and knee pain was assessed using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC). Childhood height, weight and knee injury had been measured according to standard protocols 25 years earlier and body mass index (BMI) and percentage overweight were calculated. The prevalence of knee pain was 34% and overweight in childhood and adulthood was 7% and 48%, respectively. Overall, there were no significant associations between childhood overweight measures and total WOMAC knee pain, stiffness and dysfunction scores in adulthood. However, in men, overweight in childhood was associated with adulthood WOMAC pain (relative risk (RR) 1.72, 95% CI 1.11 to 2.69) and childhood weight and BMI were associated with WOMAC stiffness and dysfunction. Childhood weight, BMI and overweight were all associated with the presence of adulthood walking knee pain in men and the whole s le. Most of these associations were independent of adult overweight measures. Subjects who were overweight in both childhood and adult life had a significant increase in the risk and prevalence of adulthood walking pain (RR=2.42, 95% CI 1.06 to 5.53). Childhood overweight measures were significantly associated with adulthood knee mechanical joint pain, stiffness and dysfunction among men, independent of adult overweight, suggesting that childhood overweight may lead to later knee symptoms in men.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.AMEPRE.2017.10.018
Abstract: This study aimed to determine if beneficial effects of in idualized feedback of fracture risk on osteoporosis preventive behaviors and bone mineral density observed in a 2-year trial were sustained long-term. This was a 10-year follow-up of a 2-year RCT in 470 premenopausal women aged 25-44 years, who were randomized to one of two educational interventions (the Osteoporosis Prevention and Self-Management Course [OPSMC] or an osteoporosis information leaflet) and received tailored feedback of their relative risk of fracture in later life (high versus normal risk groups). Bone mineral density of lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical activity, dietary calcium intake, calcium and vitamin D supplements, and smoking status were measured by questionnaires. From 2 to 12 years, the high-risk group had a smaller decrease in femoral neck bone mineral density (β=0.023, 95% CI=0.005, 0.041 g/cm Feedback of high fracture risk to younger women was associated with long-term improvements in osteoporosis preventive behaviors and attenuated femoral neck bone mineral density loss. Therefore, this could be considered as a strategy to prevent osteoporosis. Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260.
Publisher: BMJ
Date: 08-06-2010
DOI: 10.1136/EBN1065
Publisher: Wiley
Date: 02-2022
DOI: 10.1111/IMJ.15066
Abstract: A socioeconomic gradient exists in the utilisation of total hip replacements (THR) and total knee replacements (TKR) for osteoarthritis. However, the relations between socioeconomic status (SES) and time to THR or TKR is unknown. To describe the association between SES and time to THR and TKR. One thousand and seventy-two older adults residing in Tasmania, Australia, were studied. Incident primary THR and TKR were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. At baseline, each participant's area-level SES was determined using the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) from the Australian Bureau of Statistics' 2001 census data. The IRSAD was analysed in two ways: (i) categorised into quartiles, whereby quartile 1 represented the most socioeconomically disadvantaged group and (ii) the cohort dichotomised at the quartile 1 cut-point. The mean age was 63.0 (±7.5) years and 51% were women. Over the median follow up of 12.9 (interquartile range: 12.2-13.9) years, 56 (5%) participants had a THR and 79 (7%) had a TKR. Compared with the most disadvantaged quartile, less disadvantaged participants were less likely to have a THR (i.e. less disadvantaged participants had a longer time to THR hazard ratio (HR): 0.56 95% confidence interval (CI) 0.32, 1.00) but not TKR (HR: 0.90 95% CI 0.53, 1.54). However, the former became non-significant after adjustment for pain and radiographic osteoarthritis, suggesting that the associations may be mediated by these factors. The present study suggests that time to joint replacement was determined according to the symptoms/need of the participants rather than their SES.
Publisher: Oxford University Press (OUP)
Date: 1995
DOI: 10.1093/RHEUMATOLOGY/34.1.8
Abstract: Cortocosteroids have profound effects on bone, leading to accelerated osteoporosis and fracture. This review will attempt to summarize current knowledge about their effects in light of new information and important remaining questions, especially with respect to treatment of this common condition.
Publisher: Springer Science and Business Media LLC
Date: 25-10-2005
DOI: 10.1007/S10067-005-0050-Z
Abstract: Synovial haemangioma is a rare but important cause of knee symptoms, which, when undiagnosed, can lead to significant morbidity. Diagnosis is frequently difficult and delayed. We report on a case of synovial haemangioma, which demonstrates the difficulties inherent in diagnosis and the morbidity associated with diagnostic delay, in a young woman. Magnetic resonance imaging (MRI) is a useful tool for diagnosis, but detection on MRI can also be problematic, as shown by this case, demonstrating the need for greater awareness of this condition by both clinicians and radiologists. Arthroscopy is important in both the diagnosis and treatment of these lesions.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.JOCA.2005.04.009
Abstract: Although the current recommendation is to measure radiographic joint space width (JSW) to assess structural change in osteoarthritis (OA), there is increasing interest in direct measurement of cartilage volume from magnetic resonance imaging (MRI). We performed a longitudinal study to compare change in both JSW and articular cartilage volume in subjects with symptomatic knee OA. JSW was measured in 28 subjects with knee OA (57% females, mean age 62.8+/-9.8 years) who had standing radiographs in full extension, where both radiographs had satisfactory alignment. Each subject had femoral, tibial and combined femoral and tibial cartilage volumes determined from T1-weighted fat saturated sagittal knee MRI. All subjects had a repeat of the knee radiograph and MRI 1.96+/-0.4 years later. At baseline there was a moderate, but statistically significant, correlation between JSW and femoral and tibial cartilage volumes in the medial tibiofemoral joint, which was strengthened by adjusting for medial tibial bone size (R=0.58-0.66, P=0.001). Although we observed a reduction in JSW and femoral and tibial cartilage volumes over the study period, there was no significant association between reduction in JSW and cartilage volume (R<0.13). There was a trend towards a significant association between change in medial tibiofemoral cartilage volume and joint replacement at 4 years (OR=9.0, P=0.07) but not change in medial tibiofemoral JSW (OR=1.1, P=0.92). Although there was a modest correlation between cartilage volume and JSW in the medial tibiofemoral compartment, there was no correlation between longitudinal change in these measures. Change in cartilage volume appears to be a better predictor of joint replacement. Further work in larger s les over a longer period of time will be needed to confirm these findings.
Publisher: BMJ
Date: 06-2015
Publisher: Springer Science and Business Media LLC
Date: 20-02-2020
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.SEMARTHRIT.2022.152054
Abstract: To evaluate the effect of annual infusions of zoledronic acid (ZA) with or without a single injection of methylprednisolone, compared to placebo, on quantitative magnetic resonance imaging 3-D bone area and bone shape in participants with symptomatic knee osteoarthritis (OA). This was a post-hoc analysis of the ZAP2 trial. Active appearance modelling was used to assess bone area (mm At baseline 65% of participants demonstrated an OA shape. Treatment with ZA plus methylprednisolone but not ZA alone, compared to placebo, was associated with significantly slower expansion in bone area at the medial femoral (-33.9 mm ZA plus methylprednisolone may retard expansion of bone area over 24 months, but ZA alone may not. Neither ZA with or without methylprednisolone slowed progression of bone shape over 6 or 24 months.
Publisher: Springer Science and Business Media LLC
Date: 06-08-2012
Abstract: Osteoarthritis (OA) is a common health issue worldwide in the aging population who are also commonly deficient in vitamin D. Our previous study suggested that higher serum 25-(OH)D levels were associated with reduced knee cartilage loss, implying that vitamin D supplementation may prevent the progression of knee OA. The aim of the VItamin D Effects on OA (VIDEO) study is to compare, over a 2- year period, the effects of vitamin D supplementation versus placebo on knee structural changes, knee pain, and lower limb muscle strength in patients with symptomatic knee OA. Randomised, placebo-controlled, and double-blind clinical trial aiming to recruit 400 subjects (200 from Tasmania and 200 from Victoria) with both symptomatic knee OA and vitamin D deficiency (serum [25-(OH)D] level of .5 nmol/liter and nmol/liter). Participants will be randomly allocated to vitamin D supplementation (50,000 IU compounded vitamin D 3 capsule monthly) or identical inert placebo group for 2 years. The primary endpoint is loss of knee cartilage volume measured by magnetic resonance imaging (MRI) and Western Ontario and McMaster Universities Index of OA (WOMAC) knee pain score. The secondary endpoints will be other knee structural changes, and lower limb muscle strength. Several other outcome measures including core muscle images and central blood pressure will be recorded. Linear and logistic regression will be used to compare changes between groups using univariable and multivariable modeling analyses. Both intention to treat and per protocol analyses will be utilized. The trial is designed to test if vitamin D supplementation will reduce loss of knee cartilage volume, prevent the progression of other knee structural abnormalities, reduce knee pain and strengthen lower limb muscle strength, thus modify disease progression in knee OA. ClinicalTrials.gov identifier: NCT01176344 Australian New Zealand Clinical Trials Registry: ACTRN12610000495022
Publisher: BMJ
Date: 06-2016
Publisher: The Journal of Rheumatology
Date: 12-2016
Abstract: To report on the 5-year efficacy and safety results of the AMBITION (Actemra versus Methotrexate double-Blind Investigative Trial In mONotherapy) monotherapy study ( ClinicalTrials.gov : NCT00109408 , NCT00720798 ). Patients with rheumatoid arthritis for whom biologics had not failed or who did not discontinue methotrexate because of lack of efficacy or tolerability were followed up for 5 years to assess the efficacy and serious adverse events (SAE) of tocilizumab (TCZ) monotherapy. Longterm efficacy results showed that efficacy was maintained or improved for up to 264 weeks in patients receiving TCZ monotherapy. Serious infection was the most frequent SAE no new safety signals were reported. Longterm monotherapy with TCZ demonstrated continuing efficacy and safety.
Publisher: Springer Science and Business Media LLC
Date: 2014
DOI: 10.1186/AR4611
Publisher: Wiley
Date: 24-07-2000
Publisher: Wiley
Date: 07-2007
DOI: 10.1038/OBY.2007.213
Abstract: Calcium intake is a potential factor influencing weight gain and may reduce body weight, but the evidence for this in children is conflicting. The aim of this study was to use data from randomized controlled trials to determine whether calcium supplementation in healthy children affects weight or body composition. This study is a systematic review. We identified potential studies by searching the following electronic bibliographic databases: CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, MANTIS, ISI Web of Science, Food Science and Technology Abstracts, and Human Nutrition up until April 1, 2005 and hand-searched relevant conference abstracts. Studies were included if they were placebo-controlled randomized controlled trials of calcium supplementation, with at least 3 months of supplementation, in healthy children and with outcome measures including weight. Meta-analyses were performed using fixed effects models and weighted mean differences for weight and height and standardized mean differences (SMDs) for body composition measures. There were no statistically significant effects of calcium supplementation on weight [+0.14 kg 95% confidence interval (CI), -0.28, +0.57 kg], height (+0.22 cm 95% CI, -0.30, +0.74 cm), body fat (SMD, +0.04 95% CI, -0.08, +0.15), or lean mass (SMD, +0.14 95% CI, -0.03, +0.31). There is no evidence to support the use of calcium supplementation as a public health intervention to reduce weight gain or body fat in healthy children. Although our results do not rule out an effect of dietary supplementation with dairy products on weight gain or body composition, there is little evidence to support this hypothesis.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.JAMDA.2018.09.006
Abstract: To determine the effect of vitamin D supplementation and maintaining sufficient serum vitamin D on depressive symptoms in patients with knee osteoarthritis (OA) and vitamin D deficiency. A prespecified secondary analysis of a multicentre, randomized, double-blind, placebo-controlled trial. Participants were randomly assigned to receive oral vitamin D This clinical trial was conducted in participants with symptomatic knee OA and vitamin D deficiency from June 2010 to December 2013 in Tasmania and Victoria, Australia. The primary outcome was the depressive symptoms change over 24 months, which was measured using the Patient Health Questionnaire (PHQ-9, 0-27). Of 599 participants who were screened for eligibility, 413 participants were enrolled (mean age: 63.2 years 50.3% female) and 340 participants (intervention n = 181, placebo n = 159, 82.3% retention rate) completed the study. The baseline prevalence of depression (PHQ-9 score ≥5) was 25.4%. Depressive symptoms improved more in the vitamin D supplementation group compared to the placebo group [β: -0.66, 95% confidence interval (CI): -1.22 to -0.11, P for difference = .02] and in the participants who maintained vitamin D sufficiency compared to those who did not (β: -0.73, 95% CI: -1.41 to -0.05, P for difference = .04) over 24 months. These findings suggest that vitamin D supplementation and maintaining adequate vitamin D levels over 24 months may be beneficial for depressive symptoms in patients with knee OA.
Publisher: Wiley
Date: 07-2008
DOI: 10.1359/JBMR.080223
Abstract: The long-term effects of childhood exercise and body mass index (BMI) on bone mass remain uncertain. We measured 1434 children, 7-15 yr of age, as part of the Australian Schools Health and Fitness Survey in 1985 and approximately 20 yr later (mean age, 31 yr). Fitness measures included a 1.6-km run and a 50-m sprint (childhood only), leg strength, standing long jump, and physical work capacity at 170 beats/min (PWC(170) childhood and adulthood). BMI was assessed at both time points. A single Sahara bone ultrasound densitometer was used to determine heel bone mass. We found, in females, there were modest but significant beneficial relationships between the childhood 1.6-km run, 50-m sprint, standing long jump, and adult bone mass. In both sexes, PWC(170) at 9 yr of age had a greater influence on adult bone mass (r(2) = 5-8%, all p < 0.05) than it did for 15 yr olds (r(2) = 0.05), independent of adult performance. In the 12 yr olds, childhood PWC(170) was also associated with female adult bone mass (broadband ultrasound attenuation: r(2) = 6%, p = 0.045). In males, childhood BMI (but no performance measures) was positively associated with adult bone mass after adjustment for adult BMI. In conclusion, childhood fitness levels, particularly in females and in the early pubertal years, are predictive of adult skeletal status as measured by quantitative ultrasound, whereas BMI is predictive in males only. These results suggest that increased skeletal loading in childhood leads to an increase in peak bone mass independent of current loading.
Publisher: BMJ
Date: 16-06-2001
Publisher: Wiley
Date: 03-2012
DOI: 10.1111/J.1445-5994.2011.02438.X
Abstract: There is controversy about whether pain and radiographic osteoarthritis (ROA) predict subsequent cartilage loss. The aim of this study was to describe the relationship between ROA, pain and cartilage loss in the knee. We studied randomly selected subjects at baseline and approximately 2.9 years later (n= 399). The presence of ROA was assessed at baseline with a standing anteroposterior semiflexed radiograph scored using the Osteoarthritis Research Society International atlas for osteophytes (OP) and joint space narrowing (JSN). Pain was assessed by the Western Ontario McMaster Osteoarthritis Index. Subjects' medial and lateral tibial cartilage volumes were determined by magnetic resonance imaging at both time points. In cross-sectional analysis, both medial and lateral tibial cartilage volumes were lower in those with ROA. Any medial ROA predicted medial tibial cartilage loss (3.2% (standard deviation (SD) 5.6) vs 1.9% (SD 5.3) per annum) while any lateral ROA predicted both medial (4.0% (SD 6.0) vs 2.2% (SD 5.3) per annum) and lateral (3.5% (SD 5.8) vs 1.6% (SD 4.2) per annum) tibial cartilage loss (all P < 0.05). In multivariate analysis, JSN and OP at both medial and lateral sites had independent dose-response associations with tibial cartilage loss at both sites. Pain was an independent predictor of lateral, but not medial, tibial cartilage loss after taking ROA into account. Subjects with ROA (either JSN or OP) and, to a lesser extent, pain lose cartilage faster than subjects without ROA and the more severe the ROA the greater the rate of loss. These findings have implications for the design of clinical trials.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2012
Publisher: Springer Science and Business Media LLC
Date: 07-09-2012
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 04-2019
Publisher: Springer Science and Business Media LLC
Date: 21-10-2016
Publisher: Wiley
Date: 30-11-2005
DOI: 10.1002/ART.21474
Abstract: To describe the association between prevalent and incident knee cartilage defects and loss of knee cartilage in male and female adults. A convenience s le of 325 subjects (mean age 45 years age range 26-61 years) was evaluated at baseline and approximately 2 years later. Knee cartilage volume, cartilage defect scores (0-4 scale), and joint surface area were determined using T1-weighted fat-suppression magnetic resonance imaging techniques. Height, weight, and radiographic evidence of osteoarthritis were measured by standard protocols. Multivariable analysis revealed that baseline cartilage defect scores at the medial tibia, lateral tibia, and patella had a dose-response association with the annual rate of change in knee cartilage volume at the corresponding site (beta = -1.3% to -1.2% per grade P or =1) was associated with higher rates of knee cartilage volume loss at all sites (beta = -1.9% to -1.7% per year P < 0.01 for all comparisons). Furthermore, a decrease in the knee cartilage defect score (change of less than or equal to -1) was associated with an increase in knee cartilage volume at all sites (beta = 1.0% to 2.7% per year P < 0.05 for all comparisons). Prevalent knee cartilage defects are predictive of compartment-specific cartilage loss over 2 years. Both increases and decreases in knee cartilage defects are associated with changes in knee cartilage volume, which implies a potential for reversal of knee cartilage loss.
Publisher: Elsevier BV
Date: 04-2020
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/1759720X221081652
Abstract: 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). 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. 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). 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.
Publisher: Wiley
Date: 23-06-2016
DOI: 10.1002/ACR.22778
Abstract: The aim of this study was to describe the correlation between changes in structural abnormalities assessed on magnetic resonance imaging (MRI) and change in radiographic osteoarthritis (OA) over 10 years in a midlife cohort. A total of 211 participants (mean age 45 years [range 26-61 years], 57% female) were studied at baseline, 2 years, and 10 years. Approximately one-half were adult offspring of subjects who had undergone knee replacement for OA and the remainders were randomly selected controls. Joint space narrowing (JSN) and osteophytes were assessed from radiographs, while cartilage volume, cartilage defects, and meniscal tears/extrusion were assessed from MRI. Spearman ranked correlation analysis was used to describe the correlation between structural changes assessed on MRI and radiographs. Only medial tibiofemoral compartment results are presented, as the lateral compartment had limited change. Over 10 years, change in meniscal tears showed a moderate independent correlation with change in both JSN (ρ = +0.37, P < 0.01) and osteophytes (ρ = +0.31, P < 0.01) in the adjusted analysis. Meniscal extrusion (ρ = +0.22, P < 0.01) and cartilage defects (ρ = +0.16, P < 0.04) showed a slightly weaker independent correlation with JSN in the adjusted analysis, whereas cartilage volume loss showed no significant correlation with either of the 2 radiographic outcomes. Change in JSN is correlated with change in meniscal tears and, to a lesser extent, with meniscal extrusion and cartilage defects. In this s le, change in JSN is a composite measure that does not reflect cartilage volume loss, prompting the review of the use of JSN as an outcome measure in chondro-protective drug trials.
Publisher: MDPI AG
Date: 25-08-2021
DOI: 10.3390/DIAGNOSTICS11091531
Abstract: Background: Residual/reconverted red bone marrow (RBM) in adult knees is occasionally observed on routine knee magnetic resonance imaging (MRI). We aimed to identify its prevalence, distribution, and associations with lifestyle factors, knee structural abnormalities, and knee symptoms in young adults. Methods: Participants (n = 327 aged = 31–41 years) were selected from the Childhood Determinants of Adult Health (CDAH) knee study. They underwent T1-weighted and proton-density-weighted fat-suppressed MRI scans of knees. Residual/reconverted RBM in distal femur and proximal tibia were graded semi-quantitatively (grades: 0–3) based on the percentage area occupied. Knee structural abnormalities were graded semi-quantitatively using previously published MRI scoring systems. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale during CDAH knee study (year: 2008–2010) and at 6–9-year follow-up during the CDAH-3 study (year: 2014–2019). Associations between definite RBM (grade ≥ 2) and lifestyle factors, knee symptoms, and structural abnormalities were described using log-binomial regressions. Results: Definite RBM was seen in females only, in 29 out of 154 cases (18.8%), with femoral involvement preceding tibial involvement. Definite RBM was associated with increased BMI (PR = 1.09/kg/m2 95% CI: 1.03, 1.16), overweight status (PR = 2.19 95% CI: 1.07, 4.51), and WOMAC knee pain (PR = 1.75 95% CI: 1.11, 2.74) in cross-section analysis. However, there was no association between RBM and knee-pain after seven years (PR = 1.15 95% CI: 0.66, 2.00). There were no associations between RBM and knee structural abnormalities. Conclusion: Presence of definite RBM in young adult knees was observed in females only. Definite RBM was associated with overweight measures, and the modest association with knee pain may not be causally related.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2018
Publisher: Wiley
Date: 26-04-2017
DOI: 10.1002/JBMR.3103
Abstract: Poor balance is a risk factor for falls and fracture in older adults, but little is known about modifiable factors affecting balance in younger women. This study aimed to examine whether lower limb muscle strength (LMS) in young women and changes in LMS are independent predictors of balance in middle age. This was an observational 10-year follow-up of 470 women aged 25 to 44 years at baseline who had previously participated in a 2-year population-based randomized controlled trial of osteoporosis education interventions. Linear regression was used to examine the association between baseline LMS (by dynamometer) and change in LMS over 12 years with balance at 12 years (timed up and go test [TUG], step test [ST], functional reach test [FRT], and lateral reach test [LRT]). LMS declined by a mean of 17.3 kg over 12 years. After adjustment for potential confounders, baseline and change in LMS were independently beneficially associated with TUG (β = -0.008 sec/kg, 95% confidence interval [CI] -0.01 to -0.006, and β = -0.006 sec/kg, 95% CI -0.009 to -0.003 for baseline and change, respectively), FRT (β = 0.057 cm/kg, 95% CI 0.030 to 0.084, and β = 0.071 cm/kg, 95% CI 0.042 to 0.101, respectively), and LRT (β = 0.030 cm/kg, 95% CI 0.012 to 0.049, and β = 0.022 cm/kg, 95% CI 0.002 to 0.043, respectively) 12 years later. There was an association between baseline LMS and ST (β = 0.044 steps/kg, 95% CI 0.022 to 0.067) but not between change in LMS and ST. Among young women, greater LMS at baseline and slower decline over time are both associated with better balance in midlife. Analogous to the contributions of peak bone mass and bone loss to fracture risk in older adults, this suggests that both improvement of muscle strength in younger age and prevention of age-related loss of muscle strength could be potentially useful strategies to improve balance and reduce falls in later life. © 2017 American Society for Bone and Mineral Research.
Publisher: Elsevier BV
Date: 09-2005
DOI: 10.1016/J.JOCA.2005.04.014
Abstract: To resolve uncertainty regarding sex differences in osteoarthritis (OA) by performing a meta-analysis of sex differences in OA prevalence, incidence and severity. Standard search strategies for population-based studies of OA providing sex-specific data. Random effects meta-analysis to provide pooled male vs female risk and rate ratios for prevalent and incident OA, and standardized mean differences (SMD) for OA severity. Meta-regression was used to investigate sources of heterogeneity. Males had a significantly reduced risk for prevalent OA in the knee [Risk Ratio (RR) 0.63, 95% CI 0.53-0.75] and hand [RR 0.81, 95% CI 0.73-0.90] but not for other sites. Males aged or = 55 years, tended to have more severe OA in the knee but not other sites. Heterogeneity in the estimates of sex differences in prevalence was substantially explained by age and other study design factors including method of OA definition. The results demonstrate the presence of sex differences in OA prevalence and incidence, with females generally at a higher risk. Females also tend to have more severe knee OA, particularly after menopausal age. The site differences indicate the need for further studies to explore mechanisms underlying OA.
Publisher: Springer Science and Business Media LLC
Date: 08-2003
Publisher: Elsevier BV
Date: 05-2009
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2019
Publisher: Springer Science and Business Media LLC
Date: 05-12-2020
DOI: 10.1038/S41430-019-0541-7
Abstract: An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 27-05-2019
Publisher: Elsevier BV
Date: 05-2009
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.CLNU.2019.05.006
Abstract: Psoriasis is a skin disorder affecting approximately 2-3% of the global population. While research has revealed a strong genetic component, there are few studies exploring the extent to which lifestyle factors influence psoriasis pathogenesis. The aim of this review was to describe the role of lifestyle factors as both a potential cause and treatment for psoriasis. The review also examines the underlying mechanisms through which these lifestyle factors may operate. This narrative review aims to incorporate current knowledge relating to both lifestyle and pathogenetic factors that contribute to and alleviate psoriasis presentation. Studies reporting the effect of an inflammatory diet and potential dietary benefits are reported, as well as insights into the effects of stress, smoking and alcohol, insulin resistance and exercise. Poor nutrition and low Omega 3 fatty acid intake, likely combined with fat malabsorption caused by gut dysbiosis and systemic inflammation, are associated with psoriasis. The data strongly suggest that improvements to disease severity can be made through dietary and lifestyle interventions and increased physical activity. Less conclusive, although worthy of mention, is the beneficial effect of bile acid supplementation. Lifestyle interventions are a promising treatment for psoriasis and its associated co-morbidities. However, gaps and inadequacies exist within the literature, e.g. methodology, absence of a unified scoring system, lack of controlled clinical data and lack of studies without simultaneous usage of biologics or alternative therapies. Future directions should focus on high quality cohort studies and clinical trials.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.MATURITAS.2018.10.004
Abstract: To describe factors associated with prevalent and incident foot pain in a population-based cohort of older adults (n = 1092). Longitudinal observational study. Prevalent foot pain, incident foot pain after 5 years. Potential correlates included demographic factors, anthropometry, leg strength, metabolic factors, steps per day (using pedometer), pain at 6 other sites, and psychological wellbeing. Data were analysed using log binomial models. Participants were aged 50-80 years (mean 63 years), 49% male, mean body mass index (BMI) 27.8 ± 4.7 at baseline. The prevalence of foot pain at baseline was 38% and the incidence of new pain over 5 years was 20%. BMI, pain at other sites (neck, hands, knees, pain at three or more sites), and poorer psychological wellbeing were independently associated with baseline foot pain. Baseline BMI and pain in the neck, hands, and knees were independently associated with incident foot pain but change in weight or BMI, total number of painful joints and psychological wellbeing were not. Self-reported diabetes and cigarette smoking were not associated with prevalent or incident foot pain. This study demonstrates that greater body weight and joint pain at multiple sites were consistently associated with prevalent foot pain and predict incident foot pain. Addressing excess body mass and taking a global approach to the treatment of pain may reduce the prevalence and incidence of foot pain in older adults.
