Medical problems and risk factors of metabolic syndrome among radiographic knee osteoarthritis patients in the Japanese general population

doi:10.1007/s00776-011-0157-9

Journal of Orthopaedic Science

Volume 16, Issue 6, November 2011, Pages 704-709

https://doi.org/10.1007/s00776-011-0157-9 Get rights and content

Abstract

Background

The objectives of this study were to investigate the prevalence rate of metabolic syndrome (MetS) among knee osteoarthritis (OA) patients in the Japanese general population, and to analyze the relationship between MetS and knee OA.

Methods

A total of 795 volunteers participated in this study. Based on the Kellgren–Lawrence (K–L) grade, participants were classified into two groups: the non-knee OA (non-KOA) group (K–L grade 0 or 1) or knee OA (KOA) group (grade 2–4). MetS was defined according to the Japanese Committee for the Diagnostic Criteria of MetS with a slight modification. The presence of hyperlipidemia, hypertension, diabetes mellitus and MetS were compared between the non-KOA and KOA groups. Furthermore, risk factors for MetS were analyzed by logistic regression analysis.

Results

The prevalence rate of hypertension in the KOA group was significantly higher than in the non-KOA group (P = 0.025) in males. Those of hypertension (P < 0.001), hyperlipidemia (P < 0.001) and diabetes mellitus (P = 0.019) in the KOA group were significantly higher than in the non-KOA group in females. Aging was significantly associated with MetS in males; the odds ratio (OR) for age was 1.033 (P = 0.020), suggesting that a 1-year increase in age raised the risk of MetS. In females, the presence of KOA was significantly associated with MetS; the risk of MetS in the KOA group was 2.196 (P = 0.034) fold the risk in the non-KOA group.

Conclusion

The prevalence rates of MetS and knee OA tended to increase with age in males; however, there was no association between MetS and knee OA. On the other hand, knee OA was significantly associated with MetS in females. Knee OA patients must be provided the best treatment approach because of their high risk for MetS, which promotes cardiovascular diseases.

References (26)

M. Sowers et al.
C-reactive protein as a biomarker of emergent osteoarthritis
Osteoarthr Cartil.
(2002)
A. Galassi et al.
Metabolic syndrome and risk of cardiovascular disease: a meta-analysis
Am J Med.
(2006)
R. Gandhi et al.
Asian ethnicity and the prevalence of metabolic syndrome in the osteoarthritic total knee arthroplasty population
J Arthroplasty.
(2010)
Q. Lu et al.
Visceral fat, arterial stiffness, and endothelial function in peritoneal dialysis patients
J Ren Nutr.
(2008)
A. Sudo et al.
Prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women
J Orthop Sci.
(2008)
S. Muraki et al.
Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: the ROAD study
Osteoarthr Cartil.
(2009)
K. Nakamura
Locomotive syndrome: disability-free life expectancy and locomotive organ health in a “super-aged” society
J Orthop Sci.
(2009)
Y. Kadono et al.
Statistics for orthopedic surgery 2006–2007: data from the Japanese Diagnosis Procedure Combination database
J Orthop Sci.
(2010)
D.J. Hart et al.
Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study
Arthritis Rheum.
(1999)
C. Cooper et al.
Occupational activity and osteoarthritis of the knee
Ann Rheum Dis.
(1994)

H. Roos et al.

Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls

Arthritis Rheum.

(1998)

S.H. Elder et al.

Effect of compressive loading on chondrocyte differentiation in agarose cultures of chick limb-bud cells

J Orthop Res.

(2000)

D.J. Hart et al.

The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study

J Rheumatol.

