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Erschienen in: BMC Musculoskeletal Disorders 1/2016

Open Access 01.12.2016 | Research article

Relation between phalangeal bone mineral density and radiographic knee osteoarthritis: a cross-sectional study

verfasst von: Zhen-han Deng, Chao Zeng, Yu-sheng Li, Tuo Yang, Hui Li, Jie Wei, Guang-hua Lei

Erschienen in: BMC Musculoskeletal Disorders | Ausgabe 1/2016

Abstract

Background

Major reports have suggested that bone mineral density (BMD) is higher in patients with osteoarthritis (OA), while other studies do not agree. Our aim was to examine the cross-sectional association between phalangeal BMD and radiographic knee OA.

Methods

A total of 2855 participants were included in this study. Radiographic knee OA was defined as Kellgren-Lawrence (K-L) Grade ≥ 2 in at least one leg. BMD scans of the middle phalanges of the second, third and fourth digits of the nondominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). A multivariable logistic analysis model was applied to test the relation between phalangeal BMD with radiographic knee OA, the presence of knee osteophytes (OSTs), and knee joint space narrowing (JSN) after adjusting for a number of potential confounding factors.

Results

The multivariable-adjusted odds ratios with 95 % confidence intervals [ORs (95 % CI)] of radiographic knee OA across phalangeal BMDs were 1.08 (95 % CI 0.89–1.32) and 0.62 (95 % CI 0.45–0.86), respectively. The P for trend was 0.09. For the female population, the multivariable-adjusted ORs (95 % CI) of radiographic knee OA across phalangeal BMD were 1.01 (95 % CI 0.73–1.37) and 0.58 (95 % CI 0.38 − 0.87), respectively. The P for trend was 0.02. This positive finding, however, did not exist in the male subgroup. There was a significantly lower prevalence of OST in the osteoporosis (OP) group than in the normal group (OR = 0.59, 95 % CI 0.40–0.88; P for trend was 0.01). In contrast, the prevalence of JSN was significantly higher in the osteopenia group (OR = 1.22, 95 % CI 1.00–1.48) and the OP group (OR = 1.35, 95 % CI 1.00–1.84) than in the normal group. The P for trend was 0.02.

Conclusions

This study observed lower odds for the presence of radiographic knee OA and OST in OP patients than in normal subjects. The prevalence of JSN was higher in the osteopenia and OP groups than in normal subjects.
Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12891-016-0918-x) contains supplementary material, which is available to authorized users.
Zhen-han Deng and Chao Zeng contributed equally to this work.

Competing interests

These authors declared that they have no competing interests.

Authors’ contributions

ZD study design, data collection and analyses, manuscript preparation. CZ study design, data collection and analyses, manuscript preparation. YL data acquisition, manuscript preparation. TY data acquisition, manuscript preparation. HL data acquisition, manuscript preparation. JW data acquisition, manuscript preparation. GHL study design, data analyses, manuscript preparation. All authors read and approved the final manuscript.
Abkürzungen
ADL
Activities of daily life
BMD
Bone mineral density
BMI
Body mass index
Ca
Calcium
CV
Coefficient of variation
DXA
Dual energy X-ray absorptionmetry
FFQ
Food frequency questionnaire
ICC
Intraclass correlation coefficient
IGF
Insulin-like growth factor
K-L
Kellgren-Lawrence
OA
Osteoarthritis
OP
Osteoporosis
QOL
Quality of life
RA
Radiographic absorptiometry
SD
Standard deviations
TGF
Transforming growth factor
SFFQ
Semi-quantitative FFQ
XYHMCS
Xiangya Hospital Health Management Center Study

Background

Osteoarthritis (OA), the most prevalent joint disease, is characterized by progressive loss of articular cartilage, which leads to chronic pain and functional restrictions in affected joints. Worldwide estimates are that about 10 % of men and 18 % of women and about 60–65 % of those > 60 years of age have symptomatic OA and 80 % of them have movement limitations [1]. Likewise, the prevalence of .osteoporosis (OP) increases with age. OP is a metabolic bone disease characterized by abnormalities in the amount and microarchitectural arrangement of bone tissue that could lead to enhanced bone fragility and a consequent increase in fracture risk [2]. The lifetime risk of a hip fracture from age 50 years onward has been estimated at 17 % for white women and 6 % for white men in the United States [3]. The association between OA and OP has remained controversial since the release of the first research outcome 40 years ago, which indicated an apparent inverse relation between these two common diseases [4]. To date, no consensus has been reached.
Both OA and OP are multifactorial diseases and are influenced by genetics, external environment, the endocrine system, metabolism, biomechanics and trauma [59]. Although OA and OP are generally considered different diseases, they share several of the same risk factors, such as bone, cartilage metabolism, aging, sex, and timing of menopause [812]. These two common age-related disorders can cause impairment of activities of daily life and quality of life, leading to increased morbidity and mortality among the elderly.
The advent of precise, accurate measurements of bone mass and density has given researchers tools to examine the relation between OA and OP relative to bone [13]. Bone mass change is reflected in bone mineral density (BMD). According to the World Health Organization (WHO), BMD measurement has been considered the gold standard for diagnosing OP [14]. Patients with OA have been considered to have an elevated BMD [1520], as it has long been hypothesized that systemic or local bone BMD is involved in the pathogenesis of cartilage degradation [21, 22]. Previous studies have indicated that patients with OA of the knee were more likely to have greater bone mass than normal subjects or those with OP. In fact, their BMD was found to be elevated in the spine [23, 24], femoral neck [22, 25], forearm [26, 27], and knee [28, 29]. Other studies, however, indicated that, despite a higher than average bone mass, women with greater joint OA do not have the reduced risk of fracture that a higher bone mass should confer [30, 31]. Some even found lower BMD at the affected sites [32, 33]. These arguments lead to the assumption that the relation between BMD and OA is complicated and may differ by sites or stages. Based on measurements of phalangeal BMD and radiographic knee OA in a large number of apparently healthy Chinese subjects, this cross-sectional study aimed to examine whether the positive association between phalangeal BMD and radiographic knee OA exists in a Chinese population.