Publisher: BMJ
Date: 19-05-2021
DOI: 10.1136/ANNRHEUMDIS-2021-EULAR.4242
Abstract: Elevated levels of systemic inflammation are common in people with osteoarthritis and predict both pain and structural outcomes. Krill oil has anti-inflammatory properties and reduces severity of inflammatory arthritis in mice by 50% compared to controls. 1 In humans, krill oil reduced knee pain and function in two short, moderate quality randomised controlled trials (RCTs) in people with osteoarthritis. However, evidence from longer trials with imaging data is lacking. The aim of this study was to compare the efficacy of krill oil (2g / day) vs. placebo for treating knee pain in patient with clinical knee osteoarthritis who have significant knee pain and effusion-synovitis. KARAOKE was a 24-week multicentre, randomised, double-blind, placebo-controlled trial conducted at five Australian sites. Participants aged ≥40 years with symptomatic knee OA (according to ACR criteria), significant knee pain (pain score ≥40mm on a 100mm visual analogue scale [VAS]), and effusion-synovitis present on MRI (grade ≥1 according to modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) scoring) were eligible. The study protocol has been published previously. 2 Participants were randomised to receive 2g/day of krill oil, (350 mg/g omega-3 content, 12 mg/g total omega-6 content) or inert placebo (vegetable oil, no EPA or DHA, mg/g (0.05%) other omega-3s). The primary outcome was absolute change in knee pain assessed using a VAS [0-100mm] after 24 weeks. Secondary outcomes were: change in knee pain and function assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score [0-500mm]), change in back and hand pain assessed using a VAS [0-100mm], change in lower limb leg strength assessed using a dynamometer, and change in blood parameters (including CRP, triglycerides, fasting glucose and total, HDL, LDL cholesterol), after 24 weeks. Linear mixed-models were used, using patient identification as random intercepts and trial centre and treatment month as random effect to adjust for correlated data within trial centres and repeated measures and to allow different treatment effects among patients over time, respectively. 262 participants were randomised (mean age 61.5 years, 53% females) to receive krill oil (n=130) or placebo (n=132). A total of 85% completed the trial. Knee pain improved in both groups over 24 weeks, but with no between-group difference (krill oil, -20.1mm placebo, -19.3mm, p=0.81). Secondary outcomes: knee pain and function score improved in both groups, but with no between-group difference (WOMAC pain: krill oil, -86.7 placebo, -82.5mm, p=0.81 WOMAC function: krill oil, -245.3 placebo, -184.3, p=0.14 at 24 weeks). The same applies for hand pain and back pain. No significant changes were seen in leg strength or any of the blood parameters at 24 weeks). Incidence of one or more adverse events was 50% in the krill oil group (n=66) and 55% in the placebo group (n=71). There were 8 serious adverse events in the krill oil group 6 in the placebo group, all considered unrelated to treatment. Krill oil was safe and well tolerated, but did not significantly reduce knee pain in patients with clinical knee osteoarthritis, significant knee pain and effusion-synovitis after 24 weeks compared to placebo. These findings do not support use of krill oil for alleviating knee pain in clinical knee osteoarthritis. [1]Ierna M, et al. BMC Musculoskelet Disord 2010 :136. [2]Laslett L, et al. Trials 2020 :79 Outcomes Absolute between group difference at 24 weeks P value Primary Knee pain 0.8 (-5.6 to 7.2) 0.81 Secondary Knee pain (WOMAC) 4.2 (-29.1 to 37.5) 0.81 Knee function (WOMAC) 61 (-19.2 to 141.3) 0.14 Hand pain 2.8 (-2.6 to 8.3) 0.31 Back pain 1.9 (-3.9 to 7.8) 0.46 Leg strength -2.59 (-9.41 to 4.23) 0.52 Metabolic factors Total Cholesterol 0.09 (-0.1 to 0.29) 0.34 HDL Cholesterol -0.03 (-0.1 to 0.03) 0.35 LDL Cholesterol 0.05 (-0.12 to 0.22) 0.57 Triglycerides 0.12 (-0.09 to 0.33) 0.27 Fasting glucose 0.01 (-0.26 to 0.29) 0.93 hsCRP 0.64 (-0.56 to 1.84) 0.30 Laura Laslett Speakers bureau: once, several years ago, and unrelated to this topic, Grant/research support from: Yes, received funding from Aker Biomarine to conduct this trial, Lieke Scheepers Shareholder of: AstraZeneca, Grant/research support from: Pfizer, unrelated to this topic, Employee of: Previously employed by AstraZeneca, Benny Antony Speakers bureau: Zydus, Grant/research support from: Grant support for investigator-initiated trial from NR Ltd for unrelated research, Anita Wluka: None declared, Catherine Hill: None declared, Lyn March Speakers bureau: Speaker fees from Pfizer Australia Ltd, Bristol Myer Squibb Australia, Abbvie Australia, Grant/research support from: Grant support for my institution from Janssen for unrelated research, Helen Keen: None declared, Petr Otahal: None declared, Flavia Cicuttini: None declared, Graeme Jones: None declared
Publisher: Wiley
Date: 27-04-2007
DOI: 10.1002/ART.22591
Abstract: To describe the effects of smoking on change in knee cartilage volume and increases in knee cartilage defects, and to test for interaction between smoking and family history of osteoarthritis (OA). Subjects with at least 1 parent having severe primary knee OA (offspring) and randomly selected controls without this history (a total of 325 subjects with a mean age of 45 years) were measured at baseline and 2.3 years later. Knee cartilage volume and defect score (on a 0-4 scale) were determined using T1-weighted fat-saturated magnetic resonance imaging. Smoking status and duration and number of cigarettes were recorded by questionnaire. In offspring, smoking was associated with annual change in medial and lateral tibial cartilage volume (beta = -2.20% and beta = -1.45%, respectively, for current smokers versus former smokers and those who had never smoked beta = -0.07% ack-year at both tibial sites, for smoking severity) in multivariate analysis. Smoking was also associated with increases (change >or=1) in medial and lateral tibiofemoral cartilage defect scores (odds ratio [OR] 4.91 and OR 2.98, respectively, for current smokers versus those who had never smoked OR 9.90 and OR 12.98, respectively, for heavy smoking [total of >20 pack-years] versus never smoking) (all P < 0.05). In contrast, smoking was not associated with any of the above in controls except for change in lateral tibial cartilage volume. There was significant interaction between smoking and offspring-control status for change in medial tibial cartilage volume (P = 0.047) and increases in medial (P = 0.03) and lateral (P = 0.049) tibiofemoral cartilage defects. Smoking leads to knee cartilage loss and defect development primarily in in iduals with a family history of knee OA. This provides evidence for a gene-environment interaction in the etiology of knee OA.
Publisher: Wiley
Date: 13-10-2022
Publisher: Elsevier BV
Date: 03-2008
DOI: 10.1016/J.JOCA.2007.07.005
Abstract: Cartilage defects are highly prevalent in subjects with knee osteoarthritis (OA). Although they are associated with increased cartilage loss and joint replacement, there is little data on the natural history of cartilage defects. The aim of this study was to examine the progression of cartilage defects over 2 years in people with knee OA and to identify factors associated with progression. One hundred and seventeen subjects with OA underwent magnetic resonance imaging of their dominant knee at baseline and follow-up. Cartilage defects were scored (0-4) at four sites. Bone size of the medial and lateral tibial plateau was determined. Height, weight, body mass index and physical activity were measured by standard protocols. The mean cartilage defect score increased significantly over the 2-year study period in all tibiofemoral compartments (all P<0.001), except the lateral tibial compartment with age and tibial plateau bone area at baseline being predictors of progression. However, there was heterogeneity with 81% progressing at any site, 15% remaining stable and 4% decreasing. Over 2 years, cartilage defects tend to progress in people with symptomatic OA, with only a small percentage decreasing in severity. Increasing age and increased bone area are risk factors for progression. Interventions aimed at preventing cartilage defects from occurring and reducing their severity may result in a reduction in the severity of OA, by reducing loss of articular cartilage and subsequent requirement for knee joint replacement.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Springer Science and Business Media LLC
Date: 04-2005
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S13075-019-2063-Z
Abstract: To describe the association of age, sex and body mass index with the rate of change of tibial knee cartilage volume over 10.7 years in a community-based s le of older adults. Four hundred and eighty-one participants (49% female, mean age 60.8 years [range 51.1–79.7], 49% had knee pain and 58% radiographic osteoarthritis) were included. Tibial cartilage volume of the right knee was assessed on T1-weighted fat-suppressed 1.5 T MRI at baseline and 10.7 years. Data analyses were performed using linear regression models. The average rate of loss of cartilage volume was 1.2%/year (range 0.2–3.9%) with all participants losing cartilage volume over the study period. There was a significant association between age and loss of tibial cartilage volume in the medial (0.023%/year, 95% confidence interval [CI] 0.010 to 0.036%, p 0.001), lateral (0.013%/year, 95% CI 0.003 to 0.023%, p = 0.012) and total tibia (0.018%/year, 95% CI 0.009 to 0.026%, p 0.001). Higher body mass index at baseline and increases in body mass index over time were associated with a greater tibial cartilage loss at the medial (body mass index at baseline 0.040%/year, 95% CI 0.022 to 0.058%, p 0.001 increases in body mass index 0.055%/year, 95% CI 0.018 to 0.093%, p = 0.004) but not lateral compartment. No evidence of non-linear relationships was observed. Compared to males, females lost more lateral tibial cartilage with increasing age (0.023%/year, 95% CI 0.003 to 0.043%, p = 0.024 for interaction). Tibial cartilage volume declines at a faster rate with increasing age and body mass index in both males and females, particularly in the medial compartment. In contrast to the low rate of change in radiographs, our findings suggest that cartilage loss at the tibia is universal in this age group.
Publisher: BMJ
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 14-01-2016
Publisher: Wiley
Date: 28-06-2005
DOI: 10.1002/ART.21148
Abstract: The significance of asymptomatic knee cartilage defects in healthy in iduals is not known. The aim of this study was to examine the association between cartilage defects in the knee and cartilage volume both cross-sectionally and longitudinally in healthy, middle-age adults. Eighty-six healthy men and women (mean +/- SD age 53.8 +/- 8.8 years) underwent T1-weighted fat-suppressed magnetic resonance imaging of their dominant knees at baseline and at the 2-year followup visit. Knee cartilage volume was measured. Cartilage defects were scored according to a grading system (0-4) and as present (a defect score of > or = 2) or absent in the medial and lateral tibiofemoral compartments. Cartilage defects in the medial and lateral tibiofemoral compartments were very common (in 61% and 43% of subjects, respectively). Those with cartilage defects had a 25% reduction in medial tibial cartilage volume, a 15% reduction in lateral tibial cartilage volume, and a 19% reduction in total femoral cartilage volume relative to those with no cartilage defects in cross-sectional analyses (all P < 0.05). In the medial tibiofemoral compartment, the annual loss of tibial cartilage in those with cartilage defects was 2.5% (95% confidence interval [95% CI] 2.2%, 3.1%) compared with an annual loss of tibial cartilage of 1.3% (95% CI 0.5%, 2.0%) in those with no defects (P = 0.028), independent of other known risk factors for osteoarthritis (OA). These data suggest that the presence of asymptomatic, non-full-thickness medial tibiofemoral cartilage defects identifies healthy in iduals most likely to lose knee cartilage in the absence of radiographic knee OA. Thus, interventions aimed at reducing or reversing cartilage defects may reduce the risk of subsequent knee OA.
Publisher: Oxford University Press (OUP)
Date: 30-03-2016
DOI: 10.1093/RHEUMATOLOGY/KEW045
Abstract: Conflicting reports of the effect of physical activity on knee cartilage may be due to the heterogeneity of populations examined and, in particular, the underlying health of the knee joint. This study examined the influence of recreational and occupational physical activity on cartilage volume loss. A total of 250 participants with no significant musculoskeletal disease were recruited. A gender-specific median cartilage volume split was used to define people in the lowest and highest 50% of baseline cartilage volume. Baseline recreational and occupational activity was examined by questionnaire, while cartilage volume was assessed by MRI at baseline and 2.4 years later. Significant interactions were demonstrable between physical activity and cartilage volume loss based on stratification of baseline cartilage volume (all P ⩽ 0.03). There was a dose-response relationship between frequently performed baseline occupational activities and medial cartilage volume loss in both the low (B = 0.2% per annum, 95% CI: 0.0, 0.04% per annum) and high (B = -0.2% per annum, 95% CI: -0.4, 0.0% per annum) baseline cartilage volume groups (P = 0.001 for interaction). In iduals with low baseline cartilage volume who were active in their occupation and/or recreational activity had greater medial cartilage volume loss than their more inactive counterparts (2.4% per annum vs 1.5% per annum, P = 0.02). Whereas people with less baseline cartilage volume are more at risk of structural knee damage with either heavy occupational or recreational workloads or both, in iduals with high baseline cartilage volume may advantageously modify their risk for knee OA by participating in more frequent occupational physical activities.
Publisher: Wiley
Date: 09-2005
DOI: 10.1002/ART.21267
Abstract: To estimate the heritability of longitudinal changes in knee cartilage volume, chondral defects, subchondral bone size, and lower limb muscle strength. A sibpair design was used. Longitudinal changes in lateral and medial tibial cartilage volume and bone size, as well as progression of chondral defects, were determined on serial magnetic resonance images. Radiographs were obtained and scored for in idual features of radiographic osteoarthritis (OA) at baseline. Lower limb muscle strength was measured by dynamometry. Heritability was estimated using the SOLAR software package. A total of 115 subjects (55 men and 60 women, mean age 45 years) from 48 families representing 95 sibling pairs were successfully followed up for a mean of 2.4 years. The adjusted heritability estimates for changes in cartilage volume were 73% for the medial compartment (P < 0.01) and 40% for the lateral compartment (P = 0.10). The adjusted heritability estimates for changes in bone size were 62% for the lateral compartment (P = 0.03) and 20% for the medial compartment (P = 0.22). The adjusted heritability estimate for changes in muscle strength was 64% (P = 0.01). The adjusted heritability estimates for progression of chondral defects were 80% for the lateral compartment (P = 0.06) and 98% for the medial compartment (P = 0.03). These estimates changed little after adjusting for each other and for the predominantly mild radiographic OA, with the exception of progression of chondral defects in the lateral compartment. Early longitudinal changes in knee structures of relevance to later OA, such as changes in medial tibial cartilage volume, lateral tibial bone size, progression of chondral defects, and muscle strength, have high heritability, most likely reflecting a strong genetic component and suggesting their potential to be studied in quantitative trait linkage and association analysis.
Publisher: Elsevier BV
Date: 2004
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2014
Publisher: Elsevier BV
Date: 2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2003
Publisher: MDPI AG
Date: 25-02-2022
Abstract: Lipid mediators have been suggested to have a role in pain sensitivity and response however, longitudinal data on lipid metabolites and persistent multisite musculoskeletal pain (MSMP) are lacking. This study was to identify lipid metabolic markers for persistent MSMP. Lipidomic profiling of 807 lipid species was performed on serum s les of 536 participants from a cohort study. MSMP was measured by a questionnaire and defined as painful sites ≥4. Persistent MSMP was defined as having MSMP at every visit. Logistic regression was used with adjustment for potential confounders. The Benjamini–Hochberg method was used to control for multiple testing. A total of 530 s les with 807 lipid metabolites passed quality control. Mean age at baseline was 61.54 ± 6.57 years and 50% were females. In total, 112 (21%) of the participants had persistent MSMP. Persistent MSMP was significantly associated with lower levels of monohexosylceramide (HexCer)(d18:1/22:0 and d18:1/24:0), acylcarnitine (AC)(26:0) and lysophosphatidylcholine (LPC)(18:1 [sn1], 18:2 [sn1], 18:2 [sn2], and 15-MHDA[sn1] [104_sn1]) after controlling for multiple testing. After adjustment for age, sex, body mass index, comorbidities, and physical activity, HexCer(d18:1/22:0 and d18:1/24:0) and LPC(15-MHDA [sn1] [104_sn1]) were significantly associated with persistent MSMP [Odds Ratio (OR) ranging from 0.25–0.36]. Two lipid classes—HexCer and LPC—were negatively associated with persistent MSMP after adjustment for covariates (OR = 0.22 and 0.27, respectively). This study identified three novel lipid signatures of persistent MSMP, suggesting that lipid metabolism is involved in the pathogenesis of persistent pain.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.JOCA.2017.05.013
Abstract: To describe the cross-sectional associations between proximal tibiofibular joint (PTFJ) type configurations and knee joint structural abnormalities in older adults. A total of 967 community-based participants were studied. T1-weighted fat-suppressed magnetic resonance image (MRI) with spoiled gradient recalled echo sequence was utilized to assess the PTFJ type configurations. Knee cartilage volume, cartilage defects, bone marrow lesions and osteophytes were measured. Linear regression and binary logistic regression analyses were used to examine the associations between PTFJ type configurations and knee joint cartilage volume as well as knee structural abnormalities, respectively, after adjustment for potential confounders. Seven PTFJ types including plane (49.4%), trochoid (31.9%), double trochoid (4.3%), saddle (5.4%), condylar (5.3%), trochlear (3.5%) and ball & socket (0.2%) were observed. Plane type was used as the comparator. In multivariable analyses, irregular joint types (comprising the five uncommon joint types) were associated negatively with cartilage volume, and positively with knee cartilage defects, bone marrow lesions and osteophytes in the lateral (but not medial) compartments. In contrast, trochoid type was only associated with reduced femoral cartilage volume, but not with knee cartilage defects, bone marrow lesions and osteophytes. Irregular PTFJ joint shapes are associated with osteoarthritic changes in the lateral, but not medial, tibiofemoral compartment in older adults. The causal relationship needs to be examined in future longitudinal studies.
Publisher: BMJ
Date: 04-2005
Publisher: The Journal of Rheumatology
Date: 09-2017
Abstract: To describe the associations between effusion-synovitis and joint structural abnormalities in patients with knee osteoarthritis (OA) over 24 months. A posthoc analysis using data from a randomized controlled trial in 413 patients with symptomatic OA (aged 63 ± 7 yrs, 208 women). Knee effusion-synovitis volume and score, cartilage defects, cartilage volume, and bone marrow lesions (BML) were assessed using magnetic resonance imaging. Joint space narrowing (JSN) and osteophytes were assessed using radiograph. Least significant change criterion was used to define change in effusion-synovitis volume. Knee symptoms were assessed by Western Ontario and McMaster University OA Index. Multivariable linear/logistic regression and multilevel generalized mixed-effects models were used in longitudinal analyses. Total effusion-synovitis volume increased modestly from baseline (8.0 ± 8.5 ml) to followup (9.0 ± 10.5 ml). Baseline BML, cartilage defect, JSN, and osteophyte scores were positively associated with change in effusion-synovitis volume (p 0.05). Baseline cartilage defects and JSN were also associated with change in effusion-synovitis score (p 0.05). However, neither baseline effusion-synovitis score nor volume consistently predicted change in the above structures except cartilage volume. In the mixed-effects models, knee effusion-synovitis was positively associated with BML (volume: β = 1.19 ml/grade score: OR = 1.75/grade) and cartilage defects (volume: β = 1.87 ml/grade score: OR = 2.22/grade), while negatively associated with cartilage volume loss. Change in effusion-synovitis volume was positively correlated with changes in knee pain and stiffness scores (p 0.05). Knee cartilage and subchondral bone abnormalities predicted change in effusion-synovitis, but effusion-synovitis did not predict knee structural changes. These findings suggest that synovial inflammation is likely the result of joint structural abnormalities in established OA. ClinicalTrials.gov identifier: NCT01176344 . Australian New Zealand Clinical Trials Registry: ACTRN12610000495022.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 10-2000
Abstract: There is an incomplete understanding of the contribution of early growth to bone accrual in childhood. The aims of this longitudinal study were to examine the association between growth variables at birth, 1 month, and 8 years and bone density in prepubertal children. Weight and length at both birth and 1 month of age were measured in 1988 as part of a prospective study for sudden infant death syndrome. A total of 330 children (47%) and 278 of their mothers were then contacted in 1996 for measurement of anthropometrics and bone density. Birth weight, birth length, and length gain (but not weight gain) in the first month all made significant contributions to areal bone density (BMD, g/cm(2)) at all sites at age 8 even after taking into account subsequent weight and height gain (model R(2) 14-39% depending on variable and site). Adjustment for potential environmental confounders did not alter these findings, however, adjustment for maternal BMD markedly reduced the early life associations (particularly for birth weight). Though early life factors were weakly associated with bone mineral apparent density (BMAD, g/cm(3)) in correlation analysis, subsequent height and weight gain were the only significant independent contributors to BMAD. In conclusion, early life anthropometrics make little contribution to BMAD (other than through their correlation with later growth) but make significant independent contributions to BMD suggesting that the growth trajectory of bone is determined very early in life. In addition, the contribution of body size at birth to bone growth in early life appears to be mediated by genetic factors although it is possible that it may be mediated by poorly measured or as yet unidentified determinants of body size at birth.
Publisher: Springer Science and Business Media LLC
Date: 04-05-2023
DOI: 10.1186/S12916-023-02875-X
Abstract: Chronic musculoskeletal pain has been linked to dementia however, chronic pain typically occurs in multiple sites therefore, this study was to investigate whether greater number of chronic pain sites is associated with a higher risk of dementia and its subtypes. Participants ( N = 356,383) in the UK Biobank who were dementia-free at baseline were included. Pain in the hip, knee, back, and neck/shoulder or ‘all over the body’ and its duration were assessed. Participants were categorised into six groups: no chronic pain chronic pain in 1, 2, 3, and 4 sites, and ‘all over the body’. All-cause dementia and its subtypes were ascertained using hospital inpatient and death registry records. Cox regression was used to investigate the associations between the number of chronic pain sites and the incidence of all-cause dementia and its subtypes. Over a median follow-up of 13 years, 4959 participants developed dementia. After adjustment for sociodemographic, lifestyle, comorbidities, pain medications, psychological problems, and sleep factors, greater number of chronic pain sites was associated with an increased risk of incident all-cause dementia (hazard ratio [HR] = 1.08 per 1 site increase, 95% CI 1.05–1.11) and Alzheimer’s disease (AD) (HR = 1.09 per 1-site increase, 95% CI 1.04–1.13) in a dose–response manner but not vascular and frontotemporal dementia. No significant association was found between the number of chronic pain sites and the risk of incident all-cause dementia among a subs le that underwent a fluid intelligence test. Greater number of chronic pain sites was associated with an increased risk of incident all-cause dementia and AD, suggesting that chronic pain in multiple sites may contribute to in iduals’ dementia risk and is an underestimated risk factor for dementia.
Publisher: Hindawi Limited
Date: 20-12-2012
DOI: 10.5402/2012/814923
Abstract: Cathodic protection has been proven to be one of the most widely applicable and cost-effective solutions for tackling steel corrosion in reinforced concrete. In this study, the possible use of carbon fibre composites, which are primarily used to strengthen concrete members, has been investigated as impressed current cathodic protection anodes. Carbon fibre anodes have been assessed in both concrete and calcium hydroxide solution. Two bonding mediums incorporating epoxy and geopolymer have also been investigated. The results demonstrate that epoxy resin can be used for bonding carbon fibre fabric anodes to reinforced concrete structures while geopolymer is more effective for bonding carbon fibre reinforced polymer (CFRP) rod into preformed grooves in the concrete surface. The dissolution of carbon fibre anode appears to stablise after a period of time, dependent upon the size and shape of the anode and applied voltage and current. Based on the present results, a maximum current density of 128 mA/m 2 of reinforcing steel area is recommended for the operation of CFRP fabric anode and 64 mA/m 2 of reinforcing steel area for that of CFRP rod anode.
Publisher: Springer Science and Business Media LLC
Date: 24-01-2023
DOI: 10.1007/S10067-022-06477-5
Abstract: To determine the feasibility of a randomized controlled trial (RCT) examining outdoor walking on knee osteoarthritis (KOA) clinical outcomes and magnetic resonance imaging (MRI) structural changes. This was a 24-week parallel two-arm pilot RCT in Tasmania, Australia. KOA participants were randomized to either a walking plus usual care group or a usual care control group. The walking group trained 3 days/week. The primary outcome was feasibility assessed by changes being required to the study design, recruitment, randomization, program adherence, safety, and retention. Exploratory outcomes were changes in symptoms, physical performance/activity, and MRI measures. Forty participants (mean age 66 years (SD 1.4) and 60% female) were randomized to walking ( n = 24) or usual care ( n = 16). Simple randomization resulted in a difference in numbers randomized to the two groups. During the study, class sizes were reduced from 10 to 8 participants to improve supervision, and exclusion criteria were added to facilitate program adherence. In the walking group, total program adherence was 70.0% and retention 70.8% at 24 weeks. The walking group had a higher number of mild adverse events and experienced clinically important improvements in symptoms (e.g., visual analogue scale (VAS) knee pain change in the walking group: − 38.7 mm [95% CI − 47.1 to − 30.3] versus usual care group: 4.3 mm [− 4.9 to 13.4]). This study supports the feasibility of a full-scale RCT given acceptable adherence, retention, randomization, and safety, and recruitment challenges have been identified. Large symptomatic benefits support the clinical usefulness of a subsequent trial. 12618001097235. Key Points • This pilot study is the first to investigate the effects of an outdoor walking program on knee osteoarthritis clinical outcomes and MRI joint structure, and it indicates that a full-scale RCT is feasible. • The outdoor walking program (plus usual care) resulted in large improvements in self-reported knee osteoarthritis symptoms compared to usual care alone. • The study identified recruitment challenges, and the manuscript explores these in more details and provides recommendations for future studies.
Publisher: Springer Science and Business Media LLC
Date: 09-12-2009
DOI: 10.1007/S00198-009-1137-1
Abstract: In this large population-based study, walking was assessed twice yearly for a week, each time by pedometer, had consistent clinically important associations with hip areal bone mineral density (aBMD) in both sexes which appears most important in those over 65 years of age suggesting that walking becomes more important with increasing age. Walking is advocated as a preventative strategy for osteoporosis but the evidence is conflicting in females and lacking in males. The aim of this population-based longitudinal study in community dwelling older people (n=875) was to determine the association between pedometer determined ambulatory activity (PAA) and bone mass. Bone mass was assessed as aBMD at the hip and spine using dual X-ray absorptiometry. Steps per day were measured using pedometers for 1 week on four occasions at least 6 months apart. Data were analysed using linear mixed models. At baseline, PAA was positively associated with hip aBMD. An age interaction was present with steps having a stronger association for those aged over 65 years. Longitudinally, the effect of steps on hip aBMD was constant, but not additive over time. For those over 65 years, the difference in hip aBMD between the lowest and highest steps quartiles ranged from 3.1% to 9.4%. With regard to the spine, the relationship between daily steps and spine aBMD was modified by sex. For males there was no significant relationship between steps and spine aBMD. However, for females, higher steps were associated with higher spine aBMD with the effect being constant over time but not additive. There was no evidence of a threshold effect. In conclusion, pedometer-determined ambulatory activity has consistent clinically important associations with hip aBMD in both sexes which appears most important in those over 65 years of age. The associations for spine aBMD were both weaker and inconsistent suggesting site specificity.
Publisher: The Endocrine Society
Date: 02-2008
DOI: 10.1210/JC.2007-1139
Abstract: Objective: Skeletal age deviation (SAD) is associated with bone mass and fracture risk in children, but factors determining this are unknown. The aim of this population-based cross-sectional study was to describe the factors associated with SAD. Methods: A convenience s le of 640 male and female children aged 7–17 yr was studied. All were assessed for body composition (dual-energy x-ray absorptiometry), diet, strength, dexterity, habitual physical activity, sunlight exposure, smoking, and medication use. Skeletal age was assigned using the Tanner-Whitehouse-2 method. Results: Subjects with a SAD greater than the 75th percentile had significantly higher height, weight, and Tanner stage compared with all other subjects. Bone-free lean mass, fat mass, and grip strength were positively associated with SAD. In multivariate analysis, ever smoking and use of inhaled corticosteroids were negatively associated with SAD, whereas milk drinking was positively associated with SAD. There was no significant association between sunlight exposure, television watching, light, or strenuous exercise and SAD. Conclusions: The results of this study should be regarded as hypothesis generating but are biologically plausible and suggest that body composition, strength, diet, ever smoking, and inhaled corticosteroid use may be determinants of bone maturity relative to age and thus affect fracture risk in children. However, more studies are necessary to explore other determinants of SAD such as genetic and perinatal factors and whether SAD influences peak bone mass.
Publisher: BMJ
Date: 17-04-2013
DOI: 10.1136/ANNRHEUMDIS-2012-202831
Abstract: Vitamin D is important for bone, cartilage and muscle function but there are few studies on its association with joint pain. To investigate whether serum vitamin D predicts change in knee and hip pain in older adults. Longitudinal population-based cohort study of randomly selected older adults (n=769) aged 50-80 years (mean 62 years) 50% were male. Serum 25-hydroxyvitamin D (25-OHD) was assessed at baseline by radioimmunoassay, and pain at baseline, 2.6 and/or 5 years using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire. We used linear regression with adjustment for age, sex, body mass index and season, then further adjusted for potential structural mechanisms (radiographic osteoarthritis, bone marrow lesions, chondral defects and muscle strength). Mean total knee WOMAC score was 3.2 (range 0-39). 4.2% of participants had moderate vitamin D deficiency at baseline (25-OHD 12.5-25 nmol/l). 25-OHD <25 nmol/l predicted change in knee pain (using total WOMAC score) over 5 years (β=2.41, p=0.002) with a similar effect size for hip pain over 2.4 years (β=2.20, p=0.083). Results were consistent within pain subscales, and the association was independent of demographic, anthropometric and structural covariates. No association was present when 25-OHD was analysed as a continuous measure. Moderate vitamin D deficiency independently predicts incident, or worsening of, knee pain over 5 years and, possibly, hip pain over 2.4 years. Therefore correcting moderate vitamin deficiency may attenuate worsening of knee or hip pain in elderly people but giving supplements to those with a higher 25-OHD level is unlikely to be effective.
