University of Bristol, Bristol, UK.
Arthritis Rheumatol. 2014 Sep;66(9):2429-39. doi: 10.1002/art.38729.
Previous studies of skeletal remains have suggested that both enthesophytes and osteophytes are manifestations of an underlying bone-forming tendency. A greater prevalence of osteophytes has been observed among individuals with high bone mass (HBM) compared with controls. This study was undertaken to examine the possible interrelationships between bone mass, enthesophytes, and osteophytes in a population of individuals with extreme HBM.
Cases of HBM (defined according to bone mineral density [BMD] Z scores on dual x-ray absorptiometry) from the UK-based HBM study were compared with a control group comprising unaffected family members and general population controls from the Chingford and Hertfordshire cohort studies. Pelvic radiographs from cases and controls were pooled and evaluated, in a blinded manner, by a single observer, who performed semiquantitative grading of the radiographs for the presence and severity of osteophytes and enthesophytes (score range 0-3 for each). Logistic regression analysis was used to identify significant associations, with a priori adjustment for age, sex, and body mass index.
In this study, 226 radiographs from HBM cases and 437 radiographs from control subjects were included. Enthesophytes (grade ≥1) and moderate enthesophytes (grade ≥2) were more prevalent in HBM cases compared with controls (adjusted odds ratio [OR] 3.00 [95% confidence interval (95% CI) 1.96-4.58], P < 0.001 for any enthesophyte; adjusted OR 4.33 [95% CI 2.67-7.02], P < 0.001 for moderate enthesophytes). In the combined population of cases and controls, the enthesophyte grade was positively associated with BMD at both the total hip and lumbar spine (adjusted P for trend < 0.001). In addition, a positive association between osteophytes and enthesophytes was observed; for each unit increase in enthesophyte grade, the odds of any osteophyte being present were increased >2-fold (P < 0.001).
Strong interrelationships were observed between osteophytes, enthesophytes, and HBM, which may be helpful in defining a distinct subset of patients with osteoarthritis characterized by excess bone formation.
先前对骨骼遗骸的研究表明，骨赘和骨赘都是潜在的骨形成倾向的表现。与对照组相比，高骨量（HBM）个体中骨赘的发生率更高。本研究旨在研究人群中骨量、骨赘和骨赘之间可能存在的相互关系。
将英国 HBM 研究中根据双能 X 线吸收法（DXA）骨密度（BMD）Z 评分定义的 HBM 病例与对照组进行比较，对照组包括未受影响的家族成员和来自 Chingford 和 Hertfordshire 队列研究的一般人群对照。将病例和对照组的骨盆 X 线片汇集在一起，由一名观察者进行盲法评估，该观察者对 X 线片的骨赘和骨赘的存在和严重程度进行半定量分级（评分范围为 0-3）。使用逻辑回归分析来确定显著的关联，预先调整年龄、性别和体重指数。
本研究纳入了 226 例 HBM 病例和 437 例对照的 X 线片。与对照组相比，HBM 病例中存在（≥1 级）和中度骨赘（≥2 级）更为常见（任何骨赘的调整优势比[OR]3.00[95%置信区间（95%CI）1.96-4.58]，P<0.001；中度骨赘的调整 OR 4.33[95%CI 2.67-7.02]，P<0.001）。在病例和对照组的联合人群中，骨赘分级与全髋关节和腰椎的 BMD 呈正相关（趋势 P 值<0.001）。此外，还观察到骨赘和骨赘之间存在正相关；骨赘分级每增加一个单位，存在任何骨赘的几率增加 2 倍以上（P<0.001）。
观察到骨赘、骨赘和 HBM 之间存在强烈的相互关系，这有助于定义以过度骨形成为特征的特定亚组的骨关节炎患者。
