Bone histomorphometry of the iliac crest, and spinal fracture prevalence in atrophic and hypertrophic osteoarthritis of the hip Original Article Received: 08 March 1991 Accepted: 22 November 1991 DOI:
Cite this article as: Schnitzler, C.M., Mesquita, J.M. & Wane, L. Osteoporosis Int (1992) 2: 186. doi:10.1007/BF01623925 Abstract
While some authors report high bone density in osteoarthritis (OA), surgical experience with total hip arthroplasty (THA) for primary OA suggests the existence of osteoporotic subsets of patients. To identify these we analysed 107 iliac crest bone biopsies, taken at THA, by routine histomorphometry for trabecular structural and bone turnover features, and examined radiographs of the spine for vertebral fractures. Patients were grouped by hip osteophyte size (none, atrophic; small, hypotrophic; moderate, supertrophic; large, hypertrophic OA), and by major architectural disorganization of the hip (hip joint destruction, protrusio). We found hip joint destruction to be 3 times more common in atrophic than in supertrophic and hypertrophic OA (
p<0.05). Overall, the OA patients had lower bone volume ( p<0.05) and thinner trabeculae ( p<0.05) than controls. Worst affected were patients with hip joint destruction and with protrusio: they also had fewer and more widely spaced trabeculae than controls ( p<0.05). The spinal fracture prevalence was highest in patients with hip joint destruction (higher than in the general population), intermediate in those with protrusio or atrophic OA, and lowest in patients with supertrophic or hypertrophic OA. We conclude that OA hip patients with joint destruction or protrusio have a high prevalence of generalized osteoporosis, and that the larger the hip osteophytes, the lower is the prevalence of generalized osteoporosis. Our findings suggest that the generalized bone status may influence the outcome of OA of the hip. Keywords Bone histology Hip joint Iliac crest Osteoarthritis Osteoporosis References
Carlsson A, Nilsson BE, Westlin NE. Bone mass in primary coxarthrosis. Act Orthop Scand 1979;50:187–9.
Price T, Reeve J, Mitchell R, Hesp R. Bone density in generalized osteoarthritis. Ann Rheum Dis 1983;42:227–8.
Dequeker J. The relationship between osteoporosis and osteoarthritis. Clin Rheum Dis 1985;11:271–96.
Foss MVL, Byers PD. Bone density, osteoarthrosis of the hip and fracture of the upper end of the femur. Ann Rheum Dis 1972;31:259–64.
Roh YS, Dequeker J, Mullier JC. Bone mass in osteoarthrosis measured in vivo by photon absorption. J Bone Joint Surg [Am] 1974;56A:587–91.
Gevers G, Dequeker J, Geusens P, Nyssen-Behets C, Dhem A. Physical and histomorphological chracteristics of iliac crest bone differ according to the grade of osteoarthritis at the hand. Bone 1989;10:173–7.
Alhava EM, Kettunen K, Kerjalainen P. Bone mineral in patients with osteoarthrosis of the hip. Acta Orthop Scand 1975;46:709–15.
Ng KC, Revell PA, Beer M, Boucher BA, Cohen RD, Currey HLF. Incidence of metabolic bone disease in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis 1984;43:370–7.
Reid DM, Kennedy NSJ, Smith MA, Tothill P, Nuki G. Bone mass in nodal primary generalized osteoarthrosis. Ann Rheum Dis 1984;43:240–2.
Solomon L, Schnitzler CM, Browett JP. Osteoarthritis of the hip: the patient behind the disease. Ann Rheum Dis 1982;41:118–25.
Melsen F, Mosekilde L. The role of bone biopsy in the diagnosis of metabolic bone disease. Orthop Clin North Am 1981;12:571–602.
Frost HM. Bone histomorphometry: choice of marking agent and labeling schedule. In: Recker RR, editor. Bone histomorphometry: techniques and interpretation. Boca Raton, FL, CRC Press, 1983:37–51.
Schnitzler CM, Pettifor JM, Mesquita JM, Bird MDT, Schnaid E, Smyth AE. Histomorphometry of iliac crest bone in 346 normal black and white South African adults. Bone Miner 1980;10:183–99.
Malluche HH, Meyer W, Sherman D, Massry SG. Quantitative bone histology in 84 normal American subjects. Calcif Tissue Int 1982;34:449–55.
Parfitt AM, Drezner MK, Glorieux FH, Kanis JA, Malluche HH, Meunier PJ et al. Bone histomorphometry: standardization of nomenclature, symbols and units. J Bone Miner Res 1987;2:595–610.
Kellgren JH, Lawwrence JS. ‘Rome Criteria’. The epidemiology of chronic rheumatism, vol II, Atlas of standard radiographs of arthritis. Oxford: Blackwell Scientific, 1963:12–13.
Edelstein G, Murphy WA. Protrusio acetabuli: radiographic appearance in arhtritis and other conditions. Arthritis Rheum 1983;26:1511–16.
Smith-Bindman R, Cummings SR, Steiger P, Genant HK. A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 1991;6:25–34.
Gallagher JC, Heldlund LR, Stoner S, Meeger C. Vertebral morphometry: normative data. Bone Miner 1991;4:189–96.
Larsson L, Öhman S. Serum ionized calcium and corrected total calcium in borderline hyperparathyroidism. Clin Chem 1978;24:1962–5.
Ehrlich MG, Mankin HJ. Biochemical changes in osteoarthritis. In: Nuki G, editor. The aetiopathogenesis of osteoarthrosis. Bath: Pitman Medical, 1980:20–36.
Thompson RC, Oegema TR. Metabolic activity of articular cartilage in osteoarthritis. J Bone Joint Surg [Am] 1979;61A:407–16.
Radin EL, Jgor LP. Does cartilage compliance reduce skeletal impact loads? Arthritis Rheum 1970;13:139–44.
Minaire P, Meunier P, Edouard C, Bernard J, Bourret J. Quantitative histological data on disuse osteoporosis. Calcif Tissue Res 1974;17:57–73.
Arlot ME, Bonjean M, Chavassieux PM, Meunier PJ. Bone histology in adults with aseptic necrosis. J Bone Joint Surg [Am] 1983; 65A:1319–27.
Healey JH, Vigorita VJ, Lane JM. The coexistence and characteristics of osteoarthritis and osteoporosis. J Bone Joint Surg [Am] 1985;67A:586–92.
Melton III LJ. Epidemiology of vertebral fractures. In: Christiansen C, Johansen JS, Riis BJ, editors. Osteoporosis 1987. Proceedings of the Second International Symposium on Osteoporosis, Aalborg, Denmark. Copenhagen: Osteopress ApS, 1987:33–37.
Saito M, Saito S, Ohzono K, Ono K. The osteoblastic response to osteoarthritis of the hip. J Bone Joint Surg [Br] 1987;69B:746–51.
Fazzalari NL, Darracott J, Vernon-Roberts B. Histomorphometric changes in the trabecular structure of a selected stress region in the femur in patients with osteoarthritis and fracture of the femoral neck. Bone 1985;6:125–33.
Bombelli R. Pathogenesis of osteoarthritis of the hip. In: Bombelli R. Osteoarthritis of the hip. Berlin Heidelberg New York: Springer, 1976: 9 and 27–47.
Chamay A, Tschant P. Mechanical influences in bone remodeling. Experimental research on Wolffe's law. J Biomech 1972;5:173–80.
Frost HM. BMU population dynamics in bone remodeling. In: Frost HM. Bone remodeling and its relationship to metabolic bone diseases. Springfield: C. C. Thomas, 1973;80–1.
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