Methods

Study population

The Xiangya Hospital Health Management Center Study (XYHMCS) included a cohort consisting mainly of apparently healthy Chinese people from the general public who were undergoing health screening. The study design has been published elsewhere [34]. Data were collected from 2855 participants (1609 men, 1246 women) who voluntarily underwent a routine comprehensive health checkup at the Department of Health Examination Center Xiangya Hospital, Central South University in Changsha, Hunan Province, China from October 2013 to July 2014. Registered nurses interviewed all participants during the examination process using standard questionnaires, aiming to gather information on demographic characteristics and health-related habits. Inclusion criteria were as follows: (1) ≥ aged 40 years; (2) were members of general public; (3) had undergone the weight-bearing bilateral anteroposterior radiography of the knee and non-dominant hand BMD test; (4) had completed the semi-quantitative Food Frequency Questionnaire (FFQ) about the average consumption of foods and drinks over the past year; (5) had all basic characteristics, such as age, sex, body mass index (BMI), and smoking status. Initially, this cross-sectional study included 4622 participants who underwent weight-bearing bilateral anteroposterior radiography of the knee and no-dominant hand BMD test. Then, we excluded all individuals with radiographic evidence of other joint diseases such as osteochondroma or fracture (n = 105), those who did not complete the FFQ (n = 1528), and those < 40 years (n = 134).
The ethics committee of Xiangya Hospital of Central South University approved this study. All participants gave written informed consent at the time of recruitment.

Radiographic assessment of knee OA

Subjects had weightbearing semi-flexed posteroanterior and lateral view knee radiographs obtained using a standard, validated protocol [35, 36]. Two orthopedists, without knowledge of the participants’ clinical symptoms independently assessed all radiographs using the Kellgren − Lawrence (K − L) radiographic atlas [37]. Disagreements between the two orthopedists were resolved by discussion. If at least one knee joint was graded as K − L ≥ 2, the participant was diagnosed with radiographic knee OA.
Interrater reliability was calculated based on 40 random radiographs assessed by two orthopedists. Intrarater reliability was calculated based on the 40 random radiographs measured by one orthopedist, with each radiograph assessed twice, independently. The reliability of the measurements were examined using the kappa (κ) test. Interrater and intrarater reliability were both satisfied (κ = 0.85 and 0.68, respectively). In addition, joint space narrowing (JSN) and osteophytes (OSTs) were assessed individually based on a scale of 0–3 (0 = normal, 3 = most severe) according to the Osteoarthritis Research Society International atlas [38]

BMD measurement

BMD measurement is a universal method for arriving at an early diagnosis of OP. In this study, BMD was measured at the middle phalanges of the second to fourth fingers on the no-dominant hand using a compact radiographic absorptiometry system (Alara MetriScan®; Alara Inc., Fremont, CA, USA). Participants were asked to place the non-dominant hand on the molded support plate with all ornaments removed. BMD was recorded in arbitrary units (mineral mass/area) and in grams per square centimeter (g/cm2).
our staff only recorded data of people who are osteopenia or OP in order to inform patients their illness. But the data of normal BMD people wasn’t recorded.
T-scores were calculated based on the group ages according to a standard BMD database provided by the manufacturer containing data on healthy controls and ages in years. Specifically, T-scores were derived from the reference database by comparing the measured BMD with the average BMD for healthy subjects of the same sex and age. According to the WHO, BMD levels within 1 standard deviations (SD) of a normal young adult are considered normal. Osteopenia (low bone mass) refers to the condition where the BMD level is 1.0–2.5 SD below that of a normal young adult. OP refers to the condition where the BMD level is ≥ 2.5 SD below normal [39].This peripheral densitometry device has advantages, including low cost, efficiency, portability and low X-ray dose (<0.02 μSV per examination), making it suitable for epidemiological screening. The mean coefficient of variation of this method was 1.7 % [40]. Normal BMD normal is defined as a BMD within 1 SD of the young adult reference mean [14]. In this study, the control group was defined as the reference.

Assessment of dietary and non-dietary exposures

A semi-quantitative FFQ (SFFQ) especially designed for the population in Hunan province of China was used to evaluate dietary intake. This SFFQ contains 63 food items that are commonly consumed in Hunan province. Participants were required to answer the frequency—never, once per month, two to three times per month, one to three times per week, four to five times per week, once per day, twice per day, or three times or more per day—they consumed each food item and the average amount they consumed for each time (<100 g, 100–200 g, 201–300 g, 301–400 g, 401–500 g, ≥ 500 g) during the past year. To help them make choices more easily and accurately, colored pictures showing food samples with labeled weights were provided. The validity of the SFFQ was tested by comparing it with the 24-h dietary recall method for a similar population. The Chinese Food Composition Table was referenced to calculate the individual composition of macronutrients and micronutrients of the included foods [41]. This SFFQ has been validated and was used in a previously published study [42]. The weight and height of each subject were measured to calculate the BMI. People with BMI ≥ 25 kg/m2 were defined as overweight. [43] The smoking status, alcohol drinking status, and use of calcium supplements were established by direct face-to-face questioning.

Statistical analysis

The continuous data were expressed as means ± SD, and the categorical data were expressed in percentages. The OP status was classified into three levels: normal, osteopenia and OP. Differences in continuous data were evaluated by the one-way classification analysis of variance (normally distributed data) or the Kruskal − Wallis H test (non-normally distributed data). Differences in qualitative data were assessed by the χ 2 test. The relation between OA and BMD was determined by the liner trend χ 2 test, and evaluated using multivariable logistic regression. Associations between each OP status and OA were adjusted for the following variables: sex, age, BMI, smoking status, alcohol drinking status, activity level, mean total energy intake, mean Ca intake, and Ca supplementation. A test for linear trend was conducted by putting the BMD status as ranked data into the Logistic regression model. All statistical analyses were performed in both subgroups stratified by sex.
Associations between phalangeal BMD and JSN, phalangeal BMD and OST, and OP status and OA were also evaluated by conducting a multivariable logistic regression. Data analyses were performed using SPSS 17.0 (SPSS, Chicago, IL, USA). P < 0.05 was considered to indicate statistical significance.

