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Bone Mineral Density is Lower in Patients with Severe Knee Osteoarthritis and Attrition

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Abstract

Bone quality is probably important for the survival of knee arthroplasty (KA), but little is known about systemic bone mineral density and bone turnover in patients prior to KA surgery. The aim of this study was to explore the prevalence of osteoporosis and bone turnover in relation to knee osteoarthritis (OA) grade in patients scheduled for KA surgery. Prospective preoperative evaluation of 450 patients (259 females) prior to KA between 2014 and 2016 with standing knee radiography, Dual-energy X-ray absorptiometry (DXA), biomarkers for bone turnover (CTX, P1NP), and vitamin D. Grading of knee OA was done with the Altman Atlas and Kellgren Lawrence (KL). Adjustments for age and BMI were made. The mean age was 67.9 years (range 39–94), and mean BMI was 28.8 (SD 4.8). The prevalence of osteoporosis was 9.6% (CI 95% 7.2; 12.7), while the proportion of patients with osteopenia was 36.0%. T score was similar between KL OA grade 3 and 4 (p = 0.06); however, T score was lower (p = 0.02) with the worst knee OA grade (attrition). The median serum Vitamin D level was 78.5 nmol/L (range 10–196), and there was no association between serum vitamin D and the grade of OA (p > 0.88). P1NP was significantly higher in KL grade 4 compared to KL grade 3 (p = 0.03), but there was no association between KL grade and CTX (p = 0.21). 10% had osteoporosis, which is similar to the age-matched background population. Bone mineral density was lower with severe knee osteoarthritis (attrition), and P1NP was higher with worse osteoarthritis grading.

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Acknowledgements

The study was performed under the Innovation Fund Grant 69-2013-1 “Transforming radiological technology for assessment of implant fixation: from research tool to clinical application.”

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Authors and Affiliations

  1. Orthopaedic Research Unit, Aarhus University Hospital, Aarhus, Denmark

    Karina Nørgaard Linde, Kjeld Søballe, Inger Krog-Mikkelsen & Maiken Stilling

  2. Department of Radiology, Aarhus University Hospital, Aarhus, Denmark

    Katriina Bøcker Puhakka

  3. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

    Bente Lomholt Langdahl

  4. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark

    Kjeld Søballe, Frank Madsen & Maiken Stilling

  5. Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark

    Karina Nørgaard Linde & Maiken Stilling

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  1. Karina Nørgaard Linde
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Correspondence to Karina Nørgaard Linde.

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Conflict of interest

Karina Nørgaard Linde, Maiken Stilling, Inger Krog-Mikkelsen, Kjeld Søballe, Katriina Bøcker Puhakka and Frank Madsen report grants from the Innovation Fund Denmark during the conduct of the study. Main author Karina Nørgaard Linde reports a grant for a research year (salary to medical student) from Department of Clinical Medicine, Aarhus University. Bente Lomholt Langdahl reports grants from Novo Nordisk, grants from Amgen, personal fees from Eli Lilly, personal fees from Amgen, personal fees from UCB, personal fees from Merck, outside the submitted work.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

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Linde, K.N., Puhakka, K.B., Langdahl, B.L. et al. Bone Mineral Density is Lower in Patients with Severe Knee Osteoarthritis and Attrition. Calcif Tissue Int 101, 593–601 (2017). https://doi.org/10.1007/s00223-017-0315-y

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