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 30-05-2023
DOI: 10.1136/ANNRHEUMDIS-2023-EULAR.3399
Abstract: Hand osteoarthritis (OA) with synovitis is a common clinically identifiable phenotype which is associated with pain and disease progression. Methotrexate is a low-cost, well-established and effective treatment for inflammatory arthritis with a well-described safety profile. A previous randomized controlled trial showed no superiority of 10 mg methotrexate over placebo in pain relief at 3 or 12 months in patients with erosive hand OA [1] . No study has examined methotrexate in hand OA with inflammatory phenotype. To examine whether methotrexate reduced pain and improved function over 6 months in patients with hand OA and synovitis. In a multicentre, randomized, double-blind, placebo-controlled trial, patients with symptomatic hand OA and MRI-detected synovitis were recruited and randomly assigned in a 1:1 ratio to receive methotrexate 20 mg (n=50) or identical placebo (n=47) once weekly for 6 months. The primary outcome was pain reduction (assessed by 100mm visual analogue scale, VAS) at 6 months. Secondary outcomes included changes in physical function and quality of life assessed using Australian Canadian Osteoarthritis Hand Index (AUSCAN), Functional Index for Hand Osteoarthritis (FIHOA), Health Assessment Questionnaire (HAQ), and Michigan Hand Outcomes Questionnaire (MHQ). Adverse events were recorded. The primary analysis was by intention to treat, including all participants in their randomized groups. Mixed linear regression models were fit to continuous outcomes, adjusting for baseline values of outcome, sex and site, and the clustering of measurements within participants. Of 97 patients [mean age 61.4 (SD 6.7) years, 68 (70.1%) female], 82 (84.5%) provided the 6-month primary outcome. At 6 months, the methotrexate group had greater reduction in VAS pain (-15.2 vs -7.7, difference -9.9, 95% CI -19.3 to -0.6) (Figure 1), AUSCAN pain (-55.3 vs -13.5, diff -47.0, 95% CI -91.5 to -2.5) and stiffness (-14.5 vs -2.9, diff -11.4, 95% CI -20.8 to -2.0) than the placebo group (Table 1). The between-group differences were not clinically meaningful for change in AUSCAN function [-52.7 (-127.3 to 21.9)], FIHOA [-0.9 (-3.4 to 1.7)], HAQ [-0.0 (-0.2 to 0.2)], or MHQ [5.5 (-0.3 to 11.3)]. Incidence of adverse events was 62.0% in methotrexate and 59.6% in placebo group. This study provides high-quality evidence for the effect of methotrexate (20 mg once weekly) on reducing pain and stiffness over 6 months in patients with hand OA and synovitis. The results have the potential to inform clinical practice guidelines for the management of hand OA with the inflammatory phenotype. [1]Ferrero S, Wittoek R, Allado E, et al. Methotrexate treatment in hand osteoarthritis refractory to usual treatments: A randomised, double-blind, placebo-controlled trial. Semin Arthritis Rheum 2021 :831-8 Figure 1. Pain at each time point over the study period (mean with standard error) Table 1. Primary and secondary outcomes at 6 months, using a multiply imputed dataset Baseline Mean (SD) Change between baseline and 6 months Mean (SD) Between group difference Mean (95% CI)* P* Methotrexate (N=50) Placebo (N=47) Methotrexate (N=50) Placebo (N=47) Primary endpoint VAS 61.6 (15.7) 65.2 (18.1) -15.2 (24.0) -7.7 (25.3) -9.9 (-19.3, -0.6) 0.037 Secondary endpoints AUSCAN pain 233.6 (84.1) 242.7 (107.4) -55.3 (102.6) -13.5 (121.0) -47.0 (-91.5, -2.5) 0.038 AUSCAN stiffness 47.4 (23.1) 46.8 (25.6) -14.5 (24.1) -2.9 (28.7) -11.4 (-20.8, -2.0) 0.018 AUSCAN function 452.4 (198.1) 462.3 (196.3) -79.4 (170.8) -31.9 (202.5) -52.7 (-127.3, 21.9) 0.17 FIHOA 9.4 (6.0) 9.6 (5.5) 0.0 (5.1) 0.7 (5.9) -0.9 (-3.4, 1.7) 0.50 HAQ 0.7 (0.6) 0.6 (0.4) -0.0 (0.4) -0.0 (0.4) -0.0 (-0.2, 0.2) 0.89 MHQ 57.8 (11.8) 56.1 (12.9) 8.5 (11.7) 3.9 (16.1) 5.5 (-0.3, 11.3) 0.065 *Adjusted for baseline measure of outcome, sex, and study site NIL. None Declared.
Publisher: Elsevier BV
Date: 04-2019
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.JOCA.2015.02.018
Abstract: To examine the cross-sectional and longitudinal associations of patellar bone marrow lesion (BMLs) with knee pain, cartilage defects and cartilage volume in older adults. A total of 904 randomly selected subjects (mean 62.4 years, 49.9% female) were studied. Fat suppressed T1-weighted spoiled gradient recall and T2-weighted fast spin echo magnetic resonance imaging (MRI) sequences were used to assess cartilage volume, cartilage defects and/or BMLs at baseline (n = 904) and 2.6 (range: 1.4-4.8) years' follow-up (n = 414). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire at baseline (n = 904) and follow-up (n = 790). The prevalence of any patellar BMLs was 19% and was higher in those with tibiofemoral BMLs. In multivariable analyses, patellar BMLs were positively associated with any knee pain at baseline and an increase in knee pain when going up/down stairs (odds ratio (OR): 1.67, 95% confidence interval (CI): 1.08, 2.59) but not with other knee pain subscales. Patella BMLs were also associated with patellar cartilage defects both at baseline and change over time (OR: 1.76, 95% CI: 1.00, 3.70) but not tibiofemoral defects. Patellar BMLs were negatively associated with baseline and change in patella cartilage volume (β: -2.10%, 95% CI: -3.39%, -0.80%). These associations remained significant after further adjustment for tibiofemoral BMLs. Patellar BMLs were consistently associated with increased knee pain especially going up/down stairs, increased patellar cartilage defects, and decreased patellar cartilage volume cross-sectionally and longitudinally, suggesting a predominantly compartment specific role for patellar BMLs.
Publisher: Springer Science and Business Media LLC
Date: 20-11-2007
DOI: 10.1038/NCPRHEUM0676
Publisher: Wiley
Date: 06-2002
DOI: 10.1046/J.1440-1754.2002.00811.X
Abstract: To document symptomatic fracture incidence in those aged under 50 years of age. Fractures were ascertained from X-ray reports containing the word 'fracture' from all radiology providers for the geographically defined population of southern Tasmania (n = 165 175) for the period 1 July 1997 to 30 June 1999. In the 2-year study frame there were 2943 fractures in 164 730 person years in males and 1348 fractures in 165 620 person years in females. This represents a fracture incidence of 1787 per 100 000 person years in males and 819 per 100 000 person years in females. Peak fracture incidence was 10-14 years in females and 15-19 years in males although different fracture types had varying peak incidence suggesting different fracture-specific causes. The most common fractures were those of the hand (24%), forearm (17%), wrist (10%) and foot (9%). All fractures (including vertebral) were more common in males with relative risks ranging from 1.34 to 4.50. The estimated probability of at least one fracture between birth and 50 years of age was 59% for males and 34% for females. There are threefold as many fractures in this age group compared to those due to osteoporosis in the elderly in any given year. More research priority needs to be given to understanding the causes of these fractures so that preventive strategies can be formulated.
Publisher: Wiley
Date: 2008
DOI: 10.1002/JOR.20465
Abstract: Although knee malalignment is a risk factor for the progression of unicompartmental knee osteoarthritis (OA), it is unclear how this relationship is mediated. Cartilage defects are known to predate cartilage loss and the onset of knee OA, and it may be that knee malalignment increases the risk of unicompartmental knee cartilage defects. Knee radiographs and MRI were performed on a total of 202 subjects, 36.6% of whom had radiographic knee OA, to determine the relationship between static knee alignment and knee cartilage defects. Analyses were performed for the entire cohort, as well as for healthy and OA subgroups. For every 1 degrees increase in a valgus direction, there was an associated reduced risk of the presence of cartilage defects in the medial compartment of subjects with knee OA (p = 0.02), healthy subjects (p = 0.002), and the combined (p < 0.001) group. Moreover, for every 1 degrees increase in a valgus direction, there was an associated increased risk of the presence of lateral cartilage defects in the OA group (p = 0.006), although the relationship between change toward genu valgum and lateral compartment cartilage defects did not persist for the healthy group (p = 0.16). This cross-sectional study has demonstrated that knee alignment is associated with the risk for compartment specific knee cartilage defects in both healthy and arthritic people. Given that the natural history of cartilage volume reduction appears to be predated by the presence of cartilage defects, whether knee alignment affects the longitudinal progression from cartilage defects to cartilage loss requires further examination.
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.CONTRACEPTION.2011.02.001
Abstract: The associations between oral contraceptive (OC) use, bone mineral density (BMD) and the risk of fractures remain controversial. A cross-sectional study of 491 women aged 50-80 years was performed. We assessed OC use and fractures by questionnaire, and BMD and vertebral deformity by dual-energy x-ray absorptiometry. Ever use of OC was associated with significantly higher BMD at the total body (6%, p<.001) and spine (4% p=.05) (but not hip) after adjustment for confounders. There was also a significant association between duration of OC use and total body and spine BMD. Use of OCs for 5-10 years was associated with reduced vertebral deformity (adjusted odds ratio 0.46, 95% confidence interval 0.22-0.94). Oral contraceptive use and duration were associated with higher total body and spine BMD and a consistent reduction in vertebral deformities, although most associations did not reach significance.
Publisher: Elsevier BV
Date: 08-2011
Publisher: Elsevier
Date: 2006
Publisher: Elsevier BV
Date: 04-2013
Publisher: Elsevier BV
Date: 04-2016
Publisher: Wiley
Date: 28-11-2012
DOI: 10.1002/ART.34681
Abstract: Although there is evidence for a beneficial effect of increased quadriceps strength on knee symptoms, the effect on knee structure is unclear. We undertook this study to examine the relationship between change in vastus medialis cross-sectional area (CSA) and knee pain, tibial cartilage volume, and risk of knee replacement in subjects with symptomatic knee osteoarthritis (OA). One hundred seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of the knee at baseline and at 2 and 4.5 years. Vastus medialis CSA was measured at baseline and at 2 years. Tibial cartilage volume was measured at baseline and at 2 and 4.5 years. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index at baseline and at 2 years. The frequency of knee joint replacement over 4 years was determined. Regression coefficients (B) and odds ratios were determined along with 95% confidence intervals (95% CIs). After adjusting for confounders, baseline vastus medialis CSA was inversely associated with current knee pain (r = -0.16, P = 0.04) and with medial tibial cartilage volume loss from baseline to 2 years (B coefficient -10.9 [95% CI -19.5, -2.3]), but not with baseline tibial cartilage volume. In addition, an increase in vastus medialis CSA from baseline to 2 years was associated with reduced knee pain over the same time period (r = 0.24, P = 0.007), reduced medial tibial cartilage loss from 2 to 4.5 years (B coefficient -16.8 [95% CI -28.9, -4.6]), and reduced risk of knee replacement over 4 years (odds ratio 0.61 [95% CI 0.40, 0.94]). In a population of patients with symptomatic knee OA, increased vastus medialis size was associated with reduced knee pain and beneficial structural changes at the knee, suggesting that management of knee pain and optimizing vastus medialis size are important in reducing OA progression and subsequent knee replacement.
Publisher: BMJ
Date: 26-11-2015
DOI: 10.1136/ANNRHEUMDIS-2015-208360
Abstract: To describe the associations between infrapatellar fat pad (IPFP) signal intensity alteration at baseline and knee symptoms and structural changes in older adults. A total of 874 subjects (mean 62.1 years, 50.1% female) selected randomly from local community were studied at baseline and 770 were followed up (only 357 had MRI at follow-up) over 2.6 years. T1-weighted or T2-weighted fat suppressed MRI was used to assess IPFP signal intensity alteration (0-3), cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and 2.6 years later. Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index questionnaire. Radiographic osteoarthritis (OA) was assessed. In cross-sectional analyses, IPFP signal intensity alteration was significantly and positively associated with total knee pain as well as knee cartilage defects, BMLs and knee radiographic OA and negatively associated with patellar cartilage volume after adjustment for age, sex, body mass index and/or radiographic OA. Longitudinally, baseline signal intensity alteration within IPFP was significantly and positively associated with increases in knee pain when going upstairs/downstairs as well as increases in tibiofemoral cartilage defects and BMLs, and negatively associated with change in lateral tibial cartilage volume in multivariable analyses. IPFP signal intensity alteration at baseline was associated with knee structural abnormalities and clinical symptoms cross-sectionally and longitudinally in older adults, suggesting that it may serve as an important imaging biomarker in knee OA.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Elsevier BV
Date: 06-2017
Publisher: Wiley
Date: 04-2010
DOI: 10.1359/JBMR.091012
Abstract: The relationship between osteoarthritis (OA) and osteoporosis remains controversial. This study was designed to determine the association between hip and knee radiographic OA and change in total hip bone mineral density (BMD) over 2.6 years. A total of 867 population-based randomly selected subjects (mean age 62 years, range 51 to 80 years, and 49% female) were included. Hip and knee joint space narrowing (JSN, 0 to 3) and osteophytes (0 to 3) in both lower limbs was assessed using Altman's atlas. Total hip BMD was measured by dual-energy X-ray absorptiometry (DXA). We found that radiographic OA (score of JSN or osteophytes > 0) was common in this s le (hip 45%, knee 68%). In multivariable analyses, percentage change in total hip BMD per year was predicted by right and left hip axial JSN (beta = -0.25% and -0.29% per grade, respectively, both p < .05), right hip superior femoral osteophytes (grades 2 and 3 versus 0: beta = -1.60, p < .05), combined right and left knee tibiofemoral JSN (beta = -0.06 per grade from grades 0 to 12, p < .05), and osteophytes (beta = -0.06 per grade from grades 0 to 14, p < .05) independent of each other and joint pain. In conclusion, older subjects with radiographic hip and knee OA have higher total hip bone loss over 2.6 years regardless of symptoms, suggesting that consideration should be given to the monitoring of bone mass in these subjects.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Wiley
Date: 16-11-2017
DOI: 10.1111/JPC.13780
Publisher: AMPCo
Date: 03-2017
DOI: 10.5694/MJA16.01287
Abstract: There are now eight approved biological disease-modifying antirheumatic drugs (bDMARDs), two biosimilars and one targeted synthetic DMARD in Australia with a number of new products and biosimilars in the pipeline. bDMARDs have excellent efficacy, especially when combined with traditional DMARDs, and a well characterised but manageable safety profile. These expanded therapeutic options have revolutionised patient care and made remission (including drug free remission) a realistic goal. Evidence of a "window of opportunity" that changes the long term phenotype of the disease has been well established, so therapy should be commenced as early as possible in the disease process and a shared care model between general practitioner and rheumatologist provides the best outcomes. While there is no cure for rheumatoid arthritis, treatment has improved to the point where many patients can achieve a normal quality of life.
Publisher: American College of Physicians
Date: 12-2020
DOI: 10.7326/M20-0990
Publisher: BMJ
Date: 23-05-2022
DOI: 10.1136/ANNRHEUMDIS-2022-EULAR.4090
Abstract: Exercise therapy is recommended as first line treatment for knee osteoarthritis (OA), but it remains to be sub-optimally applied (1). Movement-evoked pain is a potential barrier to exercise adherence, but recent evidence suggests that such pain can be improved by training (2). Walking programs are low-cost, easily adopted and can be performed outdoors which can minimize the risk of SARS-CoV-2 transmission when in a group (3). To explore the acute pain trajectories of in iduals with knee OA during a 24-week outdoor walking intervention. In addition, to explore the effect of pain trajectories and/or baseline characteristics on retention and adherence. In iduals with clinical knee OA and bone marrow lesions (BMLs) on magnetic resonance imaging (MRI) were asked to follow a 24-week walking program. Every week consisted of two one hour supervised group sessions at various outdoor locations and one unsupervised session. At the start and end of every supervised group walk, knee pain was self-reported by participants to their trainer using a numerical rating scale (NRS) (0-10). The difference between the NRS pain values was considered as an acute pain change evoked by that walk. At baseline, the most affected knee of each participant was assessed using the Visual Analogue Scale (VAS) pain, the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) pain, stiffness and function, wellbeing (3 questionnaires) and the Osteoarthritis Research Society International (OARSI) recommended strength and performance measures. In total, N = 24 participants started the program of whom N = 7 (29%) withdrew. Pain at the start of each walk decreased from NRS 2.5 (SD 1.6) at the first walk (N = 24) to NRS 0.9 (SD 0.8) at the final walk (N = 17). This pain was estimated to decrease on NRS by -0.04 (95% CI -0.05 to -0.02) per supervised session, p 0.001 during the first 12 weeks and -0.01 (95% CI -0.02 to -0.004), p = 0.004 during the second twelve weeks of the program. The number (%) of participants who experienced an acute increase in pain decreased from 11 (45.8%) at the first walk to 4 (23.5%) at the last walk. At baseline, non-adherent participants ( % of group sessions) (N = 11) had lower physical performance scores, including the 30s Chair Stand Test (mean 10 (SD 1.7) stands versus mean 12.0 (SD 1.7) stands, p = 0.011), Fast Past Walk Test (1.23 (SD 0.14) meter per seconds (m/s) vs 1.50 (SD 0.20) m/s, p = 0.001), Six Minute Walk Test (418.8 (SD 75.9) m vs 529 (SD 72.6) m, p = 0.002), compared to adherent participants (N = 13). Non-adherent participants also had less severe self-reported symptoms including WOMAC stiffness (90.7 (SD 44.5) mm vs 121.5 (SD 17.0) mm, p = 0.031), compared to adherent participants. During the first two weeks of walking, acute increases in pain on average (mean ≥0.5 NRS) were reported by a greater number of non-adherent (N = 5 (45.5%)) than adherent participants (n = 4 (30.8%)). This was an exploratory study and results need to be interpreted with caution due to the small s le size. The walking program resulted in clinically important improvements (MCIIs) (≥ 1 on NRS) (4) in start pain and acute pain changes. Improvements in start pain during the first 12-weeks were comparable to improvements measured in the NEMEX program (2) and may suggest that 12 weeks of exercise is sufficient to achieve MCIIs in pain. Improvements in acute changes in pain were smaller, which may have been related to a floor effect (5). Lower physical performance scores at baseline and more acute increases in pain during the first two weeks was associated with non-adherence. Participants with these characteristics may benefit from a lighter introduction to exercise. [1]Bennell KL, et al. The Lancet Regional Health-Western Pacific. 2021 :100187. [2]Sandal LF, et al. Osteoarthritis and cartilage. 2016 (4):589-92. [3]Bulfone TC, et al. The Journal of infectious diseases. 2021 (4):550-61. [4]Perrot S, et al. Pain. 2013 (2):248-56. [5]McHorney CA, et al. Quality of life research. 1995 (4):293-307. We thank the participants who made this study possible. We would like to acknowledge the research staff, Kate Probert, Lizzy Reid, Simone Fitzgerald, Claire Roberts, Jasmin Ritchie, Dawn Simpson, and Tim Albion. We also thank Hamish Newsham-West for his contribution to the study design. Stan Drummen: None declared, Saliu Balogun: None declared, Lieke Scheepers Grant/research support from: Competitive Grant Program Inflammation ASPIRE 2020 Rheumatology International Developed Markets from Pfizer, Employee of: previously worked as an Associate Director Epidemiology at the Medical Evidence Observational Research Department at AstraZeneca., Ishanka Munugoda: None declared, aroub lahham: None declared, Kim Bennell: None declared, Rana Hinman: None declared, Michele Callisaya: None declared, Guoqi Cai: None declared, Petr Otahal: None declared, Tania Winzenberg Consultant of: received payment to create educational material by AMGEN, Zhiqiang Wang: None declared, Benny Antony: None declared, Johanne Martel-Pelletier Shareholder of: ArthroLab Inc., Jean-Pierre Pelletier Shareholder of: ArthroLab Inc., François Abram Consultant of: ArthroLab Inc., Employee of: Arthrolab Inc., Graeme Jones Speakers bureau: received payment for a speakers bureau from Novartis, Dawn Aitken: None declared
Publisher: Research Square Platform LLC
Date: 10-09-2020
DOI: 10.21203/RS.3.RS-31807/V2
Abstract: Background: To describe demographic and clinical factors associated with the prevalence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). Methods: 413 participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.2 ± 7.0 year, 50.4% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. Results: The prevalence and incidence of depression was 25.4% and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher prevalence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. Conclusion: Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the prevalence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA. Trial registration: ClinicalTrials.gov identifier: NCT01176344Anzctr.org.au identifier: ACTRN12610000495022
Publisher: Research Square Platform LLC
Date: 03-11-2020
DOI: 10.21203/RS.3.RS-31807/V3
Abstract: Background: To describe demographic and clinical factors associated with the presence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). Methods: 397 participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.3 ± 7.1 year, 48.6% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. Results: The presence and incidence of depression was 25.4% and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher presence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. Conclusion: Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the presence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA. Trial registration: ClinicalTrials.gov identifier: NCT01176344Anzctr.org.au identifier: ACTRN12610000495022
Publisher: Research Square Platform LLC
Date: 31-05-2020
DOI: 10.21203/RS.3.RS-31807/V1
Abstract: Background To describe demographic and clinical factors associated with the prevalence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). Methods 413 participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.2 ± 7.0 year, 50.4% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. Results The prevalence and incidence of depression was 25.4% and 11.2%, respectively. At baseline, having a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher prevalence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.04, 95%CI: 1.00, 1.08) and dysfunction score (RR: 1.01, 95%CI: 1.00, 1.02) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. Conclusion Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the prevalence and development of depression. This suggests that managing common OA risk factors and joint symptoms could be important for prevention and treatment depression in patients with knee OA.
Publisher: Informa UK Limited
Date: 25-06-2023
Publisher: Springer Science and Business Media LLC
Date: 23-10-2018
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 04-2014
Publisher: BMJ
Date: 06-2015
Publisher: Elsevier BV
Date: 10-2015
Publisher: BMJ
Date: 25-05-2011
Publisher: BMJ
Date: 06-2015
Publisher: Elsevier BV
Date: 06-2020
Publisher: Research Square Platform LLC
Date: 18-12-2020
DOI: 10.21203/RS.3.RS-31807/V4
Abstract: Background: To describe demographic and clinical factors associated with the presence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). Methods: 397 participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.3 ± 7.1 year, 48.6% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. Results: The presence and incidence of depression was 25.4% and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher presence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. Conclusion: Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the presence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA. Trial registration: ClinicalTrials.gov identifier: NCT01176344Anzctr.org.au identifier: ACTRN12610000495022
Publisher: Elsevier BV
Date: 04-2014
Publisher: Springer Science and Business Media LLC
Date: 07-04-2016
Publisher: Springer Science and Business Media LLC
Date: 2004
DOI: 10.1186/AR1389
Publisher: BMJ
Date: 15-09-2006
Publisher: Elsevier BV
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 12-2010
DOI: 10.1186/AR3209
Publisher: Springer Basel
Date: 2014
DOI: 10.1007/978-3-0348-0828-6_11
Abstract: Capsaicin appears to be effective for osteoarthritis pain but it is uncertain whether the effect has a dose response, is consistent across joints, or changes over time. Randomized controlled trials of topical capsaicin use in OA were identified from PubMed, EMBASE, and ISI Web of Knowledge. Effect on pain scores, patient global evaluation of treatment effectiveness and application site burning were assessed by standardised mean differences (SMD), using RevMan. Five double-blind randomized controlled trials and one case-crossover trial of topical capsaicin use were identified. Formulations ranged from 0.025 to 0.075%, and trial durations from 4 to 12 weeks. Trials assessed OA of the knee (n = 3), hand (n = 1), and a mix of joints (n = 2). Capsaicin treatment efficacy (vs. placebo) for change in VAS pain score was moderate, at 0.44 (95% CI 0.25-0.62) over 4 weeks of treatment. There was no heterogeneity between studies, indicating no between-study differences, including effect of OA site or treatment concentration. Two studies reported treatment beyond 4 weeks, with ergent results. One study reported an effect size of -9 mm after 12 weeks, and maximal between-group differences at 4 weeks. A second study reported that between-group differences increased over time, up to 20 weeks. Capsaicin was reported as being safe and well-tolerated, with no systemic toxicity. Mild application site burning affected 35-100% of capsaicin-treated patients with a risk ratio of 4.22 (95% CI 3.25-5.48, n = 5 trials) incidence peaked in week 1, with incidence rates declining over time. Topical capsaicin treatment four times daily is moderately effective in reducing pain intensity up to 20 weeks regardless of site of application and dose in patients with at least moderate pain and clinical or radiologically defined OA, and is well tolerated.
Publisher: Oxford University Press (OUP)
Date: 16-01-2021
DOI: 10.1093/RHEUMATOLOGY/KEAA787
Abstract: To describe the impact of OA on health-related quality of life (HRQoL) in the forms of health state utilities (HSUs) and health-dimension scores, and to compare the longitudinal changes in HRQoL for people with and without OA, using an Australian population-based longitudinal cohort. Participants of the Tasmanian Older Adult Cohort with data on OA diagnosis and HRQoL were included [interviewed at baseline (n = 1093), 2.5 years (n = 871), 5 years (n = 760) and 10 years (n = 562)]. HRQoL was assessed using the Assessment of Quality of Life four-dimensions and analysed using multivariable linear mixed regressions. Compared with participants without OA, HSUs for those with OA were 0.07 (95% confidence interval: 0.09, 0.05) units lower on average over 10 years. HSUs for participants with knee and/or hip OA were similar to those with other types of OA at the 2.5 year follow-up and then erged, with HSUs of the former being up to 0.09 units lower than the latter. Those with OA had lower scores for psychological wellness, independent living and social relationships compared with those without OA. Independent living and social relationships were mainly impacted by knee and/or hip OA, with the effect on the former increasing over time. Interventions to improve HRQoL should be tailored to specific OA types, health dimensions, and times. Support for maintaining psychological wellness should be provided, irrespective of OA type and duration. However, support for maintaining independent living could be more relevant to knee and/or hip OA patients living with the disease for longer.
