Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study.

OBJECTIVE To examine the natural history, role of risk factors, and incidence of knee osteoarthritis (OA) in a prospective study of women from a population cohort. METHODS Women from the Chingford Study who had been recruited in 1989 were followed up with knee radiographs 4 years later. A total of 715 paired radiographs (71% of the original sample) were graded for osteophytes and 644 for joint space narrowing (JSN). Women whose radiographs had been graded as 0 in 1989 and as > or =14 years later were classified as having incident disease. Incident cases were compared with controls for associations with a number of risk factors. RESULTS Eighty-one women (12.6%) developed JSN of the knee, equating to an incidence of 3.1% per year. No clear risk factors for JSN were identified. Reproducibility of measures of joint space is poor, however, leading to inaccuracy of definition. Incident knee osteophytes developed in 95 women (133%), equating to an incidence of 3.3% per year. Compared with controls, women with incident knee osteophytes were older, heavier, and had more hand OA and knee symptoms. Women in the top tertile of obesity (body mass index >26.4) had a significantly increased risk of incident knee osteophytes (odds ratio [OR] 2.38, 95% confidence interval [95% CI] 1.29-4.39). Incident knee osteophytes increased by 20% per 5-year age increase. A nonsignificant protective effect for incident knee osteophytes was seen with current estrogen replacement therapy (ERT) (OR 0.41, 95% CI 0.12-1.42). No effect was associated with smoking, physical activity, hysterectomy, or previous knee injury. CONCLUSION Obesity and aging are associated with a high risk of new knee OA developing in women. Evidence of a protective effect of ERT was seen. No clear association was found for incident JSN, suggesting that different etiologic mechanisms are operating or that standard radiographs are an inaccurate measure of incident narrowing.

[1]  T. Spector,et al.  Is hormone replacement therapy protective for hand and knee osteoarthritis in women?: The Chingford study , 1997, Annals of the rheumatic diseases.

[2]  Daniel Levy,et al.  Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. , 1997, Arthritis and rheumatism.

[3]  J. Heikkinen,et al.  Short‐Term Intravenous Bisphosphonates in Prevention of Postmenopausal Bone Loss , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[4]  S. Cummings,et al.  Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group. , 1996, Archives of internal medicine.

[5]  A. Silman,et al.  Workshop on Epidemiology of Osteoarthritis in the Peripheral Joints, Örenäs, Sweden, February 1996 , 1996 .

[6]  I. Petersson.  Occurrence of osteoarthritis of the peripheral joints in European populations. , 1996, Annals of the rheumatic diseases.

[7]  T. Spector,et al.  Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. , 1996, Arthritis and rheumatism.

[8]  T. Spector,et al.  Genetic influences on osteoarthritis in women: a twin study , 1996, BMJ.

[9]  D. Felson,et al.  The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. , 1995, Arthritis and rheumatism.

[10]  A M Walker,et al.  Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. , 1995, Arthritis and rheumatism.

[11]  T. Spector,et al.  Association between metabolic factors and knee osteoarthritis in women: the Chingford Study. , 1995, The Journal of rheumatology.

[12]  T. Spector,et al.  Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. , 1994, Annals of the rheumatic diseases.

[13]  T. Spector,et al.  Defining osteoarthritis of the hand for epidemiological studies: the Chingford Study. , 1994, Annals of the rheumatic diseases.

[14]  T. Spector,et al.  The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study. , 1994, Annals of the rheumatic diseases.

[15]  D Coggon,et al.  Occupational activity and osteoarthritis of the knee. , 1994, Annals of the rheumatic diseases.

[16]  T. Spector,et al.  Definition of osteoarthritis of the knee for epidemiological studies. , 1993, Annals of the rheumatic diseases.

[17]  T. Spector,et al.  Radiographic assessment of osteoarthritis in population studies: whither Kellgren and Lawrence? , 1993, Osteoarthritis and cartilage.

[18]  M. Doherty,et al.  Is osteoarthritis in women affected by hormonal changes or smoking? , 1993, British journal of rheumatology.

[19]  T. Spector,et al.  The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. , 1993, The Journal of rheumatology.

[20]  T. Spector,et al.  Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford study. , 1993, Annals of the rheumatic diseases.

[21]  W. Kannel,et al.  Estrogen use and radiographic osteoarthritis of the knee in women. The Framingham Osteoarthritis Study. , 1990, Arthritis and rheumatism.

[22]  T. Spector.  The fat on the joint: osteoarthritis and obesity. , 1990, Journal of Rheumatology.

[23]  W W Hauck,et al.  The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. , 1989, American journal of epidemiology.

[24]  W. Kannel,et al.  Does smoking protect against osteoarthritis? , 1989, Arthritis and rheumatism.