Results

Tables 1 and 2 present the basic characteristics of the study population according to their OP and OA status. The overall prevalence of radiographic knee OA of the subjects in this cross-sectional study (aged ≥40 years) was 29.2 % (30.0 % in men, 28.1 % in women). Significant differences were observed across different BMD statuses for age, sex ratio, BMI, smoking status, alcohol drinking status, mean total energy intake, mean Ca intake, and use of Ca supplements.
Table 1
Characteristics among 2855 participants according to status of OP
Characteristics
Status of OP
P
Normal
Osteopenia
OP
N
1803
786
266
-
OA (%)
26.8
34.2
30.1
0.01
Age (years)
50.6 ± 6.3
54.4 ± 7.4
59.5 ± 6.8
<0.001
Female (%)
36.5
45.5
86.5
<0.001
BMI (kg/m2)
24.7 ± 3.4
24.3 ± 3.1
23.6 ± 3.1
<0.001
Overweight (%)
44.0
38.3
30.5
<0.001
Smoking (%)
28.1
25.2
7.9
<0.001
Alcohol drinking (%)
42.1
32.3
16.2
<0.001
Mean total energy intake (kcal/d)
1664.1 ± 774.2
1600.7 ± 732.4
1408.4 ± 546.6
<0.001
Mean Ca intake (kcal/d)
507.9 ± 346.0
492.6 ± 308.4
431.8 ± 253.8
<0.001
Ca supplementation (%)
24.3
28.4
47.0
<0.001
N number, OA osteoarthritis, OP osteoporosis, BMI body mass index, Ca calcium
Table 2
Characteristics among 2855 participants according to status of OA
Characteristics
Status of OA
P
Normal
OA
N
2022
833
-
OP (%)
9.2
9.6
0.74
Age (years)
51.4 ± 6.7
55.1 ± 7.8
<0.001
Female (%)
44.3
42.0
0.26
BMI (kg/m2)
24.5 ± 3.2
24.5 ± 3.2
0.87
Overweight (%)
40.8
42.0
0.55
Smoking (%)
25.6
24.8
0.67
Alcohol drinking (%)
37.4
36.0
0.49
Mean total energy intake (kcal/d)
1628.1 ± 725.2
1610.1 ± 800.3
0.64
Mean Ca intake (kcal/d)
498.9 ± 342.2
490.9 ± 294.5
0.82
Ca supplementation (%)
26.3
30.6
0.02
N number, OA osteoarthritis, OP osteoporosis, BMI body mass index, Ca calcium
Significant differences were observed between different OA status levels for age and Ca supplements use. Univariate analysis indicated that there was a significant association between phalangeal BMD and OA (p = 0.01). The multivariable model was adjusted for sex, age, BMI, smoking status, alcohol drinking status, activity level, mean total energy intake, mean Ca intake, and Ca supplementation. The multivariable-adjusted odds ratios with 95 % confidence interval [OR (95 % CI)] of radiographic knee OA across phalangeal BMD were 1.08 (95 % CI 0.89–1.32) and 0.62 (95 % CI 0.45–0.86), respectively. The P for trend was 0.09 (Table 3). For the female subgroup, the multivariable–adjusted ORs (95 % CI) of radiographic knee OA across phalangeal BMD were 1.01 (95 % CI 0.73–1.37) and 0.58 (95 % CI 0.38–0.87), respectively (Table 3). The P for trend was 0.02. This positive finding, however, did not exist in the male subgroup. Furthermore, for the BMI < 25 kg/m2 subgroup, the multivariable-adjusted ORs (95 % CI) of radiographic knee OA across phalangeal BMD were 0.97 (95 % CI 0.76–1.25) and 0.56 (95 % CI 0.37–0.84), respectively (Table 3). The P for trend was 0.03. This positive finding, however, did not exist in the BMI ≥ 25 kg/m2 subgroup.
Table 3
Multivariable-adjusted relations of phalangeal BMD and radiographic knee OA (n = 2855)
 
Status of OP
 
 
Normal
Osteopenia
OP
P for trend
Participants (n)
1803
786
266
-
Knee OA (n)
484
269
80
-
Multivariable-adjusted OR
1.00 (Reference)
1.08(0.89–1.32)
0.62(0.45–0.86)
0.09
Male subgroup
Multivariable-adjusted OR
1.00 (Reference)
1.14(0.89–1.46)
0.74(0.34–1.59)
0.67
Female subgroup
Multivariable-adjusted OR
1.00 (Reference)
1.01(0.73–1.37)
0.58(0.38–0.87)
0.02
BMI < 25 kg/m2 subgroup
Multivariable-adjusted model
1.00 (Reference)
0.97(0.76–1.25)
0.56(0.37–0.84)
0.03
BMI ≥ 25 kg/m2 subgroup
    
Multivariable-adjusted OR
1.00 (Reference)
1.26(0.93–1.70)
0.78(0.45–1.34)
0.84
OA osteoarthritis, OP osteoporosis, BMI body mass index
*The multivariable-adjusted model was adjusted for sex, age, BMI, smoking status, alcohol drinking status, activity level, mean total energy intake, mean Ca intake, as well as Ca supplementation. The prevalence of osteopenia and OP in overweight (BMI ≥ 25 kg/m2) population was 25.6 % and 6.9 %, respectively
Multivariable-adjusted relations of phalangeal BMD with JSN and OST are show in Table 4. There was a significantly lower prevalence of OSTs in the OP group than in the no-OP group (OR = 0.59, 95%CI 0.40–0.88; P for trend was 0.01). In contrast, the prevalence of JSN was significantly higher in the osteopenia and OP groups than in the no-OP group (osteopenia: OR = 1.22, 95 % CI 1.00–1.48; OP: OR = 1.35, 95 % CI 1.00–1.84). The P for trend was 0.02.
Table 4
Multivariable-adjusted relations of phalangeal BMD with JSN and OST (n = 2855)
 