(1993)

Cited by (34)

Relationship between lumbar facet joint osteoarthritis and comorbidities: A cross-sectional study in the Japanese community
2023, Journal of Orthopaedic Science
Few epidemiological studies have evaluated associations between lumbar facet joint (LFJ) osteoarthritis (OA) and comorbidities. This study aimed to investigate the prevalence of LFJ OA in a Japanese community population and associations between LFJ OA and underlying diseases, including lower extremity OA.
This epidemiological cross-sectional study evaluated LFJ OA in 225 Japanese community residents (81 males, 144 females; median age, 66 years) using magnetic resonance imaging (MRI). LFJ OA from L1–L2 to L5–S1 was evaluated using a 4-grade classification. Associations between LFJ OA and comorbidities were examined using multiple logistic regression analyses adjusting for age, sex, and body mass index.
Prevalences of LFJ OA were 28.6% at L1–L2, 36.4% at L2–L3, 48.0% at L3–L4, 57.3% at L4–L5, and 44.2% at L5–S1. Males were significantly more likely to have LFJ OA at several spinal levels (L1–L2 45.7% vs 18.9%, p < 0.001; L2–L3 46.9% vs 30.6%, p < 0.05; L4–L5 67.9% vs 51.4%, p < 0.05). LFJ OA was present in 50.0% of residents <50 years old, 68.4% at 50–59 years old, 86.3% at 60–69 years old, and 85.1% at ≥70 years old. Multiple logistic regression analysis showed no associations between LFJ OA and comorbidities.
The prevalence of LFJ OA as evaluated by MRI was >85% at ≥60 years old and highest at the L4–L5 spinal level. Males were significantly more likely to have LFJ OA at several spinal levels. Comorbidities were not associated with LFJ OA.
Association between hypertension and osteoarthritis: A systematic review and meta-analysis of observational studies
2022, Journal of Orthopaedic Translation
Literature examining the relationship between elevated blood pressure and osteoarthritis (OA) has yielded conflicting results. This study aimed to systematically review the relationship between hypertension and OA in both load-bearing and non-load-bearing joints.
A systematic literature search was performed on Embase, Emcare, MEDLINE and Ovid Nursing Database. The associations between hypertension and OA development in knees, hips and hands were analysed by calculating the odds ratio (OR).
A total of 26 studies with 97,960 participants were included. The overall odds of having OA significantly increased in the people with hypertension compared to the normotensive ones (OR = 1.60, 95%CI = 1.33, 1.94). The association of hypertension with OA was detected in knee (OR = 1.62, 95%CI = 1.32, 1.98), not in hand (OR = 1.19, 95%CI = 0.92, 1.53). Moreover, there existed a stronger association of hypertension with radiographic knee OA (OR = 1.89, 95%CI = 1.40, 2.54) than symptomatic knee OA (OR = 1.39, 95%CI = 1.17, 1.65). The association between hypertension and radiographic knee OA remained statistically significant for the studies that adjusted for body mass index (BMI) (OR = 1.42, 95%CI = 1.13, 1.78), and was particularly strong in women (OR = 2.27, 95%CI = 1.17, 4.39).
A BMI-independent association between hypertension and radiographic knee OA existed with potential sex variation, which warrants further investigations into the underlying genetic, hormonal and environmental factors.
The translational potential of this article: Blood pressure has been reported to link with OA for years ago, however, its contribution to OA is still unclear and conflicted in different reports. This review indicated an intimate relationship between hypertension and structural damages of knee OA, rather than simply chronic joint pain, especially in women. This finding not only provides stronger support for further investigations into the causal risk factor, i.e. hypertension, of OA from tissue level to molecular level, but also putting forward a novel thinking in OA pathogenesis and its therapy strategies.
This study further strengthen the association between hypertension and radiographic knee OA. It points in a vascular aetiology hypothesis of OA. It might open up a new avenue for repositioning anti-hypertensive medications for osteoarthritis treatment.
Clinical and radiological features of lumbar degenerative spondylolisthesis who complicates osteoarthritis of the knee
2020, Journal of Orthopaedic Science
Citation Excerpt :
Moreover, from the fact that double adjacent level spondylolisthesis were significantly prominent in patients with DS who complicate KOA, further mismatches in lumbo-pelvic sagittal alignment might have served as a risk factor of developing KOA, while previous reports indicate that significantly greater PI, SS; LL and PI–LL were observed in double adjacent level spondylolisthesis compared with single level spondylolisthesis [24,25]. Risk factors of development of KOA in adults are well known mainly as obesity, older age, female gender, previous knee trauma and high prevalence rate of metabolic syndrome [26–29]. Clinical features of DS patients complicating KOA revealed by this study also disclosed significantly higher prevalence rate of circulatory system disorders as well as older age and high BMI, compared with those without KOA, which has been frequently pointed out as an important risk factor of KOA until now [28,29].