Publisher: Elsevier BV
Date: 10-2010
Publisher: Springer Science and Business Media LLC
Date: 02-05-2020
Publisher: BMJ
Date: 06-2013
Publisher: Springer Science and Business Media LLC
Date: 2012
DOI: 10.1186/AR3689
Publisher: BMJ
Date: 19-05-2021
DOI: 10.1136/ANNRHEUMDIS-2021-EULAR.3418
Abstract: Serum levels of osteoarthritis (OA)-related cartilage and joint-specific biochemical markers – cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-3, and hyaluronan (HA) –are shown to be associated with cartilage degradation, joint tissue degradation, and synovitis in patients with OA. Although these OA-related biochemical markers may initially precede the MRI biomarkers of joint structural changes, such changes detected in MRI can lead to biochemical marker changes later as the condition progresses. However, there is a lack of data on OA-related biochemical markers’ association with MRI-based biomarkers in the middle-aged general population. We aimed to describe the associations between OA-related biochemical markers and MRI-based imaging biomarkers in middle-aged adults followed up over 10-13 years. Blood s les were collected during the Childhood Determinants of Adult Health (CDAH)-1 study at baseline (year: 2004-06, age: 26–36 years) and 10-13 year follow-up (CDAH-3 year: 2014–2019, age: 36–49 years). Serum s les from baseline (n=156) and follow-up (n= 167) were analyzed for three OA-related biomarkers – namely COMP, MMP-3, and HA– using non isotopic ELISA assay methodology. Knee MRI scans were obtained during the CDAH-knee study (year: 2008-10, age: 30-40 years, n=313), and MRIs were assessed for cartilage volume, cartilage thickness, subchondral bone area, cartilage defects, and bone marrow lesions (BML). Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) linear regression and logistic regression were used to describe the association of biochemical marker at CDAH-1 and MRI-based imaging biomarkers at CDAH-knee, and Tobit regression was used to describe the association of MRI-based imaging biomarkers at CDAH-knee and biochemical markers at CDAH-3. In the multivariable model for the association of biochemical marker with MRI-based imaging biomarkers (assessed after 4 years), we found a significant negative association of COMP with medial femorotibial compartment cartilage thickness (-0.010 (-0.019, -0.000) p=0.045), and MMP-3 with patellar cartilage thickness (-9.075 (-16.344, -1.807) p=0.015) and total bone area (-0.047 (-0.086, -0.007) p=0.020). No significant association was observed between HA and MRI markers. In the multivariable model for association of MRI-based imaging biomarkers with biochemical markers (assessed after 6-9 years), a significant negative association of total cartilage volume (-0.0005 (-0.0008, -0.0002) p=0.001) and total cartilage thickness (-0.628 (-1.143, -0.114) p=0.017) with MMP-3, and total bone area with COMP (0.270 (-0.474, -0.006) p=0.010) was observed. No significant association was observed between MRI-based imaging biomarkers and HA. COMP and MMP-3 levels were negatively associated with knee cartilage thickness assessed 4-years later. Similarly, knee cartilage thickness and volume were negatively associated with COMP and MMP-3 levels assessed 6-9 years later in population-based middle-aged adults, indicating an interdependent negative association of OA-related biochemical markers and MRI-based imaging biomarkers. These results suggest that OA-related biochemical markers may predict future MRI-based imaging biomarkers in middle-aged adults and thus represent possible at-risk populations to target for structure modification interventions. This project was funded by the National Health and Medical Research Council of Australia Project Grant and Royal Hobart Hospital Research Foundation Project Grant. Benny Antony Grant/research support from: Investigator-Initiated Clinical Trial support from Nat Rem Ltd., Ambrish Singh: None declared, Leigh Blizzard: None declared, Alison Venn: None declared, Graeme Jones Speakers bureau: Speaker for various pharma, Grant/research support from: Investigator-Initiated Clinical Trial support, John Burgess: None declared, Venkat Parameswaran: None declared, Flavia Cicuttini: None declared, Lyn March: None declared, Changhai Ding: None declared
Publisher: AMPCo
Date: 2009
DOI: 10.5694/J.1326-5377.2009.TB02284.X
Abstract: To describe rates of occurrence of falls, injuries and fatalities to horse-racing jockeys in Australia. Retrospective analysis of data on race-day falls from stewards' reports provided by the Principal Racing Authority of each state and territory of Australia, August 2002 - July 2006. Fall, injury and fatality incidence rates comparison with overseas rates. There were 3360 jockey falls from 748 367 rides. Falls occurred at a rate of 0.42 per 100 rides in flat races and 5.26 per 100 rides in jumps races. In flat racing, 54.6% (1694/3101) of falls occurred before the start of the race and 11.1% (344/3101) of falls occurred post-race. The 34.3% (1063/3101) of falls that occurred during flat races resulted in 61.7% (516/836) of the injuries sustained. In jumps racing, most falls occurred at a jump and 9.7% (25/259) of jockeys who fell were transported to hospital and/or declared unfit to ride. There were five fatalities resulting from falls during the study period, all in flat racing. Fall and injury rates were comparable with those found in the United Kingdom, Ireland, France and Japan. Being a jockey carries a substantial risk of injury and death. Although rates of injury in Australia are not exceptional by international standards, there can be improvement to safety standards in the Australian racing industry.
Publisher: Elsevier BV
Date: 02-1999
DOI: 10.1111/J.1467-842X.1999.TB01202.X
Abstract: To use the technique of meta-analysis to address the following research questions: Is water fluoridation associated with altered fracture risk at a population level and are the differences between studies consistent with confounding or chance variation between studies? The data sources utilised were Medline 1966-97, reviews and bibliographies. The search terms were fluoridation, bone mass and/or fracture. We included all observational studies published in English relating water fluoridation to bone mass and/or fracture in the initial assessment. Water fluoridation had no evident effect on fracture risk (RR 1.02, 95% CI 0.96-1.09, n = 18 studies). There was marked heterogeneity between studies which could be explained, in part, by the combination of gender, urbanicity and study quality (R2 0.25, p = 0.05, weighted analysis). Water fluoridation both at levels aimed at preventing dental caries and, possibly, at higher naturally occurring levels appears to have little effect on fracture risk, either protective or deleterious, at a population level. The small effect on bone mass seen in studies performed at the in idual level is consistent with this finding. Variation between studies is also likely to be due to differences in the distribution of other recognised fracture risk factors between different populations. Confirmation of these findings is required in large studies performed at the in idual level.
Publisher: Springer Science and Business Media LLC
Date: 06-1994
DOI: 10.2165/00002018-199410060-00006
Abstract: Calcium homeostasis depends upon the interplay of intestinal calcium absorption, renal excretion and skeletal mobilisation of calcium, mediated through bone formation and resorption, which are closely coupled in the adult skeleton. Serum calcium is extremely important for maintenance of normal cellular functions and is regulated by the major calciotropic hormones, parathyroid hormone (PTH), 1,25-dihydroxy-vitamin D and calcitonin. Certain drugs can interfere with calcium metabolism by effects at different stages in calcium metabolism, and a knowledge of the mechanism of drug action is generally helpful in understanding the various resultant clinical skeletal syndromes. Corticosteroids, for ex le, have profound effects at multiple stages of calcium metabolism, resulting in decreased bone formation and enhanced bone resorption leading to accelerated osteoporosis. Drugs such as aluminium and anticonvulsants impair mineralisation, leading to osteomalacia. Other drugs, such as fluoride, are employed for their known effects on bone, but in excess dosage can be harmful by producing mineralisation defects. Management of these conditions will be discussed in this review.
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/ANNRHEUMDIS-2020-EULAR.5139
Abstract: Pharmacological therapies are limited, associated with off-target effects, are frequently contraindicated, and only modestly effective for pain in osteoarthritis (OA). Effusion and synovitis are common in OA and are associated with symptomatic and structural progression of OA. Curcuma longa (Turmeric) extract has anti-inflammatory effects and is gaining popularity in the treatment of OA despite the lack of high-quality evidence. The CurKOA trial aimed to determine the efficacy of Curcuma longa extract for reducing knee symptoms and effusion-synovitis in patients with symptomatic knee OA and knee effusion-synovitis. In this randomised, double-blind, placebo-controlled trial, participants with significant knee pain (≥ 40 mm on a 100-mm visual analog scale [VAS]), symptomatic knee OA (by ACR criteria) and ultrasound defined effusion-synovitis were randomised to receive Curcuma longa extract (80% aqueous based extract standardized to turmerosaccharides + 20% curcuminoids, 2 × 500 mg capsules/day) or identical placebo for 12 weeks. Knee MRI scans were obtained at baseline and 12 weeks. Coprimary outcomes were changes in knee pain assessed by VAS and change in knee effusion-synovitis volume assessed by MRI over 12 weeks. Among 70 participants (36 received Curcuma longa , 34 received placebo, age 61.8±8.6 years, 56% female), Curcuma longa significantly improved VAS knee pain compared to placebo (-9.11mm, 95% confidence interval [CI] [- 17.79 to -0.44]) over 12 weeks, equivalent to a standardised effect size of 0.50. There was no significant between group difference in change in effusion-synovitis volume (3.24 mL [-0.33, 6.82]). There were significantly greater reductions in WOMAC knee pain (-47.22mm [-81.22, -13.22]), WOMAC function (-112.26mm [-222.79 to -1.74]) and significantly more OARSI-OMERACT treatment responders (63% treatment vs. 38% placebo [Risk Ratio=1.64 (1.00 to 2.70)]) in the Curcuma longa group compared to the placebo group. There was no significant between-group difference in lateral femoral cartilage T2 relaxation time (-0.38 ms [- 1.10 to 0.34]) assessed from compositional MRI. The incidence of adverse events was similar in the Curcuma longa (n=14 (39%)) and placebo (n=18 (53%)) groups over 12 weeks (P=0.24). An extract of Curcuma longa significantly improved knee pain in an inflammatory phenotype of knee OA patients over 12 weeks compared to placebo but had no effect on knee effusion-synovitis and cartilage composition assessed using MRI. The moderate effect size of the treatment supports the use of Curcuma longa extract for the symptomatic management of knee OA. None declared
Publisher: BMJ
Date: 23-05-2022
DOI: 10.1136/ANNRHEUMDIS-2022-EULAR.2213
Abstract: Statins are often discontinued due to muscle-related side effects. The effect of statin on skeletal muscles in populations with osteoarthritis is unknown. This study aims to examine the effect of atorvastatin on skeletal muscle biochemistry, strength, size and symptoms in patients with symptomatic knee osteoarthritis. This is a post-hoc analysis of a multicentre randomised, double-blind, placebo-controlled trial over 2 years in which participants with knee osteoarthritis who met the American College of Rheumatology clinical criteria received atorvastatin 40mg daily (n=151) or placebo (n=153). Outcomes included levels of creatinine kinase (CK), aspartate transaminases (AST) and alanine transaminases (ALT) at baseline, 4 weeks, 6, 12 and 24 months muscle strength measured by dynamometry at baseline, 12 and 24 months vastus medialis cross-sectional area (CSA) on magnetic resonance imaging at baseline and 24 months and self-reported myalgia during the trial. 304 participants [mean age 55.7 (SD 7.6) years, 55.6% female] were randomised. There were no significant differences in CK and AST levels between atorvastatin and placebo groups at 4 weeks (CK median 107 vs 110, p=0.76 AST 22 vs 21, p=0.14), 6 (CK 109 vs 101.5, p=0.37 AST 21 vs 20, p=0.45), 12 (CK 103 vs 103, p=0.93 AST 22 vs 21, p=0.99), and 24 (CK 103 vs 93.5, p=0.17 AST 22 vs 21, p=0.34) months. The atorvastatin group had higher ALT levels than the placebo group at 4 weeks [26 vs 21, p=0.0004] and 6 months [25 vs 22, p=0.007] but no between-group differences at 12 [24 vs 21, p=0.08] and 24 [24 vs 21, p=0.053] months. Muscle strength significantly increased in the atorvastatin group but not the placebo group over 24 months with no between-group differences [mean 8.5 (95% CI 2.6,14.4) vs 5.6 (-0.3,11.5), p=0.50]. Change in vastus medialis CSA over 24 months showed between-group differences favouring the atorvastatin group [+0.12 (-0.09,0.34) vs -0.24 (-0.48,0.01), p=0.03] but of uncertain clinical significance. There was a trend for more myalgia in the atorvastatin group over 2 years (8/151 vs 2/153, p=0.06), mostly occurring within 6 months (7/151 vs 1/153, p=0.04). Of the 10 participants with myalgia, there was no relationship between the incidence of myalgia and CK levels. In those with symptomatic knee osteoarthritis, despite a trend for more myalgia, there was no clear evidence of an adverse effect of atorvastatin on skeletal muscles, including those most relevant to knee joint health. Yuan Lim: None declared, Flavia Cicuttini: None declared, Anita Wluka: None declared, Graeme Jones Speakers bureau: GJ received honoraria for talks from BMS, Roche, AbbVie, Amgen, Lilly, Novartis, and Janssen, Grant/research support from: GJ received grant for a clinical trial from Covance, Catherine Hill: None declared, Andrew Forbes: None declared, Andrew Tonkin Speakers bureau: AT received honoraria for lectures from Pfizer honoraria for lectures and advisory board participation from Amgen, Consultant of: AT received honoraria for lectures and advisory board participation from Amgen, honoraria for data and safety monitoring board participation from Merck, and honoraria for data and safety monitoring board participation from Novartis, Sofia Berezovskaya: None declared, Lynn Tan: None declared, Changhai Ding: None declared, Yuanyuan Wang: None declared
Publisher: BMJ
Date: 06-2013
Publisher: BMJ
Date: 06-2013
Publisher: Elsevier BV
Date: 04-2015
Publisher: The Endocrine Society
Date: 30-03-2021
Abstract: Vitamin D deficiency is a common, modifiable determinant of musculoskeletal health. There are limited data that examine the longitudinal change in population 25-hydroxyvitamin D (25[OH]D) and none that evaluate the long-term skeletal outcomes of longitudinal vitamin D status. A prospective cohort analysis was conducted of community-dwelling adults aged 50 to 80 years who had 25(OH)D assessed by radioimmunoassay and bone mineral density (BMD) by dual-energy x-ray absorptiometry at baseline (n = 1096), 2.5 (n = 870), and 10 (n = 565) years. Sun exposure was quantified by questionnaire and supplement use at clinic review. 25(OH)D less than 50 nmol/L was considered deficient. Participants were provided with their 25(OH)D results. Over 10 years 25(OH)D increased (52.2 ± 17.0 to 63.5 ± 23.6 nmol/L, P & .001). Participants with baseline deficiency had larger 25(OH)D increases than baseline sufficient participants (19.2 ± 25.3 vs 1.6 ± 23.3 nmol/L, P & .001). Longitudinal change in 25(OH)D was associated with baseline summer (β = 1.46, P & .001) and winter (β = 1.29, P = .003) sun exposure, change in summer (β = 1.27, P = .002) and winter (β = 1.47, P & .001) sun exposure, and vitamin D supplement use (β = 25.0-33.0, P & .001). Persistent vitamin D sufficiency was associated with less BMD loss at the femoral neck (β = 0.020, P = .027), lumbar spine (β = 0.033, P = .003), and total hip (β = 0.023, P = .021) compared to persistent vitamin D deficiency. Achieving vitamin D sufficiency was associated with less BMD loss at the lumbar spine (β = 0.045, P & .001) compared to persistent vitamin D deficiency. Population 25(OH)D concentration increased because of a combination of increased sun exposure and supplement use. Maintaining or achieving vitamin D sufficiency was associated with less BMD loss over 10 years.
Publisher: Springer Science and Business Media LLC
Date: 02-2019
DOI: 10.1007/S00223-019-00529-W
Abstract: This study aimed to describe the association of vitamin D status at different stages of growth with bone measures in adolescence and early adulthood. There were 415 participants followed from age 8 to 16, and 201 further followed to age 25. Areal bone mineral density (BMD) at the spine, hip and total body was measured by dual-energy X-ray absorptiometry at ages 16 and 25, and tibial and radial trabecular and cortical bone microarchitecture by high resolution peripheral quantitative computerised tomography at age 25. Serum 25-hydroxyvitamin D (25OHD) concentrations were measured at ages 8, 16 and 25. Multivariable linear regression was used to analyse the association of 25OHD concentrations at three timepoints with bone measures at ages 16 and 25. The proportion of participants with vitamin D deficiency (< 50 nmol/L) was 11%, 43% and 41% at three timepoints, respectively. Serum 25OHD concentrations at age 8 were not significantly associated with any bone measures at age 16 or 25. Serum 25OHD concentrations at age 16 had a significant association with higher BMD at nearly all sites at ages 16 and 25 as well as lower radial porosity and more compact trabecular microarchitecture (higher density, increased number and reduced separation) at both the radius and tibia at age 25. Serum 25OHD concentrations at age 25 were only associated with hip BMD. Higher vitamin D concentrations in adolescence, to a lesser extent at age 25, have beneficial associations with BMD and bone microarchitecture in early adulthood. Optimising vitamin D status particularly during adolescence should be a priority.
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 04-2015
Publisher: Oxford University Press (OUP)
Date: 30-04-2021
Abstract: Muscle strength and balance are major modifiable factors of falls in older adults, but their associations with falls in middle-aged adults are underinvestigated. We aimed to examine the association of baseline and change in leg muscle strength (LMS) and balance with the incidence of falls in a cohort of middle-aged women. This was a 5-year follow-up of a population-based s le of 273 women aged 36–57 years at baseline (2011–2012). Data on LMS (by dynamometer) and balance (timed up and go test, step test, functional reach test, and lateral reach test) were obtained at baseline and 5 years later (2017–2018). After 5 years, falls were recorded monthly for 1 year by questionnaire (2017–2019). Negative binomial/Poisson and log-binomial regressions were used as appropriate to assess associations of baseline and change in LMS and balance with any falls, injurious falls, and multiple falls. Over 1 year, 115 participants (42%) reported at least one fall. Neither baseline nor 5-year change in LMS and balance measures was associated with the risk of any falls, injurious falls, or multiple falls 5 years later, with or without adjusting for confounders at baseline (incidence rate ratio/relative risk ranging from 0.85 to 1.19, 0.90 to 1.20, and 0.82 to 1.36, respectively p & .05 for all). Baseline or change in LMS and balance measures are not associated with incident falls among middle-aged women. The contributions of environmental and other intrinsic factors such as chronic conditions and gait/mobility problems need to be investigated.
Publisher: Springer Science and Business Media LLC
Date: 10-1999
Abstract: To describe the prevalence and determinants of 25-hydroxy D3(25(OH)D) in children. Cross-sectional study. Southern Tasmania between June and November 1997. Two hundred and one 8-y old male and female children taking part in a cohort study whose principal endpoints were blood pressure and high-density lipoprotein (HDL) cholesterol. The mean 25(OH)D level was 79 nmol/l (s.d. 29.5, median 73, range 12-222). Boys had higher levels than girls (82.1 vs 72.8 nmol/l, P=0.02). 25(OH)D was associated with sunlight exposure in winter school holidays (r=0.20, P=0.005) and winter weekends (r=0.16, P=0.02), the month after school holidays (87.5 vs 69.5 nmol, P<0.0001) and body mass index (r=-0.23, P=0.001). Dietary intake of vitamin D was low (mean 40 IU/day, range 5.2-384) and was not associated with 25(OH)D levels (r=0.01, P=0.91). Variation in skin melanin density was weakly associated with 25(OH)D (r=0.09, P=0.19). Sunlight is the major determinant of vitamin D stores in our population. Neither variation in skin type within Caucasians nor diet modified this association to any significant extent. Extrapolation of these findings to sunlight bone mass associations in a very similar population suggests that a minimum level of around 50 nmol/l in the population is required for optimal bone development in prepubertal children but this needs to be confirmed with further controlled trials of vitamin D supplementation and bone mass. Arthritis Foundation of Australia, Roche Pharmaceuticals.
Publisher: Springer Science and Business Media LLC
Date: 15-02-2021
DOI: 10.1007/S40520-020-01762-2
Abstract: Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering in idual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population. Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants (2) hazard ratios (HR) were then pooled using the Hartung–Knapp modification for random-effects meta-analysis. 10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA. Participants with POA or PROA had a 35–37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality. Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.
Publisher: MDPI AG
Date: 14-11-2022
DOI: 10.3390/BIOMEDICINES10112924
Abstract: Objective: To compare whether falls risk score and incident fracture over 10.7 years were different among three previously identified pain phenotypes. Methods: Data on 915 participants (mean age 63 years) from a population-based cohort study were studied at baseline and follow-ups at 2.6, 5.1 and 10.7 years. Three pain phenotypes were previously identified using the latent class analysis: Class 1: high prevalence of emotional problems and low prevalence of structural damage Class 2: high prevalence of structural damage and low prevalence of emotional problems Class 3: low prevalence of emotional problems and low prevalence of structural damage. Fractures were self-reported and falls risk score was measured using the Physiological Profile Assessment. Generalized estimating equations model and linear mixed-effects model were used to compare differences in incident fractures and falls risk score over 10.7 years between pain phenotypes, respectively. Results: There were 3 new hip, 19 vertebral, and 121 non-vertebral fractures, and 138 any site fractures during 10.7-year follow-up. Compared with Class 3, Class 1 had a higher risk of vertebral (relative risk (RR) = 2.44, 95% CI: 1.22–4.91), non-vertebral fractures (RR = 1.20, 95% CI: 1.01–1.42), and any site fractures (RR = 1.24, 95% CI: 1.04–1.46) after controlling for covariates, bone mineral density and falls risk score. Class 2 had a higher risk of non-vertebral and any site fracture relative to those in Class 3 (non-vertebral: RR = 1.41, 95% CI: 1.17–1.71 any site: RR = 1.44, 95% CI: 1.20–1.73), but not vertebral fracture. Compared with Class 3, Class 1 had a higher falls risk score at baseline (β = 0.16, 95% CI: 0.09–0.23) and over 10.7-year (β = 0.03, 95% CI: 0.01–0.04). Conclusions: Class 1 and/or Class 2 had a higher risk of incident fractures and falls risk score than Class 3, highlighting that targeted preventive strategies for fractures and falls are needed in pain population.
Publisher: JMIR Publications Inc.
Date: 07-07-2015
DOI: 10.2196/JMIR.4376
Publisher: Wiley
Date: 25-11-2017
DOI: 10.1002/JBMR.3028
Abstract: Associations between physical activity and time spent sedentary and musculoskeletal outcomes remain unclear in middle-aged adults. This study aimed to describe associations between objectively-measured physical activity and sedentary time and musculoskeletal health outcomes in middle-aged women. This cross-sectional study from a population-based s le of 309 women (age 36 to 57 years) examined associations of total physical activity (accelerometer counts/min of wear time), and time spent sedentary, in light physical activities and moderate-to-vigorous physical activities (MVPA) (by Actigraph GT1M accelerometer) with lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) (by dual-energy X-ray absorptiometry), lower limb muscle strength (LMS), and functional mobility and balance tests (timed up and go test [TUG], functional reach test [FRT], lateral reach test [LRT], and step test [ST]) using linear regression. Total physical activity was beneficially associated with FN BMD (values are β 95% CI) (0.011 g/cm
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.JSAMS.2016.02.002
Abstract: To evaluate the associations between an objective measure of different intensities of physical activity, upper- and lower-limb muscle strength and psychomotor performance and set-shifting domains of cognitive executive function in older adults. A cross-sectional study. From the Tasmanian Older Adult Cohort Study, 188 community-dwelling older adults (53.7% female mean age±SD 63.98±7.3 years) undertook 7-day physical activity behaviour monitoring using an accelerometer. Dynamometers were used to assess leg extension strength. The Trail Maker Tests were used to measure psychomotor processing speed and set-shifting performance. When controlling for age, smoking history, alcohol intake, educational achievement and neuropsychological functioning, higher levels of light physical activity, but not sedentary behaviour or moderate or vigorous physical activity, was found to be associated with better set-shifting performance. Neither physical activity behaviour or muscle strength were found to be associated with psychomotor performance. In addition, older age, greater alcohol intake, and lower levels of educational attainment, verbal learning and memory performance were significantly associated with lower scores on the set-shifting task whereas older age and reduced neuropsychological functioning were associated with lower psychomotor processing speed scores. Light physical activity is associated with higher executive functioning in community-dwelling older adults and this strengthens the evidence supporting exercise as a neuroprotective agent. Further studies are needed to understand why light physical activity behaviour positively influences executive functioning, and how such physical activity can be implemented into the daily routine of older adults.
Publisher: Wiley
Date: 31-03-2006
DOI: 10.1002/ART.21835
Abstract: To describe the association between chondral defects, bone marrow lesions, knee and hip radiographic osteoarthritis (OA), and knee pain. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index. T1- and T2-weighted fat saturation magnetic resonance imaging was performed on the right knee to assess chondral defects and subchondral bone marrow lesions. Radiography was performed on the right knee and hip and scored for radiographic OA. Body mass index (BMI) and knee extension strength were measured. A total of 500 randomly selected men and women participated. The prevalence of knee pain was 48%. In multivariable analysis, prevalent knee pain was significantly associated with medial tibial chondral defects (odds ratio [OR] 2.32, 95% confidence interval [95% CI] 1.02-5.28 for grade 3 versus grade 2 or less OR 4.93, 95% CI 1.07-22.7 for grade 4 versus grade 2 or less), bone marrow lesions (OR 1.44, 95% CI 1.04-2.00 per compartment), and hip joint space narrowing (OR 1.36, 95% CI 1.07-1.73 per unit), as well as greater BMI and lower knee extension strength. It was not significantly associated with radiographic knee OA. These variables were also associated with more severe knee pain. In addition, there was a dose response association between knee pain and number of sites having grade 3 or 4 chondral defects (OR 1.39, 95% CI 1.12-1.73 per site), with all subjects having knee pain if all compartments of the knee had these defects. Knee pain in older adults is independently associated with both full and non-full-thickness medial tibial chondral defects, bone marrow lesions, greater BMI, and lower knee extension strength, but is not associated with radiographic knee OA. The association between radiographic hip OA and knee pain indicates that referred pain from the hip needs to be considered in unexplained knee pain.
Publisher: Springer Science and Business Media LLC
Date: 2010
DOI: 10.1186/AR3210
Publisher: Springer Science and Business Media LLC
Date: 30-07-2020
Publisher: Springer Science and Business Media LLC
Date: 27-11-2022
DOI: 10.1007/S40122-021-00341-1
Abstract: Inflammation has been suggested to be involved in the pathogenesis of osteoarthritis and pain. We sought to explore the associations between inflammatory serum markers and magnetic resonance imaging-defined long-term structural change and pain trajectory. A total of 169 randomly selected participants (mean age 63 years 47% female) from a prospective cohort study were included in this study. Circulating levels of interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-α) and high-sensitivity C-reactive protein (CRP) were measured at baseline. A knee MRI scan was performed to measure cartilage volume (CV) and bone marrow lesions (BMLs) at baseline and at 10.7 years. Knee pain at four visits was measured by the WOMAC pain questionnaire, and pain trajectories were identified using group-based trajectory modelling. Linear, log-binomial and multi-nominal logistic regression were used for the analyses. IL-6 was associated with lateral but not medial tibial CV loss (β = - 0.25% per annum, per standard deviation [SD] log pg/ml P < 0.05) in the multivariate analysis. IL-6 was also associated with a 'Moderate pain' trajectory (relative risk ratio 1.93 per SD log pg/ml 95% confidence interval 1.02-3.65) relative to the 'Minimal pain' trajectory group. There was no significant association of TNF-α and CRP with CV loss and pain trajectory groups with the exception of a beneficial relationship between CRP and medial tibial CV loss (β = 0.20% per annum, per SD log mg/l). No association between inflammatory markers and change in BML size was observed. IL-6 was independently associated with compartment-specific CV loss and worse pain trajectory, but the other markers studied were not, suggesting that components of inflammation are implicated in the pathogenesis of cartilage loss and developing a worse pain course.
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.CLNU.2007.06.014
Abstract: The role of excessive salt on bone metabolism in children is uncertain. The aim of this 6-week prospective study was to describe the association between urinary electrolytes and bone turnover markers in a convenience s le of adolescent boys (N = 136, mean age 16 yr). Urinary electrolytes (sodium, potassium, calcium and magnesium) were assessed on spot overnight urines on three occasions to minimise regression dilution bias. Bone turnover was assessed by bone specific alkaline phosphatase (BAP) and urinary pyridinoline (PYR) at baseline and follow up. In multivariate analysis, urinary sodium (but not other electrolytes) was positively associated with both PYR and BAP both before and after taking short-term growth into account (both p < 0.05) and explained 3-6% of the variation in bone turnover markers. Urinary sodium was associated with urinary magnesium (r = +0.26, p < 0.05) but only weakly with calcium (r = +0.18, p = 0.08). Urinary potassium was significantly associated with urinary magnesium (r = -0.24, p < 0.05). High urinary sodium (which largely reflects dietary sodium intake in our location) results in a high bone turnover state in adolescent boys which is most likely detrimental for bone. Other urinary electrolytes are not related to bone turnover but may influence bone via other pathways.