Status of OP
 
 
Normal
Osteopenia
OP
P for trend
Participants (n)
1803
786
266
-
OST (n)
195
122
60
-
Multivariable-adjusted OR
1.00 (Reference)
0.85(0.65, 1.12)
0.59(0.40, 0.88)
0.01
JSN (n)
444
245
102
-
Multivariable-adjusted OR
1.00 (Reference)
1.22 (1.00, 1.48)
1.35 (1.00, 1.84)
0.02
OP osteoporosis, OST Osteophyte, JSN joint space narrowing
*The multivariable-adjusted model was adjusted for sex, age, BMI, smoking status, alcohol drinking status, activity level, mean total energy intake, mean Ca intake, as well as Ca supplementation
Multivariable-adjusted relations of OP and radiographic knee OA reveals the multivariable-adjusted association of OP and radiographic knee OA. The outcome suggests a negative association between OP and OA (OR = 0.60, 95 % CI 0.44–0.82, P = 0.001) (Additional file 1).

Discussion

The present study showed that the overall prevalence of definitive radiographic knee OA was 29.2 % (30.0 % in men, 28.1 % in women). We found lower odds for the appearance of radiographic knee OA and OST in OP patients than in those with normal knees. The prevalence of JSN was higher in patients with osteopenia and OP than in normal subjects.
As far as we know, this is the first study that has evaluated phalangeal BMD in relation to radiographic knee OA with adjustment of various factors for the Chinese population. In line with most previous research findings, this study observed lower odds for the presence of radiographic knee OA and OST in OP patients than in normal knee subjects independent of certain confounding factors, such as sex, age, BMI, smoking, alcohol drinking, activity level, mean total energy intake, mean Ca intake, and Ca supplementation. The proportion of overweight men was higher than that of overweight women (45.8 % vs. 35.5 %, P < 0.001), which may be the main reason why the prevalence of knee OA was similar in men and women in this population.
A report from Global Adult Tobacco Survey showed that the overall cigarette smoking rate of the Chinese population >15 years of age is 28.1 %, including 52.9 % of the male population and 2.4 % of the female population [44]. The WHO estimated that, globally, about 53 % of people aged ≥ 15 years have ever consumed alcohol, and that alcohol consumption is generally more prevalent among men [45]. As there is a significantly higher male ratio in the no-OP group than in the OP group, it makes sense that the prevalence of smoking and alcohol drinking is higher in the former group. The prevalence of OA was supposed to be the highest in the no-OP group as people with low BMD are less likely to suffer from OA. However, we observed that the age in the no-OP group was much younger than osteopenia and OP group, which might explain why the prevalence of OA was the lowest in this group.
BMD measurement at the hip and spine with dual-energy X-ray absorptiometry (DXA) is considered the gold standard for diagnosing OP [14, 46]. However, it is a very expensive method that requires frequent calibration to work properly, so it is not always available in developing countries. Using radiographic absorptiometry (RA) (MetriScan) and DXA (Hologic 4500-A; Hologic Inc., Waltham, Mass., USA), Hansen measured the BMD of the intermediate phalanges of the second to fourth fingers, the lumbar spine (L2-L4), and the total hip in 218 men aged 60–74 years (mean 68.8 years). He concluded that RA has moderate ability to identify osteoporotic individuals. RA, however, may be used as a pre-screening tool for men because it could rule out the diagnosis in half the population at little cost [47]. In comparison with DXA as demonstrated by Daniel, this methodology is less expensive, portable, versatile, and accurate for studying changes in the density of materials [48]. The efficacy of phalangeal BMD RA, when using the same device, has been studied by several authors in different cohorts [4951].
There are several explanations for the lower odds for the presence of radiographic knee OA and OST in OP patients. BMD reflects the quality of bone. A high BMD indicates increased bone quality, which in turn could reduce the fracture risk in patients with OP. Nevitt’s study proved the existence of an association between OSTs and femoral BMD [52]. Both OSTs and bone density can be explained by bone formation. This theory suggests that high BMD is “bone formers” and shows a trend of OSTs formation, whereas low BMD levels are perhaps “bone absorbers” and may cause bone mass loss [53, 54]. Highly increased periarticular bone mass may increase the mechanical stress on cartilage and hence increase the risk of OA [55].
General factors may also play a role in OA as the disease often affects more than a single joint. Dequeker measured iliac crest bone of patients with hand OA and found that elevated serum insulin-like growth factor I (IGF-1) could stimulate OST formation. Therefore, he concluded that insulin might have an anabolic effect on bone, leading to high BMD [56]. In our study, the prevalence of JSN was greater in osteopenia and OP groups than in the no-OP group. This is in accord with Ding’s results, who also found JSN in both hips and knees in association with greater total-hip bone loss [57]. The mechanisms for the associations among JSN, OSTs, and bone loss are unclear. They were all adjusted for BMI, sex, age, activity level, and vitamin D status, suggesting that they may be independent of these common risk factors that are shared by OA and OP.
Summarizing previous studies, high bone mass in OA patients may be caused by multiple factors, including genetic factors, common risk factors, the role of subchondral bone in cartilage damage, actions of growth factors, such as IGF − I and IGF − II, and transforming growth factor β. In this study, with adjustments for age, height, body weight, BMI and so on, the significance was also observed in women with OA of the knee. Therefore, the above factors, in addition to common risk factors (e.g., high body weight or obesity), may contribute to the high BMD in patients with OA of the knee, although their specific relation with BMD have not yet been identified. Further studies may be needed to clarify the uncertainty.
The findings of this study have demonstrated a significant association between elevated metacarpal BMD and radiographic knee OA in the female subgroup, but not in the male subgroup. The reason for the apparent sex difference is still unclear. It may be due to dissimilar risk factor profiles for knee OA. That is, women may be more affected by metabolic factors and men by joint injuries. This study also shows that women with significantly increased BMD—considered to be a protective factor for OP—have a greater chance of developing OA. Higher BMD means that the weight-bearing joints may suffer from heavier impact and pressure, so the cartilage is more likely to be damaged [58]. The present study also indicated a significant association between elevated metacarpal BMD and radiographic knee OA in the normal-weight subgroup, but not in those who are overweight. The reason is not discussed in this study, and further exploration is needed.
Limitations of the present study should also be acknowledged. First, the cross-sectional design of this study precluded causal relationships. Thus, further prospective studies should be carried out to establish a causal association between OA and OP. Second, as our study based on health examination, we only recorded BMD of people who are osteopenia or OP, leaving those with normal BMD unrecorded. But it did not affect data analysis. Another limitation of this study lies in the relatively small sample size of some subgroup analyses. Future research with a larger sample size is needed to confirm the subgroup analysis findings obtained here.

