Gregson C L, Hardcastle S A, Murphy A, Faber B, Fraser W D, Williams M, Davey Smith G, Tobias J H
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK.
Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Bone. 2017 Apr;97:306-313. doi: 10.1016/j.bone.2017.01.005. Epub 2017 Jan 7.
High Bone Mass (HBM) is associated with (a) radiographic knee osteoarthritis (OA), partly mediated by increased BMI, and (b) pelvic enthesophytes and hip osteophytes, suggestive of a bone-forming phenotype. We aimed to establish whether HBM is associated with radiographic features of OA in non-weight-bearing (hand) joints, and whether such OA demonstrates a bone-forming phenotype.
HBM cases (BMD Z-scores≥+3.2) were compared with family controls. A blinded assessor graded all PA hand radiographs for: osteophytes (0-3), joint space narrowing (JSN) (0-3), subchondral sclerosis (0-1), at the index Distal Interphalangeal Joint (DIPJ) and 1st Carpometacarpal Joint (CMCJ), using an established atlas. Analyses used a random effects logistic regression model, adjusting a priori for age and gender. Mediating roles of BMI and bone turnover markers (BTMs) were explored by further adjustment.
314 HBM cases (mean age 61.1years, 74% female) and 183 controls (54.3years, 46% female) were included. Osteophytes (grade≥1) were more common in HBM (DIPJ: 67% vs. 45%, CMCJ: 69% vs. 50%), with adjusted OR [95% CI] 1.82 [1.11, 2.97], p=0.017 and 1.89 [1.19, 3.01], p=0.007 respectively; no differences were seen in JSN. Further adjustment for BMI failed to attenuate ORs for osteophytes in HBM cases vs. controls; DIPJ 1.72 [1.05, 2.83], p=0.032, CMCJ 1.76 [1.00, 3.06], p=0.049. Adjustment for BTMs (concentrations lower amongst HBM cases) did not attenuate ORs.
HBM is positively associated with OA in non-weight-bearing joints, independent of BMI. HBM-associated OA is characterised by osteophytes, consistent with a bone-forming phenotype, rather than JSN reflecting cartilage loss. Systemic factors (e.g. genetic architecture) which govern HBM may also increase bone-forming OA risk.
高骨量（HBM）与以下情况相关：（a）影像学膝关节骨关节炎（OA），部分由体重指数（BMI）升高介导；（b）骨盆附着点骨赘和髋关节骨赘，提示有骨形成表型。我们旨在确定HBM是否与非负重（手部）关节OA的影像学特征相关，以及这种OA是否表现出骨形成表型。
将HBM病例（骨密度Z评分≥+3.2）与家族对照进行比较。一位盲法评估者使用既定图谱，对所有手部正位X线片在食指远端指间关节（DIPJ）和第一掌指关节（CMCJ）处的骨赘（0 - 3级）、关节间隙变窄（JSN，0 - 3级）、软骨下硬化（0 - 1级）进行分级。分析采用随机效应逻辑回归模型，预先对年龄和性别进行调整。通过进一步调整来探讨BMI和骨转换标志物（BTMs）的中介作用。
纳入314例HBM病例（平均年龄61.1岁，74%为女性）和183例对照（54.3岁，46%为女性）。骨赘（≥1级）在HBM中更常见（DIPJ：67%对45%，CMCJ：69%对50%），调整后的比值比[95%置信区间]分别为1.82[1.11, 2.97]，p = 0.017和1.89[1.19, 3.01]，p = 0.007；JSN方面未见差异。对BMI进行进一步调整未能减弱HBM病例与对照中骨赘的比值比；DIPJ为1.72[1.05, 2.83]，p = 0.032，CMCJ为1.76[1.00, 3.06]，p = 那么调整。
HBM与非负重关节的OA呈正相关，独立于BMI。HBM相关的OA以骨赘为特征，与骨形成表型一致，而非反映软骨丢失的JSN。控制HBM的全身因素（如遗传结构）可能也会增加骨形成性OA的风险。