Publisher: Springer Science and Business Media LLC
Date: 11-1995
DOI: 10.1007/BF01626603
Abstract: Despite the multitude of available alternatives, the Grignard coupling-based synthesis of polycarbosilanes remains attractive, offering the benefit of easy structural design. Moreover, this method allows one to obtain a polymer precursor with the stoichiometric Si : C ratio required for SiC ceramic production and is also suited for the synthesis of polymers containing curable functional groups (
Publisher: Springer Science and Business Media LLC
Date: 22-12-2015
DOI: 10.1007/S00198-015-3438-X
Abstract: This study aimed to determine the effect of fish oil on bone mineral density (BMD). There were no differences in the 2-year BMD measures between high and low dose groups after adjusting for baseline BMD. This randomized controlled trial did not demonstrate any efficacy of omega-3 fatty acids on bone loss in adults. The purpose of this study is to investigate whether supplementation with high dose omega-3 fish oil could have an impact on BMD. In a multicentre, double-blind randomized controlled trial (RCT) (ACTRN 12607000415404), 202 Australian participants aged ≥40 with knee osteoarthritis (mean age, 61.0 ± 10.0 years 49 % female) were randomized to receive either high dose (4.5 g eicosapentaenoic acid and docosahexaenoic acid daily) or low dose (0.45 g/day) omega-3 fish oil for 2 years. BMD was assessed at baseline and 2 years by dual energy X-ray absorptiometry. In subjects with baseline and 2-year assessments, mean standardized BMD at baseline for low or high dose group was 1198 ± 198 and 1157 ± 169 mg/cm(2), respectively, for the lumbar spine and was 1035 ± 165 and 1017 ± 174 mg/cm(2), respectively, for the femoral neck. There were no differences in the 2-year BMD measures between high and low dose groups after adjusting for baseline BMD in the complete case regression analyses (lumbar spine 3.7, 95 % confidence interval (CI) -7.9 to 15.3 mg/cm(2) and femoral neck -5.5, 95 % CI -14.9 to 3.9 mg/cm(2)). The findings did not change with additional adjustments of age, gender, study centre and uses of bone-related drugs during the study period as well as using the intention-to-treat analysis or limiting to older participants (≥55 years at the baseline) (all P ≥ 0.25). Mild adverse events such as headache and gastrointestinal intolerance were common but did not occur more frequently in either group. There were no serious adverse events related to the intervention. A 2-year supplementation with high-dose omega-3 fish oil did not alter bone loss among men and women with knee osteoarthritis.
Publisher: Elsevier
Date: 2019
Publisher: Portico
Date: 02-2008
DOI: 10.1138/20080299
Publisher: Springer Science and Business Media LLC
Date: 13-09-2016
Publisher: Wiley
Date: 19-04-2006
Publisher: Oxford University Press (OUP)
Date: 29-03-2013
DOI: 10.1093/RHEUMATOLOGY/KET132
Abstract: To systematically review the evidence for association between serum 25-hydroxyvitamin D (25-(OH)D) and OA and the effect of vitamin D therapy on OA. An English Medline, EMBASE and Cochrane Library search for vitamin D and OA from January 1980 to June 2012 was performed. Randomized controlled trials (RCTs), cohort, case-control and cross-sectional studies in adults were included. The methodological quality of the selected studies was assessed and a best-evidence synthesis was used to summarize the results due to the heterogeneity of the studies. Of the 86 evaluated articles, 2 RCTs and 13 observational studies were included in the final analyses. The number of participants ranged from 64 to 1644 (0-100% women). The RCTs were only reported in abstract form and showed inconsistent results, most likely due to variations in their study design. There was insufficient or limited evidence for associations between 25-(OH)D and hand or hip OA. For knee radiographic OA as assessed by the Kellgren and Lawrence (KL) score, there was moderate evidence showing that low levels of 25-(OH)D were associated with increased progression of radiographic OA. Strong evidence for an association between 25-(OH)D and cartilage loss was apparent when joint space narrowing and changes in cartilage volume were considered collectively as cartilage loss. 25-(OH)D appears to be implicated in structural changes of knee OA rather than symptoms, and further well-designed RCTs are required to determine whether vitamin D supplementation can slow disease progression. There is insufficient evidence for other sites.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Springer Science and Business Media LLC
Date: 21-10-2009
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 20-02-2005
Publisher: Wiley
Date: 07-2022
Publisher: Springer Science and Business Media LLC
Date: 22-09-2022
DOI: 10.1007/S12325-022-02303-1
Abstract: To better inform clinicians about the use of etanercept biosimilar (SB4) in patients with rheumatoid arthritis (RA), COMPANION-B, a prospective real-world observational study, evaluated the effectiveness of the voluntary switch from originator (etanercept, ETN) to SB4 in patients with stable RA (low-disease activity/remission). The study recruited adult patients (18 years or older) with RA (2010 American College of Rheumatology criteria) prescribed ETN as their first or second biologic for at least 6 months across 14 sites in Canada and five in Australia. Patients had stable disease (Disease Activity Score-28 using erythrocyte sedimentation rate [DAS28-ESR] less than 3.2) at enrollment with no evidence of flare within the previous 3 months. Concomitant disease-modifying antirheumatic drugs (DMARDs) were permitted. Patients could elect to continue ETN or voluntarily switch to SB4 in consultation with their doctors. The primary effectiveness measure was the proportion of patients with disease worsening (defined as a DAS28-ESR increase of at least 1.2 from baseline and minimum score of at least 3.2 or a defined modification in RA treatment) during 12 months of follow-up. The secondary effectiveness measure was the proportion of patients with disease worsening at month 6. Serious adverse events (SAEs) and non-serious adverse reactions (NSARs) were recorded. Of 163 patients enrolled, 109 elected to continue on ETN and 54 switched to SB4 65.8% of patients received non-biologic DMARD(s), 52.6% methotrexate, and 10.5% oral corticosteroid(s). At month 12, the proportion of patients with disease worsening was comparable in the ETN group (22.8% [95% CI 15.0-32.2]) and SB4 group (17.6% [95% CI 8.4-30.9]). Similarly, the proportions of patients with disease worsening were also comparable at month 6 (ETN: 7.9% [95% CI 3.5-15.0] SB4: 7.8% [95% CI 2.2-18.9]). SAEs were low and similar across both groups (ETN: 8.7% SB4: 5.7%). NSARs were slightly higher in the SB4 vs. ETN group (13.2% vs. 2.9%). SB4 demonstrated comparable effectiveness to ETN over 12 months in patients with stable RA who voluntarily switched to the biosimilar in a real-world setting.
Publisher: Oxford University Press (OUP)
Date: 19-07-2005
DOI: 10.1093/RHEUMATOLOGY/KEI018
Abstract: To determine whether articular cartilage defects are associated with cartilage loss and joint replacement in subjects with symptomatic knee osteoarthritis (OA). One hundred and seventeen subjects with symptomatic knee OA underwent magnetic resonance imaging of their dominant knee at baseline and 2 yr later. Cartilage defects were identified as prevalent (defect score > or =2) in each knee compartment. Occurrence of joint replacement by 4 yr was documented. Cartilage defects were present in 81% of medial, 64% of lateral tibiofemoral compartments and 55% of patellar cartilages. Annual patellar cartilage loss was highest in those with defects compared with no defects (5.5% vs 3.2%, P = 0.01). Tibial cartilage loss was not associated with defects in the medial (4.6% vs 5.8%, P = 0.42) or lateral (4.7% vs 6.5%, P = 0.21) tibial cartilages. Higher total cartilage defect scores (8-15) were associated with a 6.0-fold increased risk of joint replacement over 4 yr compared with those with lower scores (2-7) (95% confidence interval 1.6, 22.3), independently of potential confounders. Articular cartilage defects are associated with disease severity in knee OA and predict patellar cartilage loss and knee replacement.
Publisher: Wiley
Date: 02-02-2018
DOI: 10.1002/JBMR.3376
Abstract: The aim of this study was to evaluate the effect of zoledronic acid (ZA) and denosumab on low back pain (LBP) and Modic change (MC) over 6 months. Adults aged ≥40 years with significant LBP for at least 6 months duration and MC (type 1, 2, or mixed) were randomized to receive ZA (5 mg/100 mL), denosumab (60 mg), or placebo. LBP was measured monthly by visual analogue scale (VAS) and the LBP Rating Scale (RS). MC was measured from MRIs of T
Publisher: Elsevier BV
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 12-2010
Publisher: Springer Science and Business Media LLC
Date: 04-03-2016
DOI: 10.1007/S00223-016-0123-9
Abstract: The purpose of this study is to determine whether low muscle mass (sarcopenia) or strength (dynapenia), in the presence of obesity, are associated with increased risk for osteoporosis and non-vertebral fracture over 5-10 years in community-dwelling older adults. N = 1089 volunteers (mean ± SD age 62 ± 7 years 51 % female) participated at baseline and 761 attended follow-up clinics (mean 5.1 ± 0.5 years later). Total body, total hip and spine BMD, and appendicular lean and total fat mass were assessed by DXA. Sarcopenic obesity and dynapenic obesity were defined as the lowest sex-specific tertiles for appendicular lean mass or lower-limb strength, respectively, and the highest sex-specific tertile for total fat mass. Fractures were self-reported on three occasions over 10.7 ± 0.7 years in 563 participants. Obese alone participants had significantly higher BMD at all sites compared with non-sarcopenic non-obese. Sarcopenic obese and dynapenic obese men had lower spine and total body BMD, respectively, and sarcopenic obese women had lower total hip BMD, compared with obese alone (all P < 0.05). Sarcopenic obese men had higher non-vertebral fracture rates compared to non-sarcopenic non-obese (incidence rate ratio: 3.0 95 % CI 1.7-5.5), and obese alone (3.6 1.7-7.4). Sarcopenic obese women had higher fracture rates compared with obese alone (2.8 1.4-5.6), but this was non-significant after adjustment for total hip BMD. Sarcopenic and dynapenic obese older adults may have increased risk of osteoporosis and non-vertebral fracture relative to obese alone counterparts. Sarcopenic and dynapenic obese in iduals potentially represent a subset of the obese older adult population who require closer monitoring of bone health during ageing.
Publisher: Springer Science and Business Media LLC
Date: 2007
DOI: 10.1186/AR2132
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2020
DOI: 10.1097/J.PAIN.0000000000002163
Abstract: Metabolic dysfunction has been suggested to be involved in musculoskeletal pain however, few studies have identified metabolic markers associated with multisite musculoskeletal pain (MSMP). This study sought to identify metabolic marker(s) for MSMP by metabolomic analysis. The Tasmanian Older Adult Cohort Study (TASOAC) provided the discovery cohort with the Newfoundland Osteoarthritis Study (NFOAS) providing the replication cohort. Multisite musculoskeletal pain was assessed by a self-reported pain questionnaire and defined as painful sites ≥4 in both the TASOAC and the NFOAS. Furthermore, MSMP was also defined as painful sites ≥7, whereas non-MSMP was defined as either painful sites or ≤1 in the NFOAS. Serum s les of the TASOAC received metabolic profiling using The Metabolomics Innovation Centre Prime Metabolomics Profiling Assay. The data on the identified metabolites were retrieved from NFOAS metabolomic database for the purpose of replication. A total of 409 participants were included in the TASOAC, 38% of them had MSMP. Among the 143 metabolites assessed, 129 passed quality control and were included in the analysis. Sphingomyelin (SM) C18:1 was significantly associated with MSMP (odds ratio [OR] per log µM increase = 3.96, 95% confidence interval, 1.95-8.22 P = 0.0002). The significance remained in multivariable analysis (OR per log µM increase = 2.70, 95% confidence interval, 1.25-5.95). A total of 610 participants were included in the NFOAS, and the association with SM C18:1 was successfully replicated with 3 MSMP definitions (OR ranging from 1.89 to 2.82 all P 0.03). Our findings suggest that sphingomyelin metabolism is involved in the pathogenesis of MSMP, and the circulating level of SM C18:1 could serve as a potential marker in the management of MSMP.
Publisher: Wiley
Date: 02-07-2013
DOI: 10.1002/OBY.20393
Publisher: BMJ
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 21-08-2012
DOI: 10.1038/IJO.2012.136
Abstract: To determine the associations between body composition at baseline and knee cartilage loss over 2.9 years in older adults. A total of 395 randomly selected subjects (mean 62 years, range 51-81, 50% female) were studied at baseline and 2.9 years later. T1-weighted fat-suppressed magnetic resonance imaging of the right knee was performed to determine knee cartilage volume and tibial bone area at baseline and follow-up. Height, weight and radiographic osteoarthritis were measured by standard protocols at baseline. Fat mass and lean mass were measured by dual-energy X-ray absorptiometry at baseline. Tibial cartilage volume decreased by 2.0-2.7% per annum. In multivariable analysis, annual change in medial cartilage volume was negatively and significantly associated with body mass index (β: -0.14% per kg m(-2), 95% confidence interval (CI): -0.25%, -0.02%), percentage total body fat (β: -0.19% per %, 95% CI: -0.30%, -0.07%) and percentage trunk fat (β: -0.10% per %, 95% CI: -0.19%, -0.02%), and positively associated with percentage lean mass (β: 0.20% per %, 95% CI: 0.08%, 0.32%). Change in lateral tibial cartilage volume was also significantly associated with percentage total body fat (β: -0.11% per %, 95% CI: -0.21%, -0.001%) and total lean mass (β: 0.13% per kg, 95% CI: 0.04%, 0.22%). These were independent of sex and age even though both were also significant predictors. Body fat adversely affects tibial cartilage loss over time, whereas lean mass is protective. Strategies aimed at reducing body fat but increasing lean mass may reduce knee cartilage loss in older people.
Publisher: Elsevier BV
Date: 04-2017
Publisher: Elsevier BV
Date: 09-2009
Publisher: BMJ
Date: 04-2016
Publisher: The Journal of Rheumatology
Date: 15-08-2014
Abstract: To compare the responsiveness of magnetic resonance imaging (MRI)-derived measures of knee osteoarthritis over 2.7 years. There were 430 community-based participants (mean age 63.0 yrs, range 51–79 yrs 51% female) measured at baseline and 2.7 years later. MRI of the right knee at both timepoints was performed to assess cartilage volume, cartilage defects, bone marrow lesions (BML), meniscal pathology, and tibial bone area. Global measurements were calculated as the sum of tibial and femoral measures. Standardized response mean (SRM) was calculated as the mean of change ided by the SD of change. Global tibiofemoral cartilage volume and cartilage defects had the best SRM of −0.80 and 0.62, respectively. Site-specific measurements were lower (SRM range for cartilage volume −0.48 to −0.54 and cartilage defects 0.33 to 0.49). The SRM for BML was 0.12, meniscal pathology 0.39, and tibial bone area −0.09. Cartilage volume and/or defects tended to be more responsive in those with knee pain, those who were obese, those who were older, and those with radiographic osteoarthritis. Global cartilage volume demonstrated the best sensitivity to change, suggesting that if we relied solely on SRM to optimize clinical trial design, then cartilage volume would be the best outcome measure. However, clinical trials have shown that cartilage volume may be less responsive to treatment compared to other measures that have lower SRM (such as BML). Therefore, although one can optimize trial efficiency by finding more responsive endpoints, both sensitivity to change and magnitude of benefit should be considered.
Publisher: Elsevier BV
Date: 09-2011
Publisher: BMJ
Date: 06-2015
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 04-2014
Publisher: BMJ
Date: 09-09-2015
DOI: 10.1136/ANNRHEUMDIS-2014-207169
Abstract: To determine whether high-dose fish oil is superior to low-dose supplementation for symptomatic and structural outcomes in knee osteoarthritis (OA). A randomised, double-blind, multicentre trial enrolled 202 patients with knee OA and regular knee pain. They were randomised 1:1 to high-dose fish oil (4.5 g omega-3 fatty acids) 15 mL/day or (2) low-dose fish oil (blend of fish oil and sunola oil ratio of 1:9, 0.45 g omega-3 fatty acids) 15 mL/day. The primary endpoints were Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score at 3, 6, 12 and 24 months, and change in cartilage volume at 24 months. Secondary outcomes included WOMAC function, quality of life, analgesic and non-steroidal anti-inflammatory drug use and bone marrow lesion score. Although there was improvement in both groups, the low-dose fish oil group had greater improvement in WOMAC pain and function scores at 2 years compared with the high-dose group, whereas between-group differences at 1 year did not reach statistical significance. There was no difference between the two groups in cartilage volume loss at 2 years. For other secondary endpoints, there was no difference between the two groups at 2 years. In people with symptomatic knee OA, there was no additional benefit of a high-dose fish oil compared with low-dose fish oil. The combination comparator oil appeared to have better efficacy in reducing pain at 2 years, suggesting that this requires further investigation. Australian New Zealand Clinical Trials Registry (ACTRN 12607000415404).
Publisher: Springer Science and Business Media LLC
Date: 09-01-2007
DOI: 10.1007/S00198-006-0303-Y
Abstract: We studied the association between osteoporotic fractures and prior non-melanoma skin cancer (NMSC, a biomarker for cumulative sun exposure). The risk of prior NMSC in our fracture cohort was significantly reduced (standardised incidence ratio 0.69, 95% CI 0.61, 0.78). Adequate lifetime sun exposure may be necessary to protect against osteoporotic fractures in later life. The relationship between cumulative sun exposure and osteoporotic fractures is uncertain. We aimed to study the association between non-melanoma skin cancer (NMSC), a marker of cumulative sun exposure, and osteoporotic fractures in an older cohort. A retrospective cohort study in southern Tasmania in people aged at least 50 years with incident radiographic fracture (n = 2,283) was carried out. By record linkage to the Tasmanian Cancer Registry the cohort was followed backwards through time until the occurrence of NMSC or end-of follow-up. Relative risk was estimated by the standardised incidence ratio (SIR) using sex-, age- and calendar year-specific cancer incidence rates in southern Tasmania as reference. The incidence of prior NMSC in the fracture cohort was 31% lower than for the general population (SIR 0.69, 95% CI 0.61, 0.78). This effect was significant for most fracture subtypes except pelvic and wrist fractures and observed for both NMSC subtypes, squamous cell carcinoma and basal cell carcinoma. Older people with osteoporotic fractures may have had lifestyles linked to lower cumulative sunlight exposure. Achieving a balance between adequate lifetime sun exposure and protection against its adverse effects (such as fractures and skin cancer) may require assessment of in idual risks.
Publisher: Wiley
Date: 26-01-2018
DOI: 10.1002/JBMR.3361
Abstract: We have previously shown that bone mineral density (BMD) tracks strongly from age 8 to 16 years. This study aimed to describe whether this strong tracking continued to age 25 years and describe factors associated with deviation from tracking. Ninety-nine participants were followed from age 8 to 25 years and 197 participants from age 16 to 25 years. Outcomes measured were BMD at the spine, hip, and total body (by dual-energy X-ray absorptiometry [DXA]). Other factors measured were anthropometrics, inhaled corticosteroids (ICS) use, history of being breastfed, sports participation, fitness (by physical work capacity [PWC
Publisher: Elsevier BV
Date: 08-2020
Publisher: Springer Science and Business Media LLC
Date: 14-08-2014
DOI: 10.1007/S10067-014-2758-0
Abstract: The aim of this cross-sectional study was to describe the associations between history of knee injury and knee structure using magnetic resonance imaging (MRI). This study included two population-based s les: the Tasmanian Older Adult Cohort (TASOAC) study (n = 430 mean age, 63.0 years range, 51-79 years 51 % female) and the Offspring study (n = 372 mean age, 45.0 years range, 26-61 years 57.5 % female). In both studies, 1.5 T MRI scans of the right knee were performed to measure bone marrow lesions (BMLs), cartilage volume, tibial bone area, cartilage defects and meniscal pathology. History of knee injury was assessed using a self-administered questionnaire. The association between knee injury and knee structure was determined using multiple linear and log binomial regression models. Nineteen percent of the middle-aged and 12 % of the older adults reported a history of knee injury. In middle-aged adults, BML presence (prevalence ratio (PR) = 1.6 (95 % CI, 1.2 2.1)), tibial bone area (difference of means (DM) = +86 (+23, +149)) and meniscal extrusion presence (PR = 2.7 (1.1, 6.8)) were significantly higher in those with knee injury. In older adults, cartilage defect presence (PR = 1.3 (1.0, 1.7)), lateral (DM = -265 (-439, -92)) and total tibial (DM = -325 (-600, -51)) cartilage volume, BML presence (PR = 1.4 (1.0, 1.9)) and tibial bone area (DM = +140 (+19, +260)) were significantly associated with knee injury. Meniscal tears showed no significant associations in either cohorts. The association between knee injury and MRI-assessed structural pathology in the knee joint is moderate and appears to be stronger in older adults compared to middle-aged adults.
Publisher: Oxford University Press (OUP)
Date: 30-07-2013
DOI: 10.1093/RHEUMATOLOGY/KET243
Abstract: Cartilage loss is a key pathological feature of OA and can be assessed indirectly using radiography or directly through MRI. A number of cross-sectional studies have suggested that primary generalized osteoarthritis (PGOA) may be a distinct disease, but despite the high frequency of involvement of the hip and the knee joints in OA, very few studies have looked at the radiographic association between these two joints, and none has done so using MRI. The aim of this study was to examine the association of hip and knee cartilage measured by both radiography and MRI. We studied 151 participants from the Tasmanian Older Adult Cohort (TASOAC) study, who were selected randomly from the southern Tasmanian electoral rolls. MRI was used to assess hip and knee cartilage volume and radiography was used to assess joint space narrowing (JSN). Correlation analyses were used to compare cartilage volume measurements and JSN. In adjusted analysis, there was a consistent, positive association between knee and hip cartilage volume that was best for total knee cartilage volume (r = 0.16-0.40, all P < 0.05). In contrast, there was at best a weak correlation, depending on the site, between hip and knee JSN (r = -0.01 to 0.21). Hip and knee cartilage volume are more strongly associated than hip and knee JSN, suggesting a commonality of cartilage volume at different anatomic sites. The weaker radiographic association may reflect less measurement error with MRI or the contribution of multiple structures to joint space in the knee.
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.JOCA.2022.02.616
Abstract: To describe the associations between osteoarthritis (OA)-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years. Blood serum s les collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06 n = 156) and 10-13 year follow-up at CDAH-3 (n = 167) were analysed for COMP, MMP-3, and HA using non-isotopic ELISA. Knee MRI scans obtained during the CDAH-knee study (year:2008-10 n = 313) were assessed for cartilage volume and thickness, subchondral bone area, cartilage defects, and BML. In a multivariable linear regression model describing the association of baseline biochemical markers with MRI-markers (assessed after 4-years), we found a significant negative association of standardised COMP with medial femorotibial compartment cartilage thickness (β:-0.070 95%CI:-0.138,-0.001), and standardised MMP-3 with patellar cartilage volume (β:-141.548 95%CI:-254.917,-28.179) and total bone area (β:-0.729 95%CI:-1.340,-0.118). In multivariable Tobit regression model, there was a significant association of MRI-markers with biochemical markers (assessed after 6-9 years) a significant negative association of patellar cartilage volume (β:-0.001 95%CI:-0.002,-0.00004), and total bone area (β:-0.158 95%CI-0.307,-0.010) with MMP-3, and total cartilage volume (β:-0.001 95%CI:-0.001,-0.0001) and total bone area (β:-0.373 95%CI:-0.636,-0.111) with COMP. No significant associations were observed between MRI-based imaging biomarkers and HA. COMP and MMP-3 levels were negatively associated with knee cartilage thickness and volume assessed 4-years later, respectively. Knee cartilage volume and bone area were negatively associated with COMP and MMP-3 levels assessed 6-9 years later. These results suggest that OA-related biochemical markers and MRI-markers are interrelated in early OA.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.JOCA.2012.07.019
Abstract: To assess the efficacy of thrice daily topical 4Jointz utilizing Acteev technology (a combination of a standardized comfrey extract and a pharmaceutical grade tannic acid, 3.5 g/day) on osteoarthritic knee pain, markers of inflammation and cartilage breakdown over 12 weeks. Adults aged 50-80 years (n = 133) with clinical knee OA were randomised to receive 4Jointz or placebo in addition to existing medications. Pain and function were measured using a visual analogue scale (VAS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale at baseline, 4, 8 and 12 weeks. Inflammation was measured analysing IL-6 expression and CTX-2 presence as representative for cartilage breakdown using ELISA, at baseline and 12 weeks. Pain scores significantly reduced in the group who received 4Jointz compared to the group who received placebo after 12 weeks using both the VAS (-9.9 mm, P = 0.034) and the KOOS pain scale (+5.7, P = 0.047). Changes in IL-6 and CTX-2 were not significant (-0.04, P = 0.5 -0.01, P = 0.68). Post-hoc analyses suggested that treatment may be most effective in women (VAS -16.8 mm, P = 0.008) and those with milder radiographic osteoarthritis (OA) (VAS -16.1 mm, P = 0.009). Rates of adverse events were similar in both groups, excepting local rash that was more common amongst participants receiving 4Jointz (21% vs 1.6%, IRR 13.2, P = 0.013), but only 26% (n = 4) of participants with rashes discontinued treatment. There were no changes in systemic blood results. Topical treatment using 4Jointz reduced pain but had no effect on inflammation or cartilage breakdown over 12 weeks of treatment. Australia and New Zealand Clinical Trials registry ACTRN12610000877088.
Publisher: Springer Science and Business Media LLC
Date: 19-05-2021
Publisher: Springer Science and Business Media LLC
Date: 17-09-2022
DOI: 10.1186/S13075-022-02907-6
Abstract: Subchondral bone plays an important role in the pathogenesis of radiographic osteoarthritis (OA). However, the bony changes that occur in hand OA (HOA) are much less understood. This study aimed to describe the association between radiographic HOA and high-resolution peripheral quantitative computed tomography (HRpQCT) measures of the hand and radius in a population-based s le. A total of 201 participants (mean age 72, 46% female) from the Tasmanian Older Adult Cohort (TASOAC) study underwent HRpQCT assessment of the 2nd distal and proximal interphalangeal (DIP, PIP), 1st carpometacarpal (CMC) joint, and distal radius. Radiographic HOA was assessed at the 2nd DIP, PIP joints, and the 1st CMC joint using the OARSI atlas. Proximal osteophyte and joint space narrowing (JSN) scores were consistently more strongly associated with HRpQCT measures compared to the distal site with positive associations for indices of bone size (total and trabecular bone area and cortical perimeter but inconsistent for cortical area) and negative associations for volumetric bone mineral density (vBMD). There was a decrease in trabecular number and bone volume fraction with increasing osteophyte and JSN score as well as an increase in trabecular separation and inhomogeneity. Osteophyte and JSN scores in the hand were not associated with HRpQCT measures at the distal radius. This hypothesis generating data suggests that bone size and trabecular disorganization increase with both osteophyte formation and JSN (proximal more than distal), while local vBMD decreases. This process appears to be primarily at the site of pathology rather than nearby unaffected bone.
Publisher: Oxford University Press (OUP)
Date: 23-10-2021
DOI: 10.1093/RHEUMATOLOGY/KEAB786
Abstract: To summarize effects of intravenous bisphosphonates (IVBP) in patients with symptomatic knee OA and bone marrow lesions (BMLs), using a meta-analysis of randomized controlled trials (RCTs). Literature databases were searched for placebo-controlled RCTs of IVBPs for knee OA from inception, and included validated pain and function scales, BML size and incidence of adverse events. Efficacy was compared using standardized mean differences (SMD) and risk ratios (RR) with fixed-effect or random-effects models. Methodological quality was assessed using the Cochrane risk of bias tool, heterogeneity was assessed by I2 statistics. We included 428 patients in four RCTs of 2–24 months duration most patients (84%) received zoledronic acid (ZA). Risk of bias was low-moderate. IVBP had large effect sizes on pain within 3 months [SMD = −2.33 (95% CI: −3.02, −1.65)] mainly driven by neridronate (resulting in substantial heterogeneity, I2 = 92%) with no effect for ZA alone. Differences in knee function were statistically significant at 3 months [SMD = −0.22 (−0.43, −0.01), I2 = 0.2%]. Effect sizes for pain did not reach statistical significance at any other time point. IVBPs improved a semi-quantitative measure of BML size within 6 months [SMD = −0.52 (−0.89, −0.14), I2 = 0%] but not at 12 months or two years. Adverse events [RR = 1.19 (1.00, 1.41) I2 = 52%], occurred more frequently with IVBP. ZA has no effect on knee pain, possibly a short-term effect on BML size and higher rates of adverse events. Neridronate may improve pain in the short term, but this is based on a single trial.