Conclusions

This study observed lower odds for the presence of radiographic knee OA and OST in OP patients than in normal subjects. The prevalence of JSN was higher in the osteopenia and OP groups than in normal subjects.

Acknowledgments

This work was supported by the Hunan Provincial Innovation Foundation for Postgraduate (CX2014A005), the National Natural Science Foundation of China (No. 81201420, 81272034, 81472130, 81501923), the Provincial Science Foundation of Hunan (No. 14JJ3032), the Scientific Research Project of the Development and Reform Commission of Hunan Province ([2013]1199), the Scientific Research Project of Science and Technology Office of Hunan Province (2013SK2018), the Doctoral Scientific Fund Project of the Ministry of Education of China (20120162110036).
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.

Competing interests

These authors declared that they have no competing interests.

Authors’ contributions

ZD study design, data collection and analyses, manuscript preparation. CZ study design, data collection and analyses, manuscript preparation. YL data acquisition, manuscript preparation. TY data acquisition, manuscript preparation. HL data acquisition, manuscript preparation. JW data acquisition, manuscript preparation. GHL study design, data analyses, manuscript preparation. All authors read and approved the final manuscript.
Literatur
1.
Zurück zum Zitat Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, et al. Osteoarthritis. Lancet. 2015;386(9991):376–87.CrossRefPubMed Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, et al. Osteoarthritis. Lancet. 2015;386(9991):376–87.CrossRefPubMed
2.
Zurück zum Zitat Curtis EM, Moon RJ, Dennison EM, Harvey NC, Cooper C. Recent advances in the pathogenesis and treatment of osteoporosis. Clin Med. 2015;15 Suppl 6:s92–6.CrossRef Curtis EM, Moon RJ, Dennison EM, Harvey NC, Cooper C. Recent advances in the pathogenesis and treatment of osteoporosis. Clin Med. 2015;15 Suppl 6:s92–6.CrossRef
3.
Zurück zum Zitat Kim BH, Lee S, Yoo B, Lee WY, Lim Y, Kim MC, et al. Risk factors associated with outcomes of hip fracture surgery in elderly patients. Korean J Anesthesiol. 2015;68(6):561–7.PubMedCentralCrossRefPubMed Kim BH, Lee S, Yoo B, Lee WY, Lim Y, Kim MC, et al. Risk factors associated with outcomes of hip fracture surgery in elderly patients. Korean J Anesthesiol. 2015;68(6):561–7.PubMedCentralCrossRefPubMed
4.
Zurück zum Zitat Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646–50. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993;94(6):646–50.
6.
Zurück zum Zitat Herrero-Beaumont G, Roman-Blas JA, Largo R, Berenbaum F, Castaneda S. Bone mineral density and joint cartilage: four clinical settings of a complex relationship in osteoarthritis. Ann Rheum Dis. 2011;70(9):1523–5.CrossRefPubMed Herrero-Beaumont G, Roman-Blas JA, Largo R, Berenbaum F, Castaneda S. Bone mineral density and joint cartilage: four clinical settings of a complex relationship in osteoarthritis. Ann Rheum Dis. 2011;70(9):1523–5.CrossRefPubMed
7.
Zurück zum Zitat Ryd L, Brittberg M, Eriksson K, Jurvelin JS, Lindahl A, Marlovits S, et al. Pre-Osteoarthritis: Definition and Diagnosis of an Elusive Clinical Entity. Cartilage. 2015;6(3):156–65.CrossRefPubMed Ryd L, Brittberg M, Eriksson K, Jurvelin JS, Lindahl A, Marlovits S, et al. Pre-Osteoarthritis: Definition and Diagnosis of an Elusive Clinical Entity. Cartilage. 2015;6(3):156–65.CrossRefPubMed
8.
Zurück zum Zitat Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):5–15.CrossRefPubMed Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014;28(1):5–15.CrossRefPubMed
9.
Zurück zum Zitat Leslie WD, Morin SN. Osteoporosis epidemiology 2013: implications for diagnosis, risk assessment, and treatment. Curr Opin Rheumatol. 2014;26(4):440–6.CrossRefPubMed Leslie WD, Morin SN. Osteoporosis epidemiology 2013: implications for diagnosis, risk assessment, and treatment. Curr Opin Rheumatol. 2014;26(4):440–6.CrossRefPubMed
11.
Zurück zum Zitat Ferencz V, Horvath C, Huszar S, Bors K. Assessment of risk factors for fractures in postmenopausal women with osteoporosis. Orv Hetil. 2015;156(4):146–53.12.CrossRefPubMed Ferencz V, Horvath C, Huszar S, Bors K. Assessment of risk factors for fractures in postmenopausal women with osteoporosis. Orv Hetil. 2015;156(4):146–53.12.CrossRefPubMed
12.
Zurück zum Zitat Wang DM, Zeng QY, Chen SB, Gong Y, Hou ZD, Xiao ZY. Prevalence and risk factors of osteoporosis in patients with ankylosing spondylitis: a 5-year follow-up study of 504 cases. Clin Exp Rheumatol. 2015;33(4):465–70.PubMed Wang DM, Zeng QY, Chen SB, Gong Y, Hou ZD, Xiao ZY. Prevalence and risk factors of osteoporosis in patients with ankylosing spondylitis: a 5-year follow-up study of 504 cases. Clin Exp Rheumatol. 2015;33(4):465–70.PubMed
13.
