Javaid M K, Lane N E, Mackey D C, Lui L-Y, Arden N K, Beck T J, Hochberg M C, Nevitt M C
University of California, San Francisco, USA.
Arthritis Rheum. 2009 Jul;60(7):2028-36. doi: 10.1002/art.24639.
Radiographic hip osteoarthritis (RHOA) is associated with increased hip areal bone mineral density (aBMD). This study was undertaken to examine whether femoral geometry is associated with RHOA independent of aBMD.
Participants in the Study of Osteoporotic Fractures in whom pelvic radiographs had been obtained at visits 1 and 5 (mean 8.3 years apart) and hip dual x-ray absorptiometry (DXA) had been performed (2 years after baseline) were included. Prevalent and incident RHOA phenotypes were defined as composite (osteophytes and joint space narrowing [JSN]), atrophic (JSN without osteophytes), or osteophytic (femoral osteophytes without JSN). Analogous definitions of progression were based on minimum joint space and total osteophyte score. Hip DXA scans were assessed using the Hip Structural Analysis program to derive geometric measures, including femoral neck length, width, and centroid position. Relative risks and 95% confidence intervals for prevalent, incident, and progressive RHOA per SD increase in geometric measure were estimated in a hip-based analysis using multinomial logistic regression with adjustment for age, body mass index, knee height, and total hip aBMD.
In 5,245 women (mean age 72.6 years), a wider femoral neck with a more medial centroid position was associated with prevalent and incident osteophytic and composite RHOA phenotypes (P < 0.05). Increased neck width and centroid position were associated with osteophyte progression (both P < 0.05). No significant geometric associations with atrophic RHOA were found.
Differences in proximal femoral bone geometry and spatial distribution of bone mass occur early in hip OA and predict prevalent, incident, and progressive osteophytic and composite phenotypes, but not the atrophic phenotype. These bone differences may reflect responses to loading occurring early in the natural history of RHOA.
影像学髋关节骨关节炎（RHOA）与髋关节面积骨密度（aBMD）增加相关。本研究旨在探讨股骨几何结构是否独立于aBMD与RHOA相关。
纳入骨质疏松性骨折研究中的参与者，这些参与者在第1次和第5次访视时（平均间隔8.3年）拍摄了骨盆X线片，并在基线后2年进行了髋关节双能X线吸收测定（DXA）。现患和新发RHOA表型定义为复合型（骨赘和关节间隙狭窄[JSN]）、萎缩型（无骨赘的JSN）或骨赘型（无JSN的股骨骨赘）。进展的类似定义基于最小关节间隙和总骨赘评分。使用髋关节结构分析程序评估髋关节DXA扫描，以得出几何测量值，包括股骨颈长度、宽度和质心位置。在基于髋关节的分析中，使用多项逻辑回归并调整年龄、体重指数、膝高和全髋关节aBMD，估计几何测量值每增加1个标准差时现患、新发和进展性RHOA的相对风险和95%置信区间。
在5245名女性（平均年龄72.6岁）中，股骨颈更宽且质心位置更靠内侧与现患和新发骨赘型及复合型RHOA表型相关（P<0.05）。颈宽增加和质心位置与骨赘进展相关（均P<0.05）。未发现与萎缩型RHOA有显著的几何结构关联。
股骨近端骨几何结构和骨量空间分布的差异在髋关节骨关节炎早期出现，并可预测现患、新发和进展性骨赘型及复合型表型，但不能预测萎缩型表型。这些骨差异可能反映了RHOA自然病程早期对负荷的反应。