Publisher: Wiley
Date: 04-2000
DOI: 10.1111/J.1445-5994.2000.TB00809.X
Abstract: To determine the prevalence and associations of vitamin D (25-OHD) deficiency in a s le of older Tasmanian subjects. A cross-sectional survey of: 109 patients with a mean age of 79 years (range 60-101 years) consecutively admitted to a short stay geriatric rehabilitation ward 52 community dwelling subjects with a mean age of 75 years (range 64-88 years). Subjects answered a questionnaire, had anthropometric measurements and underwent venepuncture. The main outcome measure was 25 hydroxy vitamin D (25-OHD) level with deficiency defined as <28 nmol/L. Vitamin D deficiency was found in 67% and secondary hyperparathyroidism in 49% of the hospitalised group. Vitamin D deficiency was also found in 17% of the community group, in particular one in three residents of Independent Living Units was deficient. Subjects who were deficient were older (80 years vs 76 years [p<0.001]), had lower body mass index (23.7 kg/m2 vs 25.9 kg/m2 [p<0.001]) and had a lower serum albumin (35 gm/L vs 39 gm/L [p<0.001]). Deficient subjects had poorer physical functional status (p=0.02) and lower activity levels (p<0.001) and reported less habitual sun exposure (p<0.001). Biochemical measures such as parathyroid hormone, alkaline phosphatase and calcium were weakly predictive of vitamin D levels. By stepwise multiple regression analysis, the only significant predictors of vitamin D levels were the Frenchay Activity Index, albumin and calcium. Vitamin D deficiency and secondary hyperparathyroidism is common in community living older people who are hospitalised in Southern Tasmania and is associated with increasing age, poor physical function and activity and low reported sun exposure.
Publisher: Springer Science and Business Media LLC
Date: 2006
DOI: 10.1186/AR2027
Publisher: Elsevier BV
Date: 12-2015
Publisher: Frontiers Media SA
Date: 25-08-2022
Abstract: Populations with knee osteoarthritis (KOA) are at increased risk of cardiovascular disease, due to higher prevalence of risk factors including dyslipidaemia, where statins are commonly prescribed. However, the effect of statins on muscles and symptoms in this population is unknown. Thus, this study examined the effect of atorvastatin on muscle properties in patients with symptomatic KOA. Post-hoc analysis of a 2-year multicentre randomised, double-blind, placebo-controlled trial. Australian community. Participants aged 40–70 years (mean age 55.7 years, 55.6% female) with KOA who met the American College of Rheumatology clinical criteria received atorvastatin 40 mg daily ( n = 151) or placebo ( n = 153). Levels of creatinine kinase (CK), aspartate transaminase (AST), and alanine transaminase (ALT) at 1, 6, 12, and 24 months muscle strength (by dynamometry) at 12 and 24 months vastus medialis cross-sectional area (CSA) on magnetic resonance imaging at 24 months and self-reported myalgia. There were no significant between-group differences in CK and AST at all timespoints. The atorvastatin group had higher ALT than placebo group at 1 (median 26 vs. 21, p = 0.004) and 6 (25 vs. 22, p = 0.007) months without significant between-group differences at 12 and 24 months. Muscle strength increased in both groups at 24 months without between-group differences [mean 8.2 (95% CI 3.5, 12.9) vs. 5.9 (1.3, 10.4), p = 0.49]. Change in vastus medialis CSA at 24 months favoured the atorvastatin group [0.11 (−0.10, 0.31) vs. −0.23 (−0.43, −0.03), p = 0.02] but of uncertain clinical significance. There was a trend for more myalgia in the atorvastatin group (8/151 vs. 2/153, p = 0.06) over 2 years, mostly occurring within 6 months (7/151 vs. 1/153, p = 0.04). In those with symptomatic KOA, despite a trend for more myalgia, there was no clear evidence of an adverse effect of atorvastatin on muscles, including those most relevant to knee joint health.
Publisher: BMJ
Date: 15-08-2012
DOI: 10.1136/ANNRHEUMDIS-2012-201691
Abstract: This study describes the longitudinal association between objectively assessed physical activity (PA) and knee structural change measured using MRI. 405 community-dwelling adults aged 51–81 years were measured at baseline and approximately 2.7 years later. MRI of the right knee at baseline and follow-up was performed to evaluate bone marrow lesions (BMLs), meniscal pathology, cartilage defects, and cartilage volume. PA was assessed at baseline by pedometer (steps/day). Doing ≥10 000 steps/day was associated with BML increases (RR 1.97, 95% CI 1.19 to 3.27, p=0.009). Participants doing ≥10 000 steps/day had a 1.52 times (95% CI 1.05 to 2.20, p=0.027) greater risk of increasing meniscal pathology score, which increased to 2.49 (95% CI 1.05 to 3.93, p=0.002) in those with adverse meniscal pathology at baseline. Doing ≥10 000 steps/day was associated with a greater risk of increasing cartilage defect score in those with prevalent BMLs at baseline (RR 1.36, 95% CI 1.03 to 1.69, p=0.013). Steps/day was protective against volume loss in those with more baseline cartilage volume but led to increased cartilage loss in those with less baseline cartilage volume. (p=0.046 for interaction). PA was deleteriously associated with knee structural change, especially in those with pre-existing knee structural abnormalities. This suggests in iduals with knee abnormalities should avoid doing ≥10 000 steps/day. Alternatives to weight-bearing activity may be needed in order to maintain PA levels required for other aspects of health.
Publisher: Springer Science and Business Media LLC
Date: 29-08-2012
DOI: 10.1007/S11657-012-0095-Y
Abstract: Between 1997-1998 and 2006-2007 in Australia, the age-standardised incidence rates of hip fractures declined by 20 and 13 %, in females and males, respectively. Although this may be related to the rollout of public health c aigns and strategies addressing osteoporosis, absolute numbers of hip fractures continued to increase. Previous reports described an increasing trend in osteoporotic hip fracture incidence in Australia in the 1980s with a stabilisation over the 1990s. The aim of this study was to describe national trends in the incidence of osteoporotic hip fracture in Australia between 1997-1998 and 2006-2007. Data on low-trauma hip fractures in persons aged 50 years and over were obtained from the National Hospital Morbidity Database. Cases where the patient was transferred in from another hospital were excluded. Age-standardised incidence rates were calculated and a linear test for trend applied. Although the absolute number of hip fracture cases has continued to increase, from 14,769 in 1997-1998 to 16,412 in 2006-2007, these numbers are lower than previous predictions based on population ageing. Over the 10-year period, the age-standardised incidence rates in females declined by 20 %, from 370 to 295 per 100,000, while the age-standardised incidence rates in males declined by 13 %, from 200 to 174 per 100,000. Both declines were statistically significant. The sex difference in incidence rates narrowed between 1997-1998 (females 85 % higher) and 2006-2007 (females 70 % higher). The age-standardised incidence of osteoporotic hip fracture in Australia is falling. This may be related to the uptake of bisphosphonates as well as the rollout of public health c aigns and strategies addressing osteoporosis.
Publisher: BMJ
Date: 06-2015
Publisher: Elsevier BV
Date: 04-2015
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2018
Publisher: Oxford University Press (OUP)
Date: 14-08-2018
Abstract: To describe the associations of between-person and within-person variability in serum 25-hydroxyvitamin D (25(OH)D), physical activity (PA), and knee pain and dysfunction with muscle mass, strength, and muscle quality over 10 years in community-dwelling older adults. Participants (N = 1033 51% women mean age 63 ± 7.4 years) were measured at baseline, 2.5, 5, and 10 years. Lower limb lean mass (LLM) was assessed using dual energy X-ray absorptiometry, lower limb muscle strength (LMS) using a dynamometer, and lower limb muscle quality (LMQ) calculated as LMS/LLM. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. PA was measured using pedometers. Linear-mixed effect regression models, with adjustment for confounders, were used to estimate the association of within-person and between-person variability in PA, 25(OH)D, and WOMAC scores with muscle mass, strength, and muscle quality. Both between-person and within-person increases in PA were associated with LLM, LMS, and LMQ (all P < 0.05). Within-person and between-person increases in knee pain and dysfunction were associated with LLS and LMQ, but not with LLM (all P < 0.05). Between-person effects showed that higher average 25(OH)D was associated with a higher 10-year average LLM, LMS, and LMQ (all P < 0.05), whereas within-person increases in average 25(OH)D were associated with a higher LMS and LMQ, but not with LLM. Variability in 25(OH)D, pain, and dysfunction within an in idual over time is related to muscle changes in that in idual. Increasing one's own PA level further increases muscle mass, strength, and quality supporting the clinical recommendation of promoting PA to reduce age-related muscle loss.
Publisher: Wiley
Date: 03-06-2013
DOI: 10.1111/PAI.12085
Abstract: It has been postulated that ultraviolet ray exposure in childhood might influence the development of allergic disease. We examined whether reported sun exposure during childhood or in adolescence is related to the occurrence of atopy or allergic disease. Population-based longitudinal cohort study with sixteen-year follow-up (N = 415). Subjects were recruited at birth as part of an infant health study. The reported daily duration of sun exposure in the summer months was recorded at 8 and 16 yrs of age. Allergen sensitization and the presence of eczema, asthma, and rye grass positive rhinitis were recorded at age 16. Reported sun exposures of more than 4 h per day during summer holidays in adolescence were associated with reduced eczema and rhinitis but not inhalant allergen sensitization or asthma risk. Thus, higher sun exposure during summer holidays and summer weekends in adolescence was associated with significantly reduced eczema (test of trend p-value = 0.001 summer holidays test of trend p-value = 0.003 summer weekends) and rye grass positive rhinitis (test of trend p-value = 0.03 summer holidays test of trend p-value = 0.02 summer weekends). Sun exposure at adolescence or age 8 was not related to inhalant allergen sensitization. There was no association between serum 25(OH)D levels at adolescence with either inhalant allergen sensitization or allergic disease and adjustment for serum 25(OH)D levels did not alter these findings. Increased sun exposure during summer holidays in adolescence was associated with reduced eczema and rhinitis risk, independently of measured vitamin D levels but no difference in inhalant allergen sensitization or asthma. The beneficial effects of sun exposure on allergic disease may operate independently from vitamin D or an effect on allergen sensitization.
Publisher: Wiley
Date: 08-07-2020
DOI: 10.1002/JBMR.4044
Publisher: BMJ
Date: 23-05-2022
DOI: 10.1136/ANNRHEUMDIS-2022-EULAR.2543
Abstract: Knee magnetic resonance imaging (MRI)-based morphological markers (quantitative biomarkers) and structural abnormalities (semi-quantitative biomarkers) are known to be associated with the progression of knee osteoarthritis (OA). However, there is conflicting evidence on the association between knee MRI-based morphological markers and knee symptoms. Besides, there is a lack of evidence on the clinical significance of MR imaging markers in the general population-based young adults. Hence, our aim was to investigate the associations between MR imaging biomarkers and knee symptoms in middle-aged adults followed over seven years. To describe the associations of cartilage volume, cartilage thickness, subchondral bone area, cartilage defects, and bone marrow lesions (BML) with knee symptoms in young adults followed up over 6-9 years. Knee symptoms (pain, stiffness, and dysfunction) were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scale during Childhood Determinants of Adult Health (CDAH)-knee study at baseline (year: 2008-10, age: 30–40 years) and 6-9 year follow-up (CDAH-3 year: 2014–2019, age: 36–49 years). Knee MRI scans were obtained at baseline and were assessed quantitatively for morphological markers such as cartilage volume, cartilage thickness, subchondral bone area using semi-automated segmentation (Chondrometrics, Germany). Cartilage defects and BMLs were assessed using semi-quantitative scoring systems. Univariable and multivariable (adjusted for age, sex, and body mass index (BMI)) zero-inflated Poisson (ZIP) regression model with random effects were used to describe the cross-sectional and longitudinal associations. The prevalence of knee pain at baseline (mean age (SD): 34 (2.7) female 49%) was 34% that increased to 50% over 6-9 year follow-up (mean age (SD): 43 (3.2)). Cross sectionally, there was a weak but statistically significant negative association between medial femorotibial compartment (MFTC) [Ratio of Mean (RoM)= 0.99971084 95% CI: (0.9995525, 0.99986921 p .001], lateral femorotibial compartment (LFTC) [RoM=0.99982602 95% CI: 0.99969915, 0.9999529 p=0.007], and patellar cartilage volume [RoM=0.99981722 95% CI: 0.99965326, 0.9999811 p=0.029] with knee symptoms. Similarly, there was a negative association between patellar cartilage volume (RoM=0.99975523 95% CI: 0.99961427, 0.99989621 p=0.014), MFTC cartilage thickness (RoM= 0.72090775 95% CI: 0.59481806, 0.87372596 p=0.001) and knee symptoms assessed after seven years. The total bone area was consistently and negatively associated with knee symptoms at baseline [RoM= 0.9210485 95%CI: 0.8939677, 0.9489496 p .001] and over seven years (RoM=0.9588811 95% CI: 0.9313379, 0.9872388 p=0.005). Presence of any cartilage defect or BML was associated with higher knee symptoms at baseline and after seven years. In the middle-aged adult population, BML and cartilage defects were positively associated with knee symptoms, whereas cartilage volume and thickness at MFTC and total bone area were weakly and negatively associated with knee symptoms. These results suggest that the quantitative and semi-quantitative MR imaging biomarkers can be explored as a marker of the clinical progression of OA in a young adult population. Benny Antony: None declared, Alison Venn: None declared, Leigh Blizzard: None declared, Lyn March: None declared, Flavia Cicuttini: None declared, Felix Eckstein Shareholder of: Shareholder of Chondrometrics, image processing company, Graeme Jones: None declared, Changhai Ding: None declared, Ambrish Singh: None declared
Publisher: Springer Science and Business Media LLC
Date: 18-05-2017
Publisher: Springer Science and Business Media LLC
Date: 13-10-2023
Publisher: Wiley
Date: 29-07-2010
DOI: 10.1111/J.1365-2796.2010.02267.X
Abstract: To determine the associations between body adiposity and change in serum 25-(OH)D levels over 2.6 years, and if these associations are mediated by metabolic and inflammatory factors in older adults. This is a longitudinal study of 859 randomly selected subjects (mean 62 years, range 51-80, 49% women). Serum 25-hydroxyvitamin D [25-(OH)D] was assessed by radioimmunoassay at baseline and 2.6 years later. Baseline serum level of leptin was assessed by radioimmunoassay and interleukin (IL)-6 by a chemiluminescent immunoassay in the first 183 subjects. In multivariable analyses, body mass index, trunk fat percentage and waist-to-hip ratio were significant predictors of increased incident vitamin D deficiency [a 25-(OH)D < 50 nmol L⁻¹ at follow-up when ≥50 nmol L⁻¹ at baseline] and decreased recovery of vitamin D deficiency [a 25-(OH)D ≥ 50 nmol L⁻¹ at follow-up when < 50 nmol L⁻¹ at baseline]. Change in 25-(OH)D levels per annum was also independently predicted by baseline leptin (β: -0.09/unit, 95% CI: -0.17, -0.03), IL-6 (β: -0.68/quartile, 95% CI: -1.35, -0.02) and total cholesterol/high-density lipoprotein (HDL) ratio (β: -0.51, 95% CI: -0.88, -0.14). The associations between body adiposity measures and change in 25-(OH)D completely disappeared after adjustment for leptin, diminished after adjustment for IL-6, but remained unchanged after adjustment for total cholesterol/HDL ratio. All associations were independent of season and sun exposure. Body fat is not simply a passive reservoir for 25-(OH)D. In addition to season and sun exposure, 25-(OH)D levels appear to be determined by metabolic and, to a lesser extent, inflammatory factors, and these appear to mediate the effects of adiposity on change in 25-(OH)D.
Publisher: Elsevier BV
Date: 05-2010
DOI: 10.1016/J.MATURITAS.2010.01.014
Abstract: Knee osteoarthritis (OA) is a major cause of pain and disability in women, becoming a major health problem in mid to later life. A better understanding of factors contributing to deleterious structural knee changes may be important for preventing OA. In men, occupations associated with frequent knee bending have been shown to be associated with damage to knee cartilage. This has not been examined in women. The aim of this study was to examine the effect of occupational specific knee activities on tibial and patella cartilage morphology among healthy females. 96 females aged 26-62 years with no history of knee injury or symptoms were recruited as part of a study of community-based study of lifestyle factors on knee health. Occupational activity data examining the frequency of tasks such as heavy lifting, knee bending, stair climbing, walking and standing were obtained by questionnaire. Tibial and patella cartilage volumes and defects were measured from magnetic resonance imaging using validated methods. Heavy lifting/bending/squatting, knee bending, stair climbing and walking were all associated with an increased risk of patella, but not tibial, cartilage defects (odds ratio 1.8-2.9 p<or=0.05) after adjustment for potential confounders, including knee alignment and radiographic joint space narrowing. There was a trend towards knee bending being associated with a reduction in patella cartilage volume (p=0.07). Our results demonstrate that asymptomatic adult females with occupations requiring frequent knee bending have patella, but not tibial cartilage damage. These findings suggest that vocational tasks requiring knee bending are detrimental to the structure of cartilage in females and may be an area to consider in the prevention of knee OA.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.JBSPIN.2016.03.011
Abstract: Vertebral endplate (Modic) lesions are gaining interest, with varied phenotypes recognised to have distinct clinical and histological correlates. Nevertheless, the natural history of these lesions is unclear. This study examined the natural history of Modic changes and their potential relationship to the intervertebral disc. Seventy-two community-based adults not selected for low back pain had lumbar spine magnetic resonance imaging (MRI) performed at baseline (2012) and approximately 2 years later to assess Modic lesions. Fifty-six participants completed the study. Intervertebral disc pathology was assessed by disc height and the Pfirrmann grading system at baseline. At baseline, 6 Modic type 1 lesions were present in 3 (4.2%) participants. At follow-up, 4 persisted, 2 changed to a Modic type 2 lesion, and there were 4 incident lesions. Only 1 participant (1.4%) had a baseline Modic type 3 lesion, which persisted at follow-up, with one further incident lesion. Modic type 2 lesions were most common (n=47, in 20 of 72 [27.8%] participants). Resolution of Modic type 2 lesions was uncommon (n=1, with 2 changing to a type 1 lesion). 18 incident lesions occurred in 7 (12.5%) participants, with most occurring both sides of the intervertebral disc. A reduction in the average baseline disc height was associated with an increased risk for type 2 incident lesions (OR 1.9, 95% CI 1.1 to 3.3, P=0.03). Similarly, severe baseline disc degeneration at L3/4, L4/5 and L5/S1 was associated with an increased risk for type 2 incident lesions (all P≤0.05). This longitudinal study has demonstrated that Modic type 2 are the most common of the Modic lesions in community-based adults and while resolution of these lesions is uncommon, incident disease develops on both sides of the intervertebral disc in the setting of severe disc degeneration. These results suggest that type 2 Modic changes are a sequel of disc degeneration.
Publisher: Springer Science and Business Media LLC
Date: 09-1994
DOI: 10.1007/BF01623352
Abstract: We investigated the clinical features and surgical outcomes of lung adenocarcinoma with minimal solid or micropapillary (S/MP) components, with a focus on stage IA. We enrolled 506 patients with lung adenocarcinoma who underwent curative resection in this study. Clinical features and surgical outcomes were compared between the groups with and without the S/MP subtype (S/MP+ and S/MP-, respectively), and between the group with an S/MP proportion of ≤5% (S/MP5) and the S/MP-. The S/MP subtype was present in 247 patients (48.8%) 129 (25.5%) were grouped as the S/MP5 group. The S/MP+ and S/MP5 groups had larger tumors, higher frequency of lymph node metastasis, and more advanced stages of disease than the S/MP- group (P < 0.001, all comparisons). Pleural, lymphatic, and vascular invasions occurred more frequently in the S/MP+ and S/MP5 groups (P < 0.001, all comparisons for S/MP+ vs. S/MP- P ≤ 0.01, all comparisons for S/MP5 vs. S/MP-). The S/MP+ and S/MP5 groups showed a shorter time to recurrence and cancer-related death than the S/MP- group(P < 0.001, both comparisons). For stage I, the presence or absence of the S/MP subtype defined prognostic subgroups better than the stage IA/IB classification. Notably, in the multivariate analysis, the minimal S/MP component was a significant predictor of recurrence, even in stage IA. The presence of the minimal S/MP component was a significant predictor of poor prognosis after surgery, even in stage IA patients. Clinical trials to evaluate the advantages of adjuvant chemotherapy for this subset of patients and further investigations to understand underlying biological mechanisms of poor prognosis are needed. Significant findings of the study: We demonstrated that only minimal presence of solid or micropapillary component was profoundly associated with aggressive clinicopathological features and poor prognosis after complete resection even in stage IA lung adenocarcinoma. Our results suggest that minimal presence of these subtypes is a strong prognostic factor which should be taken into account in the risk assessment for adjuvant chemotherapy in lung adenocarcinoma.
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2018-023044
Abstract: Very-low birthweight (VLBW, g) infants comprise about 1%–1.4% of all births in high-income countries. Every year, about 3000 VLBW babies in Australia and New Zealand receive intensive care. Many die or else survive with severe brain injury, retinopathy, late-onset sepsis or necrotising enterocolitis (NEC), each of which carries substantial risk of disability. This trial tests whether adding bovine lactoferrin (bLF) to feeds in VLBW infants improves (1) survival to hospital discharge free from brain injury, late-onset sepsis, NEC and treated retinopathy of prematurity (primary composite end point) (2) each component of the primary composite end point and (3) time to reach full enteral feeds, number of blood transfusions, chronic lung disease and length of hospital stay. It includes a cost-effectiveness analysis of bLF in improving survival free from major morbidity, and evaluates the effect of bLF on survival and developmental outcomes at 24 to 36 months corrected gestational age. This is a multicentre, two-arm, randomised trial comparing the treatment group receiving bLF added to breast milk or formula milk daily (up to 250 mg/kg/day bLF) versus the control group receiving no bLF supplementation. The intervention is administered until 34 completed weeks corrected gestation or for 2 weeks, whichever is longer, or until discharge home, if earlier. The target s le size of 1500 participants yields 85% power, at the two-sided 5% level significance, to detect a difference in proportions meeting the primary outcome assuming the true probability is 74% in controls and 80.5% in the bLF group. This protocol was approved by Northern Sydney Local Human Research Ethics Committee in January 2017 (Version 2.0, Reference 1003-118M) and other relevant ethics committees. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations. ACTRN12611000247976 Pre-results.
Publisher: Wiley
Date: 11-2007
DOI: 10.1111/J.1525-1470.2007.00549.X
Abstract: Topical corticosteroids remain the most common treatment for eczema however, it is uncertain whether long-term use of these agents has any adverse effect on bone mass. Cyclosporin is very useful in patients with severe atopic dermatitis who have failed conventional therapy. It has been shown to induce bone loss. We compared 43 children with severe eczema who were using topical corticosteroids with 73 healthy children. Of the 43 patients, six were also taking cyclosporin. Bone mineral density was measured in the lumbar spine and in the femoral neck using dual-energy X-ray absorptiometry. In multivariate analysis, subjects with eczema had lower lumbar spine bone mineral density (-0.03 g/cm(2) p = 0.015) and bone mineral apparent density (-0.01 g/cm(3) p = 0.008) but higher FN BMAD (+0.02 g/cm(3) p = 0.029) compared with controls. Patients with eczema on topical corticosteroids who had used cyclosporin had lower lumbar spine bone mineral apparent density (-0.01 p = 0.006) compared with those only on topical corticosteroids in both adjusted and unadjusted analysis. In conclusion, children with severe eczema have decreased lumbar spine bone mass, which is primarily mediated by cyclosporin use rather than by topical corticosteroid use. This effect is likely to lead to a modest increase in the risk of wrist and forearm fractures in children using this agent.
Publisher: Wiley
Date: 12-2009
DOI: 10.1359/JBMR.090532
Abstract: Subchondral bone is hypothesized to be important in the development and progression of osteoarthritis (OA) however, little is known about the determinants of subchondral bone. This study describes the relationship between tibial subchondral BMD (sBMD) and anthropometric, lifestyle, and structural measures in 740 randomly selected subjects (mean age, 62 yr range, 50-80 yr 52% women). We measured medial tibial sBMD by DXA at two regions of interest (ROIs). We also assessed anthropometrics, vitamin D, steps per day by pedometer, joint space narrowing (JSN) and osteophytes (by X-ray), cartilage defects, cartilage volume, and bone marrow lesions (BML by MRI), and hip and spine BMD (by DXA). sBMD using ROI 1 was negatively associated with age and female sex and positively associated with BMI. In multivariable analysis, sBMD was positively correlated with steps per day (r = 0.08, p = 0.025), tibial osteophytes (r = 0.08, p = 0.028), JSN (r = 0.11, p < 0.01), cartilage defects (r = 0.16, p < 0.01), cartilage volume (r = 0.12, p = 0.01), BMLs (r = 0.17, p = 0.013 [tibial] r = 0.16, p = 0.018 [femoral]), and hip and spine BMD (r = 0.36, p < 0.01 and r = 0.38, p < 0.01, respectively). Similar associations were observed using ROI 2, with vitamin D also associated with sBMD (r = 0.10, p < 0.01). In conclusion, this study identified a large number of factors associated with sBMD, of which the most novel is cartilage defects. Longitudinal studies are required to address causality.
Publisher: Bentham Science Publishers Ltd.
Date: 11-2006
Publisher: American Medical Association (AMA)
Date: 20-12-1995
Publisher: Wiley
Date: 19-04-2013
DOI: 10.1111/CEN.12101
Abstract: Obesity is characterized by hyperleptinaemia, which is associated with diabetes, hypertension and coronary heart disease. The aim of this study was to determine if body fat and muscle measures predict the natural increase in leptin over 2·6 years in older adults. A total of 190 subjects (50% females) aged between 50 and 79 years were selected to perform the serum measurements for leptin. Height and weight were measured and body mass index (BMI) was calculated. Fat and lean mass of the whole body and the trunk were acquired through dual-energy X-ray absorptiometry (DXA). Leg muscle strength and handgrip strength were measured using dynamometry. In multivariable analyses, leg muscle strength was negatively associated with both baseline leptin (β: -0·05 μg/l per kg, 95% CI: -0·08, -0·02) and follow-up leptin (β: -0·04 μg/l per kg, 95% CI: -0·07, -0·01). BMI, and percentage total fat and trunk fat and their respective change per annum (cpa) were significantly and positively associated with leptin. Lean mass was negatively associated with baseline leptin. Gender-specific analyses produced similar associations between leg muscle strength, fat measures and follow-up leptin in males and females. Besides positive associations between body fat, trunk fat and leptin, we found that leg muscle strength was negatively associated with leptin after 2·6 years in a s le of older population. This suggests that interventions to maintain or increase muscle strength may have a protective effect on hyperleptinaemia.