Zurück zum Zitat Dequeker J. Inverse relationship osteoarthritis-osteoporosis: what is the evidence? What are the consequences? Br J Rheumatol. 1996;35(9):813–20.CrossRefPubMed Dequeker J. Inverse relationship osteoarthritis-osteoporosis: what is the evidence? What are the consequences? Br J Rheumatol. 1996;35(9):813–20.CrossRefPubMed
14.
Zurück zum Zitat Ito M. Absolute risk for fracture and WHO guideline. Recent interest in bone quality. Clin Calcium. 2007;17(7):1066–70.PubMed Ito M. Absolute risk for fracture and WHO guideline. Recent interest in bone quality. Clin Calcium. 2007;17(7):1066–70.PubMed
15.
Zurück zum Zitat Dequeker J, Aerssens J, Luyten FP. Osteoarthritis and osteoporosis: clinical and research evidence of inverse relationship. Aging Clin Exp Res. 2003;15(5):426–39.CrossRefPubMed Dequeker J, Aerssens J, Luyten FP. Osteoarthritis and osteoporosis: clinical and research evidence of inverse relationship. Aging Clin Exp Res. 2003;15(5):426–39.CrossRefPubMed
16.
Zurück zum Zitat Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE. The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: a cohort study in 1.2 million persons. Arthritis Rheum. 2006;54(3):802–7.CrossRefPubMed Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE. The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: a cohort study in 1.2 million persons. Arthritis Rheum. 2006;54(3):802–7.CrossRefPubMed
17.
Zurück zum Zitat Jarvholm B, Lewold S, Malchau H, Vingard E. Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men. Eur J Epidemiol. 2005;20(6):537–42.CrossRefPubMed Jarvholm B, Lewold S, Malchau H, Vingard E. Age, bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men. Eur J Epidemiol. 2005;20(6):537–42.CrossRefPubMed
18.
Zurück zum Zitat Reijman M, Pols HA, Bergink AP, Hazes JM, Belo JN, Lievense AM, et al. Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study. Ann Rheum Dis. 2007;66(2):158–62.PubMedCentralCrossRefPubMed Reijman M, Pols HA, Bergink AP, Hazes JM, Belo JN, Lievense AM, et al. Body mass index associated with onset and progression of osteoarthritis of the knee but not of the hip: the Rotterdam Study. Ann Rheum Dis. 2007;66(2):158–62.PubMedCentralCrossRefPubMed
19.
Zurück zum Zitat Yoshimura N, Muraki S, Oka H, Mabuchi A, Kinoshita H, Yosihda M, et al. Epidemiology of lumbar osteoporosis and osteoarthritis and their causal relationship--is osteoarthritis a predictor for osteoporosis or vice versa?: the Miyama study. Osteoporos Int. 2009;20(6):999–1008.CrossRefPubMed Yoshimura N, Muraki S, Oka H, Mabuchi A, Kinoshita H, Yosihda M, et al. Epidemiology of lumbar osteoporosis and osteoarthritis and their causal relationship--is osteoarthritis a predictor for osteoporosis or vice versa?: the Miyama study. Osteoporos Int. 2009;20(6):999–1008.CrossRefPubMed
20.
Zurück zum Zitat Okano K, Ito M, Aoyagi K, Osaki M, Enomoto H, Yamaguchi K. Discrepancy in bone mineral densities at different skeletal sites in hip osteoarthritis patients. Mod Rheumatol. 2014;24(2):340–2.CrossRefPubMed Okano K, Ito M, Aoyagi K, Osaki M, Enomoto H, Yamaguchi K. Discrepancy in bone mineral densities at different skeletal sites in hip osteoarthritis patients. Mod Rheumatol. 2014;24(2):340–2.CrossRefPubMed
21.
Zurück zum Zitat Guler-Yuksel M, Bijsterbosch J, Allaart CF, Meulenbelt I, Kroon HM, Watt I. Accelerated metacarpal bone mineral density loss is associated with radiographic progressive hand osteoarthritis. Ann Rheum Dis. 2011;70(9):1625–30.CrossRefPubMed Guler-Yuksel M, Bijsterbosch J, Allaart CF, Meulenbelt I, Kroon HM, Watt I. Accelerated metacarpal bone mineral density loss is associated with radiographic progressive hand osteoarthritis. Ann Rheum Dis. 2011;70(9):1625–30.CrossRefPubMed
22.
Zurück zum Zitat Bergink AP, Uitterlinden AG, Van Leeuwen JP, Hofman A, Verhaar JA, Pols HA. Bone mineral density and vertebral fracture history are associated with incident and progressive radiographic knee osteoarthritis in elderly men and women: the Rotterdam Study. Bone. 2005;37(4):446–56.CrossRefPubMed Bergink AP, Uitterlinden AG, Van Leeuwen JP, Hofman A, Verhaar JA, Pols HA. Bone mineral density and vertebral fracture history are associated with incident and progressive radiographic knee osteoarthritis in elderly men and women: the Rotterdam Study. Bone. 2005;37(4):446–56.CrossRefPubMed
23.
Zurück zum Zitat Povoroznyuk V, Lamy O, Dzerovych N, Hans D. Trabecular bone score and BMD of lumbar spine in healthy women: Pros and cons. Osteoporos Int. 2013;24(1):S244. Povoroznyuk V, Lamy O, Dzerovych N, Hans D. Trabecular bone score and BMD of lumbar spine in healthy women: Pros and cons. Osteoporos Int. 2013;24(1):S244.
24.
Zurück zum Zitat Im GI, Kwon OJ, Kim CH. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: A cross-sectional study from a Korean population in women. CiOS Clin Orthop Surg. 2014;6(4):420–5.CrossRefPubMed Im GI, Kwon OJ, Kim CH. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: A cross-sectional study from a Korean population in women. CiOS Clin Orthop Surg. 2014;6(4):420–5.CrossRefPubMed
