Duong Vicky, Abdel Shaheed Christina, Ferreira Manuela L, Narayan Sujita W, Venkatesha Venkatesha, Hunter David J, Zhu Jimmy, Atukorala Inoshi, Kobayashi Sarah, Goh Siew Li, Briggs Andrew M, Cross Marita, Espinosa-Morales Rolando, Fu Kai, Guillemin Francis, Keefe Francis, Stefan Lohmander L, March Lyn, Milne George J, Mei Yifang, Mobasheri Ali, Namane Mosedi, Peat George, Risberg May Arna, Sharma Saurab, Sit Regina, Telles Rosa Weiss, Zhang Yuqing, Cooper Cyrus
Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Level 10, St Leonards, Sydney 2065, New South Wales, Australia.
Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, University of Sydney, Level 10, St Leonards, Sydney 2065, New South Wales, Australia; Faculty of Medicine and Health, School of Public Health, University of Sydney, Level 10N, King George V Building, Royal Prince Alfred Hospital, Sydney 2050, New South Wales, Australia.
Osteoarthritis Cartilage. 2025 Mar 31. doi: 10.1016/j.joca.2025.03.003.
To identify and quantify risk factors for incident knee osteoarthritis (KOA) across the lifespan.
This systematic review and meta-analysis identified eligible studies from seven electronic databases and three registries. Longitudinal cohort studies or randomised controlled trials evaluating participants who developed incident symptomatic and/or radiographic KOA were included. Two independent reviewers completed data screening and extraction. Estimates were pooled using a random effects model and reported as odds ratio (OR), hazard ratio, or risk ratio and corresponding 95% confidence intervals (95% CI). Grading of Recommendations, Assessment, Development and Evaluation was used to determine the certainty of evidence. Population attributable fractions were calculated, including risk factors significantly associated with radiographic KOA based on the pooled meta-analysis and where we could determine communality scores using existing clinical datasets.
We identified 131 studies evaluating > 150 risk factors. Previous knee injury, older age and high bone mineral density were associated with an increased risk of incident radiographic KOA based on the pooled analysis [OR (95% CI): 2.67 (1.41, 5.05), 1.15 (1.00, 1.33) and 1.82 (1.12, 2.94), respectively], with moderate-to-high certainty. Two risk factors (overweight/obesity and previous knee injury) accounted for 14% of incident radiographic KOA. Other modifiable risk factors, including occupational physical activity, also contribute to radiographic or symptomatic KOA.
Novel strategies addressing known modifiable risk factors including overweight/obesity, knee injuries and occupational physical activity are needed to reduce overall burden of KOA.
PROSPERO ID: CRD42023391187.
确定并量化一生中发生膝关节骨关节炎（KOA）的风险因素。
本系统评价和荟萃分析从七个电子数据库和三个登记处中识别出符合条件的研究。纳入评估发生症状性和/或影像学KOA的参与者的纵向队列研究或随机对照试验。两名独立的评审员完成数据筛选和提取。使用随机效应模型汇总估计值，并报告为比值比（OR）、风险比或风险率以及相应的95%置信区间（95%CI）。采用推荐分级、评估、制定与评价方法来确定证据的确定性。计算人群归因分数，包括基于汇总的荟萃分析与影像学KOA显著相关的风险因素，以及我们能够使用现有临床数据集确定共性分数的情况。
我们识别出131项评估超过150个风险因素的研究。基于汇总分析，既往膝关节损伤、高龄和高骨密度与发生影像学KOA的风险增加相关[OR（95%CI）分别为：2.67（1.41，5.05）、1.15（1.00，1.33）和1.82（1.12，2.94）]，证据确定性为中到高。两个风险因素（超重/肥胖和既往膝关节损伤）占影像学KOA发病的14%。其他可改变的风险因素，包括职业体力活动，也与影像学或症状性KOA有关。
需要采取新策略来应对已知的可改变风险因素，包括超重/肥胖、膝关节损伤和职业体力活动，以减轻KOA的总体负担。
PROSPERO编号：CRD42023391187。