Publisher: Informa UK Limited
Date: 12-2017
DOI: 10.2147/DDDT.S158965
Publisher: BMJ
Date: 06-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-06-2022
DOI: 10.1097/J.PAIN.0000000000002383
Abstract: Periarticular muscle plays an important role in the pathogenesis of musculoskeletal pain. We recently reported that pain population consists of distinct subgroups of which the causes and mechanisms may differ. This study aimed to examine the association of lean mass, muscle strength, and quality with 10.7-year pain trajectory. Nine hundred forty-seven participants from a population-based cohort study were analysed. Dual-energy X-ray absorptiometry was used to assess lean and fat mass. Leg strength, knee extensor strength, and lower-limb muscle quality were measured/calculated. Knee pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index pain questionnaire. Radiographic knee osteoarthritis was assessed by X-ray. Three distinct pain trajectories were identified: “Minimal pain” (53%), “Mild pain” (34%), and “Moderate pain” (13%). Higher total and lower-limb lean mass were associated with an increased risk of “Mild pain” and “Moderate pain” trajectories relative to the “Minimal pain” trajectory group, but these associations became nonsignificant after further adjustment for fat mass. Total lean mass percentage was associated with a lower risk of “Mild pain” (relative risk ratio [RRR]: 0.95, 95% confidence interval 0.92-0.98) and “Moderate pain” trajectory (RRR: 0.92, 95% confidence interval 0.87-0.96). Greater leg and knee extensor strength and muscle quality were associated with “Mild pain” and “Moderate pain” trajectories (RRR: 0.52-0.65, all P 0.05). Similar results were found in those with radiographic knee osteoarthritis. Higher lower-limb muscle strength and quality, and relative lean mass, are associated with a reduced risk of severe knee pain trajectories, suggesting that improving muscle function and composition may protect against persistent unfavourable knee pain courses.
Publisher: Elsevier BV
Date: 06-2006
DOI: 10.1016/J.JOCA.2005.12.007
Abstract: To describe the association between knee and hip radiographic osteoarthritis (ROA), a measure of knee pain, stiffness and functional ability and objectively measured physiological falls risk predictors. Cross-sectional, population-based study of 850 randomly selected men and women aged 50-80 years (mean 62.5, SD 7.4). Falls risk (Z score) was determined objectively with the short form Physiological Profile Assessment (PPA). Two observers assessed knee and hip ROA using the Altman atlas. Pain, stiffness and functional ability were assessed using the Western Ontario McMasters Osteoarthritis index (WOMAC). Overall, the study population was at a mild risk of falling. In multivariable analysis, the WOMAC function and pain score were significantly associated with reaction time, balance, proprioception, knee extension strength, and edge contrast sensitivity. Stiffness was associated with knee extension strength and edge contrast sensitivity. Males had a dose response association between the global WOMAC score and falls risk (r=0.17, P<0.001). Those who reported a global WOMAC score of 50 and above had a higher risk of falling compared to those with a score below 50 (Z score: 0.53 vs 0.14, P<0.001). Hip joint space narrowing (JSN) was significantly associated with knee extension strength (r=-0.10, P=0.003), however, no other significant associations were observed between ROA and falls risk predictors. Self-reported functional ability and pain, and to a lesser extent, stiffness (but not knee and hip ROA), have a modest but independent association with physiological predictors of falls risk.
Publisher: The Endocrine Society
Date: 04-2003
Abstract: The aim of this population-based case-control study was to examine the association between bone mass and upper limb fractures in children aged 9–16 yr. Areal bone mineral density and bone mineral apparent density (BMAD) were measured by both dual energy absorptiometry (DXA) and metacarpal index (MI) by hand radiograph. A total of 321 fracture cases and 321 randomly selected in idually matched controls were studied. For all fractures, cases had lower DXA measures at all sites (1.1–3.3% all P & 0.05). A larger reduction was observed for those with wrist and forearm fractures (1.2–4.5% all P & 0.05, except total body BMAD) but not other upper limb fractures (hand, −1.6 to +1.2% upper arm: 0.9–4.8% all P & 0.05). For metacarpal measures, cases had a thinner cortical width and lower MI for wrist and forearm fractures only. In multivariate modeling, both spine BMAD (odds ratio, 1.4/sd reduction) and MI (odds ratio, 1.5/sd reduction) remained statistically significant predictors of wrist and forearm fractures. In conclusion, both DXA measures and MI are independently associated with wrist and forearm but not other upper limb fractures. The magnitude of this association is somewhat weaker than in adults but suggests that optimizing age-appropriate bone mass will lessen the risk of fracture in children.
Publisher: Springer Science and Business Media LLC
Date: 07-01-2021
DOI: 10.1186/S12891-020-03875-1
Abstract: To describe demographic and clinical factors associated with the presence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA). Three hundred ninety-seven participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.3 ± 7.1 year, 48.6% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months. The presence and incidence of depression was 25.4 and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher presence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months. Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the presence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA. ClinicalTrials.gov identifier: NCT01176344 . Anzctr.org.au identifier: ACTRN12610000495022 .
Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism
Date: 06-2017
Publisher: Springer Science and Business Media LLC
Date: 14-01-2020
DOI: 10.1186/S13063-019-3915-1
Abstract: Knee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at modifying structures visible on imaging have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic inflammation and could be used for targeting inflammatory mechanisms of OA. We will recruit 260 patients with clinical knee OA, significant knee pain and effusion-synovitis present on MRI in five Australian cities (Hobart, Melbourne, Sydney, Adelaide and Perth). These patients will be randomly allocated to the two arms of the study, receiving 2 g/day krill oil or inert placebo daily for 6 months. MRI of the study knee will be performed at screening and after 6 months. Knee symptoms, function and MRI structural abnormalities will be assessed using validated methods. Safety data will be recorded. Primary outcomes are absolute change in knee pain (assessed by visual analog score) and change in size of knee effusion-synovitis over 24 weeks. Secondary outcomes include improvement in knee pain over 4, 8, 12, 16 and 20 weeks. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per protocol analyses adjusting for missing data and for treatment compliance will be performed as the secondary analyses. This study will provide high-quality evidence to assess whether krill oil 2 g/day reduces pain and effusion-synovitis size in older adults with clinical knee OA and knee effusion-synovitis. If krill oil is effective and confirmed to be safe, we will provide compelling evidence that krill oil improves pain and function, changes disease trajectory and slows disease progression in OA. Given the lack of approved therapies for slowing disease progression in OA, and moderate cost of krill oil, these findings will be readily translated into clinical practice. Australian New Zealand Clinical Trials Registry, ACTRN12616000726459 . Registered on 02 June 2016. Universal Trial Number (UTN) U1111–1181-7087.
Publisher: Informa UK Limited
Date: 02-1997
Abstract: This study examined psychopathology and substance use in 15 African American adolescents who attempted suicide and 15 African American adolescents who did not attempt suicide (control group). Both groups of adolescents and their parents completed questionnaires that addressed depression, behavior problems, family functioning, and drug and alcohol use. On the basis of group means of the Children's Depression Inventory (Kovacs & Beck, 1977), the Youth Self-Report (Achenbach & Edelbrock, 1987), and the Child Behavior Checklist (Achenbach & Edelbrock, 1983), the suicidal youth were found to have a significant level of depression in addition to a variety of internalizing and externalizing behavior disorders. Similarly, on the Multigating Substance Use Evaluation System (Jurkovic & Bruce, 1991), the suicidal youth were at a high risk for alcohol and drug abuse. The suicidal group reported more alcohol and drug abuse than the control group. The results indicated that suicidal African American adolescents used significant amounts of drugs and alcohol, which may be associated with suicide attempts.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2012
Publisher: Wiley
Date: 24-07-2013
Publisher: BMJ
Date: 17-01-2008
Publisher: Springer Science and Business Media LLC
Date: 21-12-2011
Abstract: We aimed to assess the safety and efficacy of high-dose intermittent vitamin D supplementation in adolescents. Twenty-two healthy adolescents with serum 25 hydroxy-vitamin D (25-OHD) of 12.5-50 nmol/l were randomised to receive 300,000 IU or 150,000 IU of vitamin D3, or placebo orally 6-monthly for 1 year. At 12 months, the average vitamin D levels for the 300,000 IU, 150,000 IU and placebo groups were 63.0, 41.1 and 35.8 nmol/l, respectively, (P=0.004 for difference between 300 000 IU group and placebo after adjustment for age, sex and seasonal variation). At 12 months, one participant receiving 300,000 IU was mildly deficient (25-OHD 49 nmol/l), whereas five out of six (83%) in the placebo and four out of seven participants (57%) in the 150,000 IU group remained deficient. There were no adverse events. Compliance was high. This suggests that 300,000 IU vitamin D3 orally 6-monthly may safely and effectively correct vitamin D deficiency in adolescents.
Publisher: Wiley
Date: 20-01-2010
Publisher: Springer Science and Business Media LLC
Date: 14-11-2013
Publisher: Oxford University Press (OUP)
Date: 15-05-2016
DOI: 10.1093/RHEUMATOLOGY/KEW214
Abstract: The aim was to determine the non-melanoma skin cancer (NMSC) risk in patients with RA or PsA exposed to MTX and other DMARDs. Information on medication was collected on 405 patients with RA or PsA in two private rheumatology practices and was matched to comprehensive histologically confirmed cancer registry data for the years 1978-2005. Relative risks (RRs) were estimated by logarithmic binomial modelling, and standardized incidence ratios (SIRs) were calculated from year-, sex- and age-specific rates of NMSC for the local population. Compared with no MTX usage, any MTX usage was associated with a higher rate of at least one histopathologically confirmed NMSC (SIR 4.64, 95% CI: 0.67, 33.2). The SIR was 4.81 (95% CI: 3.60, 6.29) for those receiving a cumulative dose >8000 mg compared with SIR 2.31 (95% CI: 1.58, 2.36) for <5000 mg. An increased risk was shown for both basal cell carcinomas and squamous cell carcinomas, with an apparent dose-response relationship for basal cell carcinomas but not for squamous cell carcinomas. There was an increased risk of NMSC in patients taking CSA (RR = 2.51, 95% CI: 1.23, 5.13) and D-Pen (RR 3.49, 95% CI: 1.34, 4.63) in addition to MTX, but not for patients taking AZA or LEF. MTX, and concurrent MTX and CSA or D-Pen use, is associated with an increased risk of NMSC. These results should encourage greater clinical vigilance for NMSC in treated patients with RA and PsA.
Publisher: Springer Science and Business Media LLC
Date: 10-10-2012
Abstract: Overweight and obesity are becoming increasingly prevalent problems worldwide. A number of factors in early life have been found to be associated with body composition of neonates or young children but there is limited follow-up data for adolescents. This study aims to describe associations between early nutrition and body composition in adolescents. Birth cohort study of 415 pregnant women and their offspring (mean age 16 years). Body composition including fat mass (FM) and lean body mass (LBM) of adolescents at 16 years of age was measured by dual-energy X-ray absorptiometry. Information on maternal food and nutrients intake during the third trimester of pregnancy and breastfeeding was collected by questionnaires soon after birth. A total of 264 mother-adolescents pairs were studied. Maternal antenatal meat intake was positively associated with FM of adolescents (an increase of 0.9% ortion, P 25 days was negatively associated with FM in adolescents (a decrease of 14%, P=0.01). These associations were independent of the significant association between maternal energy and macronutrient intakes during pregnancy and adolescent intakes at 16 years of age. No significant association was found between maternal dietary intake and lean mass in adolescents. Breastfeeding may have a biological effect that is beneficial for the prevention of obesity. Conversely, higher maternal meat intake during pregnancy may increase FM in adolescents.
Publisher: Public Library of Science (PLoS)
Date: 31-12-2015
Publisher: BMJ
Date: 11-12-2016
Publisher: Wiley
Date: 03-12-2010
DOI: 10.1111/J.1365-2222.2010.03668.X
Abstract: There is considerable controversy whether maternal peanut ingestion during pregnancy might influence sensitization in later life. Objective To examine whether maternal peanut ingestion during pregnancy might increase sensitization in the offspring. A population-based longitudinal cohort study with 16 years follow-up was conducted (N=373). Subjects were recruited at birth as part of an infant health study. Maternal antenatal peanut consumption was documented at birth and peanut and rye sensitization were determined by measurement of serum-specific IgE at age 16. Peanut sensitization was common (14%). In the entire cohort (n=310), there was no association between antenatal peanut ingestion and peanut sensitization (P=0.17). However, there was a strong association between antenatal peanut ingestion and decreased risk of rye sensitization and peanut sensitization in those (n=201) without a family history (FH) of asthma (Rye OR 0.30, 95% CI 0.14-0.63, P=0.001 and Peanut OR 0.18, 95% CI 0.04-0.78, P=0.02). There was an increased risk of rye sensitization in those (n=108) with a FH of asthma and antenatal peanut ingestion (Rye OR 2.69, 95% CI 1.11-6.51 P=0.03). It was considered that these sensitizations were likely to be related to the presence of IgE antibodies to cross-reacting carbohydrate epitopes common to rye and peanut allergens. Antenatal peanut ingestion may influence the development of IgE antibody to cross-reacting carbohydrate epitopes in later life. Genetic factors may modify this association.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.SOARD.2015.04.021
Abstract: Marked weight loss reduces lean body mass and quadriceps thickness. It is unclear whether muscle loss varies according to the method of weight loss. This study compared the association of surgical versus nonsurgical weight loss with change in vastus medialis (VM) properties in obese adults. Twenty obese patients (body mass index ≥ 30 kg/m(2)) who lost weight via laparoscopic gastric banding were matched for weight loss with obese patients who lost weight nonsurgically. The thickness and fat infiltration of VM were assessed at baseline and a mean of 2.4 years later. After adjusting for confounders, the annual change in VM thickness was -2.9% in the surgical group and -.5% for the nonsurgical group (P = .02). There was also a tendency toward an increased risk for VM fat infiltration to be reduced when weight loss occurred nonsurgically (OR 5.1, 95% CI .8-32.8 P = .09). Compared with nonsurgical weight loss, laparoscopic gastric banding was associated with greater VM muscle thickness loss. Relative to laparoscopic gastric banding, there was also a tendency toward an increased risk for VM fat infiltration to be reduced with nonsurgical weight loss. Close attention to preserving muscle properties at the knee when significant amounts of weight loss have occurred is required. Physical therapy may be important in the management of patients after laparoscopic gastric banding in an attempt to preserve skeletal muscle mass.
Publisher: MDPI AG
Date: 27-02-2020
DOI: 10.3390/JCM9030632
Abstract: Pain is the main impetus for osteoarthritis (OA) patients to seek healthcare including joint replacement. The pain experience in OA is heterogeneous and affected by factors across multiple domains—peripheral, psychological, and neurological. This indicates the existence of homogenous subgroups henotypes within OA patients with pain. We recently identified three pain phenotypes using a wide spectrum of pain-related factors, including structural damage on magnetic resonance imaging (MRI), emotional problems, number of painful sites, sex, body mass index, education level and comorbidities (i.e., Class 1: high prevalence of emotional problems and low prevalence of structural damage (25%) Class 2: low prevalence of emotional problems and high prevalence of structural damage (20%) Class 3: low prevalence of emotional problems and low prevalence of structural damage (55%)). This study was to examine whether the total knee replacement (TKR) risk over 12 years was different among these three pain phenotypes. Data on 963 participants (mean age 62.8 ± 7.4 years) from a population-based cohort study were utilised. Data on socio-demographic, psychological and comorbidities were collected. MRI of the right knee structural pathology was performed. TKR history was ascertained by linking to the Australian Orthopedic Association National Joint Replacement Registry. Latent class analysis and the Cox proportional hazards model were applied for the analysis. During the follow-up period, 41 right and 44 left TKRs in 67 participants were identified. In multivariable analyses, participants in Class 1 and 2 had a higher risk of having a TKR (Class 1 vs. Class 3, HR (hazard ratio) 4.81, 95%CI (confidence interval) 2.33–9.93 Class 2 vs. Class 3, HR 9.23, 95%CI 4.66–18.30). These associations were stronger in the imaged right knee but were also significant in the left knee. Participants within distinct pain phenotypes have different risks of TKR, suggesting that the identified phenotypes reflect distinct clinical subgroups with different prognoses. The risk for TKR was higher in Class 1 than that in Class 3, suggesting that pain/emotional status is a stronger driver for TKR than structural damage, and that selecting patients for TKR needs to be optimized in clinical practice.
Publisher: Wiley
Date: 11-05-2017
DOI: 10.1002/EJP.1027
Publisher: Oxford University Press (OUP)
Date: 29-05-2003
DOI: 10.1046/J.1365-2249.2003.02167.X
Abstract: The objective of this study was to investigate the effect of the oral administration of type II collagen (CII) on pro-inflammatory mediator production by synoviocytes in rats with adjuvant arthritis (AA). Sprague-Dawley rats were fed with bovine CII either before immunization with Complete Freund's adjuvant (CFA) or after initiation of arthritis. Hind paw secondary swelling was measured and synoviocytes were harvested. Sera from portal vein of oral tolerized rats were collected and in vitro synoviocytes culture or synoviocytes-Peyer's Patches (PP) cells coculture system were developed. Interleukin (IL)-1 activity was measured by a mouse thymocyte activation assayed by MTT dye reduction and tumour necrosis factor (TNF) activity was measured by an L929 cytotoxicity bioassay. Nitric oxide (NO) and malondialdehyde (MDA) levels were measured by biochemical methods. We found that feeding with CII (5, 50 and 500 µg/kg) for 7 days before immunization significantly suppressed hind paw secondary swelling measured at day 16, 20, 24 and 28 (all P & 0·01) and pro-inflammatory mediator (IL-1, TNF, NO and MDA) production by synoviocytes (all P & 0·01) in rats with AA. Feeding with CII (5, 50 and 500 µg/kg) for 7 days after initiation of arthritis had a similar effect. CII (1, 10, 100 µg/ml) had no effect on IL-1 and TNF production by synoviocytes in vitro, but CII 10 µg/ml suppressed IL-1 and TNF production by synoviocytes-PP cells coculture system (P & 0·01), which was antagonized by anti-TGF-β antibody (10 µg/ml) (P & 0·01). Portal serum (1 : 10) from oral tolerized rats suppressed IL-1 and TNF production by synoviocytes (P & 0·01), which was also antagonized by anti-TGF-β antibody (10 µg/ml) (P & 0·01). We conclude that oral administration of CII had prophylactic and therapeutic effects on AA and over-production of IL-1, TNF, NO and MDA by synoviocytes was suppressed. Bystander active suppression may be the main mechanism of oral CII in the suppression of synoviocyte function.
Publisher: SAGE Publications
Date: 2006
DOI: 10.1345/APH.1G208
Abstract: Osteoporosis is underdiagnosed, and rural communities often have limited technical resources for the assessment of osteoporosis. To evaluate the impact of a pharmacist, trained in the use of a portable heel ultrasound device, in screening elderly rural women for risk of osteoporosis and determine whether those found to be at risk seek further help and treatment from their general practitioner (GP) following screening. Following promotion of the service, 345 women were recruited from 6 rural community pharmacies in Tasmania, Australia, and underwent quantitative heel ultrasound screening. Women were comprehensively educated on risk factors for osteoporosis and completed a calcium intake questionnaire. Results were forwarded to each woman's GP, and the participants were followed up 3 months later to assess outcomes from the screening procedure. Approximately 20% of women were shown to be at high risk for osteoporosis 201 (58%) of these were referred to their GP for further assessment. Sixty-eight percent of women who were screened discussed their results with their GP, and 11% underwent further investigation. Over one-third of women screened began medication (30% calcium, 6% bisphosphonate, 6% vitamin D) for osteoporosis. Pharmacist-provided screening for osteoporosis in rural areas is a potentially useful method to identify women at risk for fracture and a convenient time point for discussion of preventive therapy.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2005
DOI: 10.1007/S00198-004-1733-Z
Abstract: There are limited data on vitamin D insufficiency in healthy children. The aim of this study was to describe the prevalence and determinants of vitamin D insufficiency and its association with bone turnover in adolescent boys (N = 136, mean age 16 years). Sun exposure and physical activity were assessed by questionnaire. Vitamin D stores were assessed by serum 25-hydroxyvitamin D3 (25[OH]D3). Bone turnover was assessed by bone-specific alkaline phosphatase (BAP) and urinary pyridinoline (PYR) to creatinine (Cr) ratio (mmol PYR/micromol Cr). The mean 25(OH)D3 level was low (44 nmol/l 68% < 50 nmol/l range, 16-87) and was associated with self-reported sun exposure on winter weekends (r = 0.23, p = 0.01), school holidays (r = 0.22, p = 0.01), and weekdays (r = 0.17, p = 0.05). It was also associated with number of sports (r = 0.34, p < 0.001) and vigorous activity (r = 0.22, p = 0.01) but not television, computer, and video watching (r = -0.04, p = 0.68). In multivariate analysis, number of sports but not total sun exposure remained significantly associated with 25(OH)D3. Furthermore, 25(OH)D3 was significantly associated with BAP in cutpoint analysis (cutpoint 55 nmol/l, p = 0.03) but not continuous analysis (r = -0.12, p = 0.16) and PYR in both forms (r = -0.23, p = 0.01, cutpoint 43 nmol/l, p = 0.01). In conclusion, vitamin D insufficiency is common in healthy adolescent boys in winter in our setting, is primarily derived from sports-related sun exposure, and is associated with bone turnover markers. These data suggest that a 25(OH)D3 level of at least 43-55 nmol/l is required for optimal bone health in children.
Publisher: Oxford University Press (OUP)
Date: 09-05-2016
Publisher: Springer Science and Business Media LLC
Date: 21-01-2004
DOI: 10.1007/S00198-003-1579-9
Abstract: The aim of this population based case-control study was to examine the association between risk-taking behaviour, motor coordination and upper limb fractures in children aged 9-16 years. A total of 321 fracture cases and 321 randomly selected in idually matched controls were studied. The number for different types of upper limb fractures was 91 for hand, 190 for wrist and forearm and 40 for upper arm. Risk-taking behaviour was determined by a 5-item interview-administered questionnaire. Motor coordination was assessed by the 8-point movement ABC that tests manual dexterity, ball skills as well as static and dynamic balance. Bone mass was assessed by dual energy X-ray absorptiometry (DXA) and metacarpal morphometry. In general, there was heterogeneity by fracture site with regard to associations. Risk-taking behaviour was associated with hand fracture risk but not other fracture sites for downhill cycling behaviour (OR: 2.0/category, 95% CI: 1.1-3.7), dare behaviour (OR: 3.3/category, 95% CI: 1.1-10.0) and total risk-taking score (OR: 2.6/category, 95% CI: 1.3-5.7). Conversely, coordination measures were associated with wrist and forearm fractures only: cutting/threading (OR: 1.2/unit, 95% CI: 1.0-1.4) flower trail (OR: 1.2/unit, 95% CI: 1.0-1.4) and dynamic balance score (OR: 1.1/unit, 95% CI: 1.0-1.2). Backward stepwise analysis selected total risk taking score for hand fracture, and dynamic balance score for wrist and forearm fracture. None of the risk-taking or coordination scores were associated with upper arm fractures. These associations were unchanged following adjustment for bone mass. In conclusion, the propensity to take risks is most strongly associated with hand fracture risk while dynamic balance is most strongly associated with wrist and forearm fracture risk in children. These results inform the development of fracture prevention strategies in children.
Publisher: BMJ
Date: 03-11-2015
Publisher: Springer Science and Business Media LLC
Date: 12-09-2020
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.JOCA.2012.08.026
Abstract: To describe the natural history of knee cartilage defects, and their relationship to cartilage volume loss and risk of knee replacement in a longitudinal study of older adults. 395 randomly selected older adults (mean age 62.7 years) had magnetic resonance imaging of their right knee at baseline and approximately 2.9 years later to determine cartilage defect grade (0-4), cartilage volume, medial and lateral tibial bone size, and presence of bone marrow lesions (BMLs). Height, weight, body mass index (BMI) and radiographic osteoarthritis were measured by standard protocols. At baseline higher grade cartilage defects (grade ≥2) were significantly associated with age, BMI, lateral tibial bone size, BMLs, and radiographic osteoarthritis. Over 2.9 years, the average defect score increased statistically significantly in all compartments however, the majority of defects remained stable and regression of defects was rare. Baseline factors associated with increase in defect score over 2.9 years were radiographic osteoarthritis, tibial bone size, BMI and being female. In multivariate analysis, baseline cartilage defect grade predicted cartilage volume loss at the medial tibia, lateral tibia and patella over 2.9 years (β = -1.78% to -1.27% per annum per 1 grade increase, P < 0.05 for all comparisons), and risk of knee replacement over 5 years (odds ratio (OR) = 1.73 per 1 grade increase, P = 0.001). Knee cartilage defects in older adults are common but less likely to regress than in younger life. They independently predict cartilage volume loss and risk of knee replacement, suggesting they are potential targets for intervention.
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.JOCA.2011.07.020
Abstract: Sex hormones and reproductive factors may be important for osteoarthritis (OA). The aim of this study was to describe the associations of parity, use of hormone replacement therapy (HRT) and oral contraceptives (OCs) with cartilage volume, cartilage defects and radiographic OA in a population-based s le of older women. Cross-sectional study of 489 women aged 50-80 years. Parity, use of HRT and OC was assessed by questionnaire knee cartilage volume and defects by magnetic resonance imaging and knee joint space narrowing (JSN) and osteophytes by X-ray. Parity was associated with a deficit in total knee cartilage volume [adjusted β=-0.69 ml, 95% confidence interval (CI) -1.34, -0.04]. Increasing parity was associated with decreasing cartilage volume in both the tibial compartment and total knee (both P trend <0.05). Parity was also associated with greater cartilage defects in the patella compartment [adjusted odds ratio (OR)=2.87, 95% CI=1.39, 5.93] but not other sites. There was a consistent but non-significant increase in knee JSN (OR=2.78, 95% CI=0.75, 10.31) and osteophytes (OR=1.69, 95% CI=0.59, 4.82) for parous women. Use of HRT and/or OC was not associated with cartilage volume, cartilage defects or radiographic change. Parity (but not use of HRT or OC) is independently associated with lower cartilage volume primarily in the tibial compartment and higher cartilage defects in the patella compartment in this population-based s le of older women.
Publisher: Elsevier BV
Date: 04-2015
Publisher: Wiley
Date: 22-11-2019
DOI: 10.1002/JCSM.12364
Publisher: Springer Science and Business Media LLC
Date: 30-07-2004
DOI: 10.1007/S00223-004-0274-Y
Abstract: Carbonated beverages have been reported to increase fracture risk in children but the mechanism is unclear. The aim of this population-based case-control study was to investigate the association between soft drink and milk consumption, physical activity, bone mass, and upper limb fractures in children aged 9-16 years. A total of 206 fracture cases and 206 randomly selected in idually matched controls were studied. There were 47 hand fractures 128 wrist and forearm fractures, and 31 upper arm fractures. An interviewer-administered questionnaire was utilized to retrospectively assess last-year physical activity (including television, computer, and video watching) and to recall the average weekly consumption of milk, colas, and total carbonated drinks. Bone mass at the spine, hip, and total body was assessed by dual-energy X-ray absorptiometry (DXA) and metacarpal morphometry. For total fractures, none of the above drink types was significantly different between cases and controls. For wrist and forearm fractures, there was a positive association between cola drink consumption and fracture risk (OR 1.39/unit, 95% CI: 1.01, 1.91). Cola consumption was significantly correlated with television, computer, and video watching (r = 0.20, P = 0.001) but not bone mineral density or milk drinks. After adjustment for television, computer, and video watching and bone mineral density, the association between cola drinks and fracture risk became nonsignificant (OR 1.31/unit, 95% CI: 0.94, 1.83). No association with other fracture sites was observed. In conclusion, cola, but not total carbonated beverage consumption, is associated with increased wrist and forearm fracture risk in children. However, this association is not independent of other factors and appears to be mediated by television watching and bone mineral density but not by decreased milk intake.