25.
Zurück zum Zitat Bischoff-Ferrari HA, Zhang Y, Kiel DP, Felson DT. Positive association between serum 25-hydroxyvitamin d level and bone density in osteoarthritis. Arthritis Rheum. 2005;53(6):821–6.CrossRefPubMed Bischoff-Ferrari HA, Zhang Y, Kiel DP, Felson DT. Positive association between serum 25-hydroxyvitamin d level and bone density in osteoarthritis. Arthritis Rheum. 2005;53(6):821–6.CrossRefPubMed
26.
Zurück zum Zitat Iwamoto J, Takeda T, Ichimura S. Forearm bone mineral density in postmenopausal women with osteoarthritis of the knee. J Orthop Sci. 2002;7(1):19–25.CrossRefPubMed Iwamoto J, Takeda T, Ichimura S. Forearm bone mineral density in postmenopausal women with osteoarthritis of the knee. J Orthop Sci. 2002;7(1):19–25.CrossRefPubMed
27.
Zurück zum Zitat Sudo A, Miyamoto N, Horikawa K. Prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women. J Orthop Sci. 2008;13(5):413–8.CrossRefPubMed Sudo A, Miyamoto N, Horikawa K. Prevalence and risk factors for knee osteoarthritis in elderly Japanese men and women. J Orthop Sci. 2008;13(5):413–8.CrossRefPubMed
28.
Zurück zum Zitat Ichchou L, Allali F, Rostom S, Bennani L, Hmamouchi I, Abourazzak FZ, et al. Relationship between spine osteoarthritis, bone mineral density and bone turn over markers in post-menopausal women. BMC Womens Health. 2010;10:25.PubMedCentralCrossRefPubMed Ichchou L, Allali F, Rostom S, Bennani L, Hmamouchi I, Abourazzak FZ, et al. Relationship between spine osteoarthritis, bone mineral density and bone turn over markers in post-menopausal women. BMC Womens Health. 2010;10:25.PubMedCentralCrossRefPubMed
29.
Zurück zum Zitat Burnett WD, Kontulainen SA, McLennan CE, Hazel D, Talmo C, Hunter DJ, et al. Knee osteoarthritis patients with severe nocturnal pain have altered proximal tibial subchondral bone mineral density. Osteoarthritis Cartilage. 2015;23(9):1483–90.CrossRefPubMed Burnett WD, Kontulainen SA, McLennan CE, Hazel D, Talmo C, Hunter DJ, et al. Knee osteoarthritis patients with severe nocturnal pain have altered proximal tibial subchondral bone mineral density. Osteoarthritis Cartilage. 2015;23(9):1483–90.CrossRefPubMed
30.
Zurück zum Zitat Jones G, Nguyen T, Sambrook PN, Lord SR, Kelly PJ, Eisman JA. Osteoarthritis, bone density, postural stability, and osteoporotic fracture: a population based study. J Rheumatol. 1995;22(5):921–5.PubMed Jones G, Nguyen T, Sambrook PN, Lord SR, Kelly PJ, Eisman JA. Osteoarthritis, bone density, postural stability, and osteoporotic fracture: a population based study. J Rheumatol. 1995;22(5):921–5.PubMed
31.
Zurück zum Zitat Arden NK, Nevitt MC, Lane NE, Gore LR, Hochberg MC, Scott JC, et al. Osteoarthritis and the risk of falls, rates of bone loss, and osteoporotic fractures. Arthritis Rheum. 1999;42(7):1378–85.CrossRefPubMed Arden NK, Nevitt MC, Lane NE, Gore LR, Hochberg MC, Scott JC, et al. Osteoarthritis and the risk of falls, rates of bone loss, and osteoporotic fractures. Arthritis Rheum. 1999;42(7):1378–85.CrossRefPubMed
32.
Zurück zum Zitat Goerres GW, Häuselmann HJ, Seifert B, Michel BA, Uebelhart D. Patients with knee osteoarthritis have lower total hip bone mineral density in thesymptomatic leg than in the contralateral hip. J Clin Densitom. 2005;8(4):484–7.CrossRefPubMed Goerres GW, Häuselmann HJ, Seifert B, Michel BA, Uebelhart D. Patients with knee osteoarthritis have lower total hip bone mineral density in thesymptomatic leg than in the contralateral hip. J Clin Densitom. 2005;8(4):484–7.CrossRefPubMed
33.
Zurück zum Zitat El-Sherif HE, Kamal R, Moawyah O. Hand osteoarthritis and bone mineral density in postmenopausal women; clinicalrelevance to hand function, pain and disability. Osteoarthritis Cartilage. 2008;16(1):12–7.CrossRefPubMed El-Sherif HE, Kamal R, Moawyah O. Hand osteoarthritis and bone mineral density in postmenopausal women; clinicalrelevance to hand function, pain and disability. Osteoarthritis Cartilage. 2008;16(1):12–7.CrossRefPubMed
34.
Zurück zum Zitat Zhang Y, Zeng C, Li H, Yang T, Deng ZH, Yang Y, et al. Relationship between cigarette smoking and radiographic knee osteoarthritis in Chinese population: a cross-sectional study. Rheumatol Int. 2015. [Epub ahead of print] Zhang Y, Zeng C, Li H, Yang T, Deng ZH, Yang Y, et al. Relationship between cigarette smoking and radiographic knee osteoarthritis in Chinese population: a cross-sectional study. Rheumatol Int. 2015. [Epub ahead of print]
35.
Zurück zum Zitat Peterfy CG, Li J, Duryea J, Lynch JA, Miaux Y, Genant HK. Nonfluoroscopic method for flexed radiography of the knee that allows reproducible joint-space width measurement. Abstract Arthritis Rheum. 1998;41 Suppl 89:S361. Peterfy CG, Li J, Duryea J, Lynch JA, Miaux Y, Genant HK. Nonfluoroscopic method for flexed radiography of the knee that allows reproducible joint-space width measurement. Abstract Arthritis Rheum. 1998;41 Suppl 89:S361.