Correlation between lumbar degenerative disease and degenerative disorders of the knee joint have often been reported, however, detailed research concerning lumbar degenerative spondylolisthesis (DS) who complicates osteoarthritis of the knee (KOA) are scarce.
A total of 184 consecutive surgically treated DS patients were identified, and divided into two groups: DS patients who complicate KOA (KOA group) and DS patients without KOA (non-KOA group). DS was defined as grade 1 or more, according to Meyerding's classification, and KOA was defined as grade 3 or more according to Kellgren–Lawrence classification. Clinical and the radiological differences of DS patients between KOA group and non-KOA group were investigated in order to clarify the features of DS patients who complicate KOA. Statistical significance using student's t-test and multivariate logistic regression analysis was performed to identify independent predictors of complicating KOA in DS.
KOA group and non-KOA group consisted of 57 and 127 patients, respectively, with both group predominantly of female patients. Clinical features of KOA group were significantly high in age and body mass index (BMI), and more likely to complicate circulatory system disorders than non-KOA group. Radiological features of KOA group were significantly high in frequency of double adjacent level spondylolisthesis, Pelvic incidence (PI), Pelvic tilt (PT), and PI–LL. Multivariate logistic regression analysis identified coexistence of circulatory system disorders (OR 2.251, p = 0.024) and PI–LL (OR 1.04, p < 0.001) to be an independent predictors of complicating KOA in DS patients.
Older age and overweighted female patients coexistence of circulatory system disorders, containing double adjacent level spondylolisthesis with high PI, PT, and PI–LL were the characteristics of DS patients who complicate KOA, particularly coexistence of circulatory system disorders and significantly high lumbo-pelvic sagittal mismatch were the most significant factors above all.
Evaluation of the association between locomotive syndrome and metabolic syndrome
2018, Journal of Orthopaedic Science
Citation Excerpt :
The JOA developed the Locomotive Syndrome Risk Test in 2013 and announced its clinical criteria in 2015. Although some reports [6–9] have suggested that LS may be related to MetS, few reports have evaluated the relationship between MetS and LS. The Annual Health, Labor and Welfare Report in Japan 2008–2009 recommends physical exercise as part of specific health guidance to prevent or improve MetS.
Locomotive syndrome (LS) includes disorders of the musculoskeletal system and is a high-risk condition that requires nursing care. We included an examination of locomotive function in specific health checkups to investigate the relationship between LS risk and the muscle strengths. The purpose of this study was to determine the distribution of LS and the relationship between LS and metabolic syndrome (MetS).
Among 2695 participants who undertook a specific health checkup, 790 received a locomotive examination (302 men and 488 women; mean age, 65.9 years). Data for MetS components were measured in the specific health checkup. Data about the locomotive examination were obtained from five tests: the two-step test, stand-up test, 25-question Geriatric Locomotive Function Scale, and measurement of lower limb muscular strength and grip strength.
The MetS components did not differ according to LS risk level in men. In women, body weight, body mass index, and abdominal circumference were significantly lower in the non-LS group than in the LS risk level 1 or 2 groups. The ratio of lower limb muscular strength to body weight differed significantly between all risk groups in men and women. In women, lower limb muscular strength was significantly higher in those at risk of both LS and MetS (double-risk group) than in the LS-only group. In women, the ratio of lower limb muscular strength to body weight was significantly lower in the double-risk group than in the LS-only group.
Adding a locomotive examination to the specific health checkup may be useful for identifying people at risk of LS or MetS. The prevalence rates of LS and MetS correlate positively in women. The ratio of lower limb muscular strength to body weight might be a better index of locomotor dysfunction than lower limb muscular strength alone.
Is abnormal glucose tolerance or diabetes a risk factor for knee, hip, or hand osteoarthritis? A systematic review