Publisher: Wiley
Date: 25-01-2012
DOI: 10.1002/ACR.20663
Abstract: To examine the relationship between obesity, body composition, and foot pain as assessed by the Manchester Foot Pain and Disability Index (MFPDI). Subjects 25-62 years of age (n = 136) were recruited as part of a study examining the relationship between obesity and musculoskeletal health. Foot pain was defined as current foot pain and pain in the last month, and an MFPDI score of ≥1. Body composition (tissue mass and fat distribution) was measured using dual x-ray absorptiometry. The body mass index (BMI) in this population was normally distributed around a mean of 32.1 kg/m(2). The prevalence of foot pain was 55.1%. There was a positive association between BMI and foot pain (odds ratio [OR] 1.11, 95% confidence interval [95% CI] 1.06-1.17). Foot pain was also positively associated with fat mass (OR 1.05, 95% CI 1.02-1.09) and fat mass index (FMI OR 1.16, 95% CI 1.06-1.28) when adjusted for age, sex, and skeletal muscle mass and age, sex, and fat-free mass index (FFMI), respectively. When examining fat distribution, positive associations were observed for android/total body fat ratio (OR 1.42, 95% CI 1.11-1.83) and android/gynoid fat ratio (OR 35.15, 95% CI 2.60-475.47), although gynoid/total body fat ratio was inversely related to foot pain (OR 0.83, 95% CI 0.73-0.93). Skeletal muscle mass and FFMI were not associated with foot pain when adjusted for fat mass or FMI, respectively. Increasing BMI, specifically android fat mass, is strongly associated with foot pain and disability. This may imply both biomechanical and metabolic mechanisms.
Publisher: Wiley
Date: 28-02-2016
DOI: 10.1002/ACR.22963
Abstract: Pain is common in older adults and typically involves multiple sites. Obesity is an important risk factor in the pathogenesis of pain and multisite pain (MSP). This study aimed to examine longitudinal associations between fat mass and MSP, and to explore the potential mechanisms of any associations. Data from a longitudinal population-based study of older adults (n = 1,099) were utilized with measurements at baseline and after 2.6 and 5.1 years. At each time point, presence/absence of pain at the neck, back, hands, shoulders, hips, knees, and feet was assessed by questionnaire. Fat mass was assessed by dual x-ray absorptiometry, and height and weight were measured. Participants were of mean age 63 years, mean body mass index (BMI) 27.9 kg/m Fat mass, FMI, and BMI are associated with MSP and pain at all lower-extremity sites and hand pain, independent of sociodemographic, physical activity, and psychological factors. This suggests that both loading and systemic inflammatory factors may have an important role in the pathogenesis of fat-related MSP.
Publisher: Wiley
Date: 28-12-2011
DOI: 10.1002/ACR.20545
Abstract: To examine the potential role of self-reported joint pain, stiffness, and dysfunction, and radiographic osteoarthritis (ROA), in sarcopenia progression and falls risk in older adults. Seven hundred nine older adults (50% women, mean ± SD age 62 ± 7 years) were examined at baseline and followup (mean ± SD 2.6 ± 0.4 years). ROA was assessed using the Altman atlas, and pain at 7 anatomic sites was self-reported. Dual x-ray absorptiometry assessed leg lean mass, dynamometry assessed knee extension and whole leg strength, leg muscle quality (LMQ) was calculated as whole leg strength relative to leg lean mass, and the Physiological Profile Assessment assessed falls risk. In women only, baseline knee pain predicted a greater decline in knee extension strength, whole leg strength, and LMQ, and a greater increase in falls risk. Severe knee pain, stiffness, and dysfunction predicted greater declines in knee extension strength and increases in falls risk (all P < 0.05). Hip pain also predicted a greater decline in knee extension strength (-1.53 kg 95% confidence interval [95% CI] -2.95, -0.11). No associations were observed between pain and sarcopenia indicators in men. Somewhat surprisingly, higher baseline total knee ROA score predicted a greater increase in mean leg lean mass (0.05 kg 95% CI 0.02, 0.08) in both sexes. A path analysis demonstrated that knee ROA may contribute to declines in LMQ in women, through increases in pain, stiffness, and dysfunction. Knee and hip pain may directly contribute to the progression of sarcopenia and increased falls risk in older women.
Publisher: Springer Science and Business Media LLC
Date: 02-02-2016
Publisher: Wiley
Date: 10-04-2017
DOI: 10.1002/ACR.22964
Abstract: Pain is common in the elderly. Knee pain may predict knee cartilage loss, but whether generalized pain is associated with knee cartilage loss is unclear. This study, therefore, aimed to determine whether pain at multiple sites predicts knee cartilage volume loss among community-dwelling older adults, and, if so, to explore potential mechanisms. Data from the prospective Tasmanian Older Adult Cohort study was utilized (n = 394, mean age 63 years, range 52-79 years). Experience of pain at multiple sites was assessed using a questionnaire at baseline. T1-weighted fat-saturated magnetic resonance imaging of the right knee was performed to assess the cartilage volume at baseline and after 2.6 years. Linear regression modeling was used with adjustment for potential confounders. The median number of painful sites was 3 (range 0-7). There was a dose-response relationship between the number of painful sites and knee cartilage volume loss in the lateral and total tibiofemoral compartments (lateral β = -0.28% per annum total β = -0.25% per annum, both P for trend < 0.05), but not in the medial compartment. These associations were stronger in participants without radiographic knee osteoarthritis (OA) (P < 0.05) and independent of age, sex, body mass index, physical activity, pain medication, and knee structural abnormalities. The number of painful sites independently predicts knee cartilage volume loss, especially in people without knee OA, suggesting that widespread pain may be an early marker of more rapid knee cartilage loss in those without radiographic knee OA. The underlying mechanism is unclear, but it is independent of anthropometrics, physical activity, and knee structural abnormalities.
Publisher: Wiley
Date: 09-2007
DOI: 10.1359/JBMR.070509
Abstract: This study reports on the association between DXA at age 8 and subsequent fractures in both male and female children. Bone densitometry at the total body and spine (but not hip) is a strong predictor of fracture (especially upper limb) during puberty. The aim of this study was to determine if prepubertal DXA can predict fracture risk during puberty. We studied 183 children who were followed for 8 yr (1460 person-years). Bone densitometry was measured at the total body, hip, and spine by DXA and reported as BMC, BMD, and bone mineral apparent density (BMAD). Fractures were self-reported at age 16 with X-ray confirmation, There were a total of 63 fractures (43 upper limb). In unadjusted analysis, only total body BMD showed an inverse relationship with upper limb fracture risk (p = 0.03). However, after adjustment for height, weight, age (all at age 8), and sex, total body BMC (HR/SD, 2.47 95% CI, 1.52-4.02), spine BMC (HR/SD, 1.97: 95% CI, 1.30-2.98), total body BMD (HR/SD, 1.67 95% CI, 1.18-2.36), total body BMAD (HR/SD, 1.54 95% CI, 1.01-2.37), and spine BMD (HR/SD, 1.53 95% CI, 1.10, 2.22) were all significantly associated with upper limb fracture risk. Similar, but weaker associations were present for total fractures. There was a trend for overweight/obesity to be associated with increased upper limb fracture risk (HR, 1.53/category p = 0.08). Measurement of bone mass by DXA is a good predictor of upper limb fracture risk during puberty. Although we did not measure true BMD, the constancy of fracture prediction after a single measure suggests bone strength remains relatively constant during puberty despite the large changes in bone size.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 2012
DOI: 10.1002/EBCH.1822
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 2010
DOI: 10.1186/AR3022
Publisher: Elsevier BV
Date: 05-2009
Publisher: Wiley
Date: 11-2000
DOI: 10.1002/1529-0131(200011)43:11<2543::AID-ANR23>3.0.CO;2-K
Publisher: Elsevier BV
Date: 10-2001
Publisher: BMJ
Date: 06-2020
DOI: 10.1136/ANNRHEUMDIS-2020-EULAR.5461
Abstract: Evidence suggests that periarticular muscles have a role in the pathogenesis of pain, but results have not been consistent. We recently reported that pain population is heterogenous and consists of different subgroups of which the causes and mechanisms differ. To examine the association of muscle mass, leg strength, knee extensor strength, low-limb muscle quality with knee pain trajectories. Data on 975 participants from a population-based older adult cohort study were utilised. Dual-energy X-ray absorptiometry was used to assess muscle/fat mass. Leg strength in both legs and dominant knee extensor strength were measured. Low-limb muscle quality was calculated (i.e. leg strength ided by lower-limb muscle mass). The Western Ontario and McMaster Universities Osteoarthritis Index pain questionnaire was used to measure knee pain at each time-point. Radiographic knee osteoarthritis (ROA) was assessed by X-ray. Group-based trajectory modelling was applied to identify pain trajectories. Multi-nominal logistic regression was used for the analyses. A total of 975 participants [Mean±SD: age 62.2±7.4 years, body mass index (BMI) 27.8±4.6 kg/m 2 and 51% of females] were included in the analysis. Three distinct pain trajectories were identified: ‘Minimal pain’ (53%), ‘Mild pain’ (34%) and ‘Moderate pain’ (13%). In multivariable analysis, both greater total and low-limb muscle mass were associated with an increased risk of ‘Mild pain’ [total muscle mass: relative risk (RR): 1.51 per SD increase, 95%CI: 1.14−1.98 low-limb muscle mass RR: 1.33 per SD increase, 95%CI: 1.07−1.66] and ‘Moderate pain’ [total muscle mass: RR: 2.57 per SD increase, 95%CI: 1.70−3.89) low-limb muscle mass RR: 2.03 per SD increase, 95%CI: 1.47−3.80)] compared to the ‘Minimal pain’ trajectory group. After further adjustment for fat mass, these associations disappeared. Total muscle mass percentage was associated with a reduced risk of being worse pain trajectories. In relative to the ‘Minimal pain’ trajectory group, leg strength, knee extensor strength and quality were associated with a reduced risk of being in more severe pain trajectories after adjustment for covariates (RR=0.56 to 0.71 per SD increase, all P .05). Similar results were observed in those with ROA. Muscle percentage, strength and quality, but not muscle mass itself are associated with a reduced risk of being more severe pain trajectories, suggesting that improving muscle composition, muscle function and power are of more clinically relevance to preventing the development and maintenance of worse pain trajectories. None declared
Publisher: BMJ
Date: 06-2014
Publisher: Springer Science and Business Media LLC
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 2012
Publisher: Wiley
Date: 02-2016
DOI: 10.1111/IMJ.12763
Abstract: Osteoarthritis is the leading musculoskeletal cause of disability in the Western society. Despite this, it is still difficult to gain a precise definition of what osteoarthritis actually is. The methods used for the study are narrative review and viewpoint focussing on the knee. It is well known that there is a modest correlation between X-ray changes and pain. Improvements in imaging have shown that osteoarthritis should be regarded as an umbrella term for a number of pathophysiological processes leading to pain and/or cartilage loss. If these are inside the joint (such as bone marrow lesions, cartilage defects or meniscal tear) then they can be considered osteoarthritis, while those outside the joint (such as obesity, weak muscles and vitamin D deficiency) could be considered the osteoarthritis syndrome. These improvements in basic science are leading to lesion-specific therapies indicating the importance of trying to pinpoint causes of pain in the in idual.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 04-2020
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 04-2013
Publisher: BMJ
Date: 12-05-2012
DOI: 10.1136/ANNRHEUMDIS-2011-201047
Abstract: To determine the association between inflammatory markers and change in knee pain over 5 years. A total of 149 randomly selected subjects (mean 63 years, range 52-78 46% female) was studied. Serum levels of high sensitivity C-reactive protein (hs-CRP), tumour necrosis factor alpha (TNF-α) and interleukin (IL)-6 were measured at baseline and 2.7 years later. Knee pain was recorded using the Western Ontario and McMasters osteoarthritis index questionnaire at baseline and 5 years later. Knee radiographic osteoarthritis of both knees was assessed at baseline, and knee bone marrow lesions, joint effusion and cartilage defects were determined using T1 or T2-weighted fat saturated MRI. After adjustment for confounding variables, baseline hs-CRP was positively associated with change in total knee pain (β=0.33 per mg/l, p=0.032), as well as change in the pain at night in bed (β=0.12 per ml g, p=0.010) and while sitting/lying (β=0.12 per ml g, p=0.002). Change in hs-CRP was also associated with change in knee pain at night and when sitting/lying (both p<0.05). Baseline TNFα and IL-6 were associated with change in pain while standing (β=0.06 per ml g, p=0.033 β=0.16 per ml g, p=0.035, respectively), and change in TNFα was positively associated with change in total knee pain (β=0.66 ml g, p=0.020) and change in pain while standing (β=0.26 ml g, p=0.002). Adjustment for radiographic osteoarthritis or MRI-detected structural abnormalities led to no or minor attenuation of these associations. Systemic inflammation is an independent predictor of worsening knee pain over 5 years.
Publisher: Wiley
Date: 04-08-2017
DOI: 10.1002/ART.40159
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.SEMARTHRIT.2015.10.006
Abstract: The aim of this study was to describe the longitudinal relationship between adiposity and change in knee pain. A total of 1099 participants aged 50-79 were randomly selected from the local community in Southern Tasmania, of which 767 were followed up on average 5.1 years later. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at each time point. Consistent knee pain was defined as knee pain at all three time-points. The five pain subscales were grouped into weight-bearing pain and non-weight-bearing pain according to the nature of pain. Body fat and lean mass were assessed using dual energy x-ray absorptiometry (DXA). Baseline body mass index (BMI) and body fat mass were deleteriously associated with consistent knee pain over follow-up. BMI was consistently associated with increases in weight-bearing and non-weight-bearing pain. Fat mass was associated with an increase in non-weight-bearing pain. In mixed-model analyses, WOMAC total pain score was associated with BMI (β = 1.27) and body fat mass (β = 1.17). The association of lean mass was not significant after adjustment for fat mass. BMI is the most consistent correlate of knee pain in older adults. Fat mass is associated with non-weight-bearing knee pain suggesting systemic mechanisms are involved.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2013
DOI: 10.1007/S10067-013-2394-0
Abstract: The objective of this study was to describe the cross-sectional and longitudinal relationship between hip bone marrow lesions (BMLs), high cartilage signal, and hip and knee pain. One hundred ninety-eight participants in the Tasmanian Older Adult Cohort Study with right hip MRI conducted at two time points, approx. 2.3 years apart, were included. Short T1 Inversion Recovery MR images were used to quantitatively measure hip BML size and determine high cartilage signal presence. Hip and knee pain were in idually assessed using the Western Ontario and McMaster Universities Osteoarthritis index pain score. Fifty-five participants (28%) had either femoral and/or acetabular BMLs. Cross-sectionally, the presence of large femoral, acetabular, or any hip BMLs was associated with higher odds of hip pain (OR = 4.42, 95% CI = 1.37-19.7 OR = 5.23, 95% CI = 1.17-22.9 OR = 4.43, 95% CI = 1.46-13.2, respectively). High cartilage signal was strongly associated with hip BMLs (OR = 6.45, 95% CI = 3.37-12.6), but not with pain. Longitudinally, incident acetabular (Mean diff = +5.90, 95% CI = +3.78 to +8.15) and femoral BMLs (Mean diff = +1.18, 95% CI = 0.23-1.94) were associated with worsening hip pain, while resolving femoral BMLs were associated with a decrease in knee pain (Mean diff = -3.18, 95% CI = -5.99 to -0.50). The evidence is consistent for hip, but not knee pain, and strongly suggests that large hip BMLs are associated with hip pain. Furthermore, high cartilage signal is asymptomatic, but strongly associated with hip BMLs. These findings suggest that hip BMLs play an important role in hip osteoarthritis.
Publisher: Elsevier BV
Date: 04-2016
Publisher: Wiley
Date: 27-12-2012
DOI: 10.1002/ACR.21745
Abstract: To examine the longitudinal association between significant weight change and change in knee symptoms (pain, stiffness, and function), and to determine whether the effects differ in those who are obese and those with osteoarthritis (OA). Two hundred fifty subjects ranging from normal weight to obese (body mass index range 16.9-59.1 kg/m(2) ) and no significant musculoskeletal disease were recruited from the general community and weight loss clinics and organizations. Seventy-eight percent were followed at ~2 years. Weight, height, and knee symptoms (using the Western Ontario and McMaster Universities Osteoarthritis Index) were assessed at baseline and followup. Any weight loss methods were recorded. Thirty percent of subjects lost ≥5% of baseline weight, 56% of subjects' weight remained stable (loss or gain of <5% of baseline weight), and 14% of subjects gained ≥5% of baseline weight. Using estimated marginal means, weight gain was associated with worsening pain (mean 27.1 mm 95% confidence interval [95% CI] -1.1, 55.2), stiffness (mean 18.4 mm 95% CI 1.5, 35.3), and function (mean 99.3 mm 95% CI 4.0, 194.6) compared to stable weight. Weight loss was associated with reduced pain (mean -22.4 mm 95% CI -44.4, -0.3), stiffness (mean -15.3 mm 95% CI -28.50, -2.0), and function (mean -73.2 mm 95% CI -147.9, 1.3) compared to stable weight. Weight gain was associated with adverse effects on knee symptoms, particularly in those who are obese and who have OA. Although losing weight is potentially beneficial for symptom improvement, the effects were more modest. Avoiding weight gain is important in managing knee symptoms.
Publisher: Wiley
Date: 06-09-2016
DOI: 10.1002/ACR.22834
Abstract: To describe associations between serum high-sensitivity C-reactive protein (hsCRP), knee bone marrow lesions (BMLs), and knee pain, cross-sectionally and longitudinally, in patients with knee osteoarthritis (OA). Patients (n = 192) with symptomatic knee OA (mean age 63 years, range 50-79, women 53%) were assessed at baseline and after 24 months. Serum hsCRP was measured using enzyme-linked immunosorbent assay. Knee BMLs were scored using the modified Whole-Organ Magnetic Resonance Imaging (MRI) Score from T2-weighted fat-supressed fast spin-echo MRI. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Quartiles of baseline serum hsCRP were associated with the presence of knee BMLs (prevalence ratio 1.07 per quartile [95% confidence interval (95% CI) 1.00, 1.15]) and total knee pain scores (β 13.66 per quartile [95% CI 2.26, 25.07]) in multivariable analyses. Longitudinally, higher baseline hsCRP was associated with an increase in BML score (risk ratio 1.37 per quartile [95% CI 1.10, 1.70]), and change in hsCRP was positively associated with change in BML score (β 0.19 [95% CI 0.05, 0.34]) in adjusted analyses. Baseline hsCRP was not associated with change in total knee pain, but change in hsCRP was positively and significantly associated with change in total knee pain (β 4.71 [95% CI 0.48, 8.94]). This became nonsignificant after adjustment for changes in BML score. In patients with knee OA, serum hsCRP is associated with knee BML scores and, to a lesser extent, pain both cross-sectionally and longitudinally, suggesting that inflammation is linked with BMLs and their associated pain.
Publisher: Wiley
Date: 24-03-2016
DOI: 10.1002/ACR.22715
Abstract: To describe the associations between body composition and hormonal and inflammatory factors measured 5 years prior and tibial cartilage volume in young adults, and to explore if these factors contribute to the sex difference in tibial cartilage volume. Subjects broadly representative of the young adult Australian population (n = 328, ages 31-41 years, 47.3% women) were selected. They underwent T1-weighted fat-suppressed magnetic resonance imaging (MRI) of their knees. Tibial cartilage volume was measured from MRI. Sex hormone binding globulin (SHBG) and testosterone in a subset of women and C-reactive protein (CRP) level and fibrinogen in both sexes were measured 5 years prior. Body mass index (BMI), fat mass, and lean mass were calculated from height, weight, and skinfolds. In multivariable analyses, correlates of tibial cartilage volume included lean body mass (β = 26.4 mm(3) 95% confidence interval [95% CI] 13.6, 39.1), fat mass (β = -11.8 mm(3) 95% CI -22.2, -1.4), and fibrinogen (β = -146.4 mm(3) 95% CI -276.4, -16.4), but not BMI, testosterone, or CRP level. In women, SHBG was positively associated with tibial cartilage volume (β = 0.67 mm(3) 95% CI 0.14, 1.20) and Free Androgen Index was negatively associated with lateral tibial cartilage volume (β = -0.04 mm(3) 95% CI -0.07, 0.00). Men had 13% more tibial cartilage volume (500 mm(3) ) than women. The magnitude of this association decreased by 38%, 20%, and 37% after adjustment for lean body mass, fat mass, and fibrinogen, respectively. Body composition, sex hormones, and fibrinogen correlate with knee cartilage volume in young adult life. Sex difference in knee cartilage volume is contributed largely by variations in body composition and/or fibrinogen.
Publisher: Wiley
Date: 05-2017
DOI: 10.1111/IMJ.5_13463
Publisher: Springer-Verlag
Publisher: Springer Science and Business Media LLC
Date: 16-09-2017
DOI: 10.1007/S10067-017-3838-8
Abstract: The objective of this study was to investigate the associations of knee structural abnormalities with different patterns of pain. A total of 891 participants (average age 63 years range 50 to 80 years) participated in this study. Presence of pain at the neck, back, hands, shoulders, hips, knees, and feet was assessed by questionnaire. Participants were categorized as having no pain at any site (no pain), pain only at the knee (KP), pain at other sites but not the knee (OP), and pain at the knee and other sites (KOP). T1-weighted or T2-weighted MRI of the right knee was performed to measure cartilage defects, bone marrow lesions (BMLs), and effusion-synovitis. Osteophytes and joint space narrowing were assessed by X-ray. KP, KOP, and OP were, respectively, present in 3, 43, and 42% of the participants. In multivariable analyses, KOP was associated with the presence of cartilage defects, BMLs, and osteophytes (OR 3.57 (95% CI 1.78 to 7.14), 2.37 (1.27 to 4.43), and 2.87 (1.10 to 7.51), respectively) in those with radiographic knee OA. KP was also associated with presence of these structural abnormalities as well as effusion-synovitis, and these associations were much stronger. The associations between structural abnormalities and KOP were weaker than those with KP in those with radiographic knee OA. This suggests that mechanisms mediating the association between structural pathology, localized, and generalized pain may be different, and central sensitization is possibly involved in generalized pain. Pain at other sites needs to be considered in the management and treatment of OA-related pain.
Publisher: SAGE Publications
Date: 2010
DOI: 10.4137/CMAMD.S4864
Abstract: Recent years have seen many exciting developments in the treatment of rheumatoid arthritis. Tocilizumab (TCZ) is a monoclonal antibody which inhibits the interleukin-6 receptor. After initial studies in Japan, it has been extensively studied in five multicentre clinical trials. This report summarises the key efficacy and toxicity findings from the major clinical trials. TCZ works quickly and effectively in rheumatoid arthritis either as monotherapy or in combination with other agents in early disease, DMARD inadequate responders, seronegative disease and after anti-TNF failure. The toxicity profile is manageable but includes infections (most notably skin and soft tissue), increases in serum cholesterol, transient decreases in neutrophil count and abnormal liver function tests (especially in combination with methotrexate). In summary, there is sufficient evidence to make TCZ a first line biologic therapy for rheumatoid arthritis especially for those who are unable to take methotrexate or who fail anti-TNF therapy.
Publisher: BMJ
Date: 02-1998
DOI: 10.1136/ARD.57.2.94
Abstract: To describe the relation between spinal degenerative disease, allelic variation in the vitamin D receptor gene, and lifestyle factors in a population-based association study. Random population-based s le of 110 men and 172 women over 60 years of age participating in the Dubbo Osteoporosis Epidemiology Study who had spinal radiographs (performed according to a standardised approach), assessment of lifestyle factors, bone densitometry as well as blood taken for genotyping. Spinal degenerative disease of varying severity was common in this s le. Multivariate analysis of genetic and lifestyle factors simultaneously strengthened the statistical significance of each indicating the presence of additive gene environment interaction. Allelic variation in the vitamin D receptor gene was associated with severity of osteophytosis (adjusted OR "TT" v "tt" 0.41, 95% CI 0.17, 0.97), presence of disc narrowing (adjusted OR "TT" v "tt" 0.45, 95% CI 0.20, 0.99) and weakly with presence of osteophytosis (adjusted OR "TT" v "tt" 0.47, 95% CI 0.19, 1.16) but not with severity of disc narrowing (OR "TT" v "tt" 1.05, 95% CI 0.40, 2.72) or apophyseal arthritis (OR "TT" v "tt" 0.63, 95% CI 0.24, 1.59). Adjustment for femoral neck bone density did not change these findings suggesting that the association is not mediated through bone density. Presence and severity of spinal degenerative disease increased with age at all sites. Current smoking increased both the presence (adjusted OR 9.70, 95% CI 2.08, 45.1) and severity (adjusted OR 2.91, 95% CI 1.16, 9.03) of spinal osteophytosis with intermediate values for past smokers. Severity of osteophytosis was also independently associated with body mass index and quadriceps strength consistent with a contributory effect of physical loading. In this elderly s le, both genetic and lifestyle factors were associated with the presence and severity of spinal degenerative disease. There were site specific differences in associations at the spine, which may be because of misclassification of disease status or may indicate possible environmental and genetic differences in the pathophysiology of spinal degenerative disease. Further studies are required to confirm these findings in different population s les and to further explore potential aetiological mechanisms particularly gene environment interaction.
Publisher: Springer Science and Business Media LLC
Date: 30-03-2006
DOI: 10.1007/S10067-006-0248-8
Abstract: The aim of this study was to describe clinical, structural and biochemical factors associated with knee pain in younger subjects. A cross-sectional convenience s le of 371 male and female subjects (mean age, 45 years, range 26-61) was studied. Knee pain was assessed by questionnaire. Chondral defects, cartilage volume, and bone area of the right knee were determined using T1-weighted fat saturation magnetic resonance imaging (MRI). X-ray was performed on the same knee for the assessment of radiographic features of osteoarthritis. The urinary C-terminal cross-linking telopeptide of type II collagen (CTX-II) was measured by enzyme-linked immunosorbent assay (ELISA). Height and weight were measured by standard protocols and body mass index (BMI) was calculated. The prevalence of knee pain was 35% in this s le. Chondral defect scores (particularly femoral and patellar but not tibial) were significantly associated with knee pain in a dose-response fashion (all p<0.01). Cartilage volume and bone area were not associated with knee pain in multivariate analysis in this s le. Urinary CTX-II was higher in subjects with knee pain (p=0.04), but this became nonsignificant after adjustment for BMI and osteophytes (both of which were significant) suggesting potential mechanisms of effect. In conclusion, knee pain is significantly associated with non-full thickness chondral defects (particularly femoral and patellar), osteophytes, CTX-II, and obesity but not other factors. MRI and biochemical measures can add to radiographs in defining unexplained knee pain in younger subjects.
Publisher: Elsevier BV
Date: 05-2009
Publisher: Wiley
Date: 28-09-2018
Publisher: Wiley
Date: 20-08-2009
DOI: 10.1111/J.1399-3038.2008.00817.X
Abstract: Studies on early life viral respiratory infection and subsequent atopic disease in childhood have conflicting findings. Animal models show that viral respiratory infection in conjunction with allergen presentation can enhance sensitization. This prospective study assesses the influence of an upper respiratory tract infection (URI) in the first month of life and the season of birth on the development of hay fever and ryegrass allergen sensitization in childhood. From a Tasmanian cohort born during 1988 and 1989, a group of 498 children were followed up at 8 yr and another different group of 415 children were followed up at 16 yr. The ryegrass pollen season in Tasmania occurs in November and December. Forty-four (9.6%) children in Follow-up s le 1 and 47 (12.5%) children in Follow-up s le 2 were born in the pollen season. The parental report of an early upper respiratory tract infection (EURI) was documented prospectively by a home interview at 1 month of age (median age 5.1 wk). Sensitization to ryegrass and house dust mite (HDM) was determined at 8 yr of age by skin prick testing and at 16 yr by ImmunoCap. Ryegrass sensitized hay fever was defined as a positive response to a question on hay fever plus the presence of ryegrass allergy. For children tested at age 8 and born in the pollen season, a EURI by postnatal interview was associated with an increased risk of ryegrass sensitization (OR 5.80 95% CI 1.07, 31.31) but not for children with a EURI born outside the pollen season (OR 0.62 95% CI 0.35, 1.08). Similarly, EURI was significantly associated with early onset (< or = 8 yr) ryegrass sensitized hay fever for children born in the pollen season (AOR 4.78 95% CI 1.17, 19.47) but was not associated with early onset ryegrass sensitized hay fever for children born outside the pollen season (AOR 0.76 95% CI 0.43, 1.33). These findings suggest that early life viral URI interacts with ryegrass allergen exposure in the development of ryegrass allergen sensitization and ryegrass sensitized hay fever symptoms.
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