Osteoporosis is Associated with Varus Deformity in Postmenopausal Women with Knee Osteoarthritis: A Case-Control Study

Background: Varus deformity of the knee is a common pathological characteristic in knee osteoarthritis (KOA), and not enough attention has been given to the relationship between knee varus deformity and the state of systemic bone mass. The purpose of this study is to evaluate the potential relationship between bone mineral density (BMD) and varus deformity in postmenopausal women with KOA.Methods: This case-control study included 202 postmenopausal women with KOA with or without varus deformity. The hip-knee-ankle angle of the lower extremity (HKA), medial distal femoral angle (MDFA), medial proximal tibial angle (MPTA), and the angle of the joint line (JLCA) were measured in all patients. The BMD of the lumbar (L1-L4), left femoral neck, and left hip were measured by dual-energy X-ray absorptiometry in all patients. The difference in BMD between the knee varus deformity group and the normal limb alignment group was compared, and the relationship between the different angles of limb alignment and the BMD values at different sites was evaluated.Results: The BMD at different sites of the knee varus deformity group was lower than of the normal limb alignment group, and the incidence of osteoporosis was higher. Pearson correlation analysis showed that BMD of the lumbar spine (L1-L4), left femoral neck and left hip joint were positively correlated with the HKA, but negatively correlated with JLCA. MPTA was positively correlated with the left femoral neck and left hip joint BMD, but not correlated with lumbar bone density. Furthermore, in the normal limb alignment group, the HKA was only negatively correlated with JLCA, but not significantly correlated with MDFA and MPTA. In the varus deformity group, the HKA was not only negatively correlated with JLCA but also positively correlated with MDFA and MPTA. Conclusions: Osteoporosis should be an important predicting factor for exacerbating knee varus deformity. Maintaining a systemic bone mass level may help to prevent the progression of knee varus deformity in the treatment of KOA.

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