2018, Seminars in Arthritis and Rheumatism
Citation Excerpt :
Yoshimura et al. [30] showed a significant association in unadjusted analysis, but after adjustment for age and gender the relation became insignificant. Three studies showed significant associations in females but not males in unadjusted analysis [22,28,30]. Hart et al. [20] demonstrated a significant association between participants in the highest tertile of FBG and OA in females after adjustment for age and BMI (odds ratio 1.95, 95% CI: 1.08–3.59).
Diabetes (DM) and osteoarthritis (OA) are two common co-existing chronic conditions. However, whether this is due to shared risk factors or may differ between joints is unclear. We performed a systematic review to determine whether abnormal glucose metabolism is a risk factor for knee, hip and hand OA, separately, independent of age and obesity.
A systematic search of Ovid Medline and EMBASE was performed from inception until October 2016 to identify studies relating glucose metabolism to osteoarthritis-related outcomes. Studies were included if they related DM and OA and the knee, hip, or hand were examined separately. In the structured synthesis, objective measures of DM and adjustment for age and obesity were also required.
Of the 40 included studies, 28 examined the knee, nine the hip and 14 the hand. Five studies with a longitudinal component used objective measures of DM (blood glucose) and knee OA (radiography or joint replacement) and adjusted for age and obesity (21,299 participants). Of these, three found no association, one found a reduction in risk and one, which adjusted for the presence but not magnitude of obesity, found an increase in risk. Of the longitudinal studies examining the relationship between DM and OA that accounted for obesity, none provided evidence of an independent relationship between DM and hip (2 studies) or hand OA (1 study).
There is little evidence to suggest that impaired glucose metabolism is a risk factor, independent of obesity, for knee OA and no evidence that impaired glucose metabolism is an independent risk factor for hip or hand OA.
Diabetes is a risk factor for knee osteoarthritis progression
2015, Osteoarthritis and Cartilage
Recent studies have suggested that metabolic factors (obesity, diabetes, hypertension and dyslipidemia) and their clustering in metabolic syndrome (MetS) might be involved in the pathophysiology of knee osteoarthritis (OA). We investigated their impact on radiographic progression by an annualised measure of the joint space narrowing (JSN) of the medial tibiofemoral compartment.
559 patients older than 50 years with symptomatic knee OA were recruited for the placebo arm of the SEKOIA trial. The presence of diabetes, hypertension and dyslipidemia was determined at baseline interview. Body mass index (BMI) was calculated, obesity was considered >30 kg/m². MetS was defined by the sum of metabolic factors ≥3. Minimal medial tibiofemoral joint space on plain radiographs was measured by an automated method at baseline and then annually for up to 3 years.
The mean age of patients was 62.8 [62.2–63.4] years; 392 were women. A total of 43.8% was obese, 6.6% had type 2 diabetes, 45.1% hypertension, 27.6% dyslipidemia and 13.6% MetS. Mean annualised JSN was greater for patients with type 2 diabetes than without diabetes (0.26 [−0.35 to −0.17] vs 0.14 [−0.16 to −0.12] mm; P = 0.001). This association remained significant after adjustment for sex, age, BMI, hypertension and dyslipidemia (P = 0.018). In subgroup analysis, type 2 diabetes was a significant predictor of JSN in males but not females. The other metabolic factors and MetS were not associated with annualised JSN.
Type 2 diabetes was a predictor of joint space reduction in men with established knee OA. No relationships were found between MetS or other metabolic factors and radiographic progression.

View all citing articles on Scopus

: None.

View full text

Original ArticleMedical problems and risk factors of metabolic syndrome among radiographic knee osteoarthritis patients in the Japanese general population

Abstract

Background

Methods

Results

Conclusion

Osteoarthr Cartil.

Am J Med.

J Arthroplasty.

J Ren Nutr.

J Orthop Sci.

Osteoarthr Cartil.

J Orthop Sci.

J Orthop Sci.

Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study

Arthritis Rheum.

Occupational activity and osteoarthritis of the knee

Ann Rheum Dis.

Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls

Arthritis Rheum.

Effect of compressive loading on chondrocyte differentiation in agarose cultures of chick limb-bud cells

J Orthop Res.

The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study

J Rheumatol.

Original Article
Medical problems and risk factors of metabolic syndrome among radiographic knee osteoarthritis patients in the Japanese general population