36.
Zurück zum Zitat Kothari M, Guermazi A, von Ingersleben G, Miaux Y, Sieffert M, Block JE, et al. Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol. 2004;14(9):1568–73.CrossRefPubMed Kothari M, Guermazi A, von Ingersleben G, Miaux Y, Sieffert M, Block JE, et al. Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. Eur Radiol. 2004;14(9):1568–73.CrossRefPubMed
38.
Zurück zum Zitat Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1–129. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1–129.
39.
Zurück zum Zitat Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage. 2007;15(Suppl A):A1–56.CrossRefPubMed Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage. 2007;15(Suppl A):A1–56.CrossRefPubMed
40.
Zurück zum Zitat Matkovic V, Jelic T, Wardlaw GM, Ilich JZ, Goel PK, Wright JK, et al. Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model. J Clin Invest. 1994;93(2):799–808.PubMedCentralCrossRefPubMed Matkovic V, Jelic T, Wardlaw GM, Ilich JZ, Goel PK, Wright JK, et al. Timing of peak bone mass in Caucasian females and its implication for the prevention of osteoporosis. Inference from a cross-sectional model. J Clin Invest. 1994;93(2):799–808.PubMedCentralCrossRefPubMed
41.
Zurück zum Zitat Cheng Y, Dibley MJ, Zhang X, Zeng L, Yan H. Assessment of dietary intake among pregnant women in a rural area of western China. BMC Public Health. 2009;9:222.PubMedCentralCrossRefPubMed Cheng Y, Dibley MJ, Zhang X, Zeng L, Yan H. Assessment of dietary intake among pregnant women in a rural area of western China. BMC Public Health. 2009;9:222.PubMedCentralCrossRefPubMed
42.
Zurück zum Zitat Wei J, Zeng C, Gong QY, Yang HB, Li XX, Lei GH, et al. The association between dietary selenium intake and diabetes: a cross-sectional study among middle-aged and older adults. Nutr J. 2015;14(1):18.PubMedCentralCrossRefPubMed Wei J, Zeng C, Gong QY, Yang HB, Li XX, Lei GH, et al. The association between dietary selenium intake and diabetes: a cross-sectional study among middle-aged and older adults. Nutr J. 2015;14(1):18.PubMedCentralCrossRefPubMed
44.
Zurück zum Zitat Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet. 2012;380(9842):668–79.CrossRefPubMed Giovino GA, Mirza SA, Samet JM, Gupta PC, Jarvis MJ, Bhala N, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet. 2012;380(9842):668–79.CrossRefPubMed
45.
Zurück zum Zitat World Health Organisation. Global Status Report on Alcohol and Health. Geneva: World Health Organization; 2014. World Health Organisation. Global Status Report on Alcohol and Health. Geneva: World Health Organization; 2014.
46.
Zurück zum Zitat Boot AM, de Ridder AAJ, van der Sluis IM, van Slobbe I, Krenning EP, SMPF d M K-S. Peak bone mineral density, lean body mass and fractures. Bone. 2010;46(2):336–41.CrossRefPubMed Boot AM, de Ridder AAJ, van der Sluis IM, van Slobbe I, Krenning EP, SMPF d M K-S. Peak bone mineral density, lean body mass and fractures. Bone. 2010;46(2):336–41.CrossRefPubMed
47.
Zurück zum Zitat Hansen SJ, Nielsen MM, Ryg J, Wraae K, Andersen M, Brixen K. Radiographic absorptiometry as a screening tool in male osteoporosis: results from the odense androgen study. Acta Radiol. 2009;50(6):658–63.CrossRefPubMed Hansen SJ, Nielsen MM, Ryg J, Wraae K, Andersen M, Brixen K. Radiographic absorptiometry as a screening tool in male osteoporosis: results from the odense androgen study. Acta Radiol. 2009;50(6):658–63.CrossRefPubMed
48.
Zurück zum Zitat Jimenez-Mendoza D, Espinosa-Arbelaez DG, Giraldo-Betancur AL, Hernandez-Urbiola MI, Vargas-Vazquez D, Rodriguez-Garcia ME. Single x-ray transmission system for bone mineral density determination. Rev Sci Instrum. 2011;82(12):125105.CrossRefPubMed Jimenez-Mendoza D, Espinosa-Arbelaez DG, Giraldo-Betancur AL, Hernandez-Urbiola MI, Vargas-Vazquez D, Rodriguez-Garcia ME. Single x-ray transmission system for bone mineral density determination. Rev Sci Instrum. 2011;82(12):125105.CrossRefPubMed
49.
Zurück zum Zitat Boonen S, Nijs J, Borghs H, Peeters H, Vanderschueren D, Luyten FP. Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital x-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study. Osteoporos Int. 2005;16(1):93–100.CrossRefPubMed Boonen S, Nijs J, Borghs H, Peeters H, Vanderschueren D, Luyten FP. Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital x-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study. Osteoporos Int. 2005;16(1):93–100.CrossRefPubMed
50.
Zurück zum Zitat Buch I, Oturai PS, Jensen LT. Radiographic absorptiometry for pre-screening of osteoporosis in patients with low energy fractures. Scand J Clin Lab Invest. 2010;70(4):269–74.CrossRefPubMed Buch I, Oturai PS, Jensen LT. Radiographic absorptiometry for pre-screening of osteoporosis in patients with low energy fractures. Scand J Clin Lab Invest. 2010;70(4):269–74.CrossRefPubMed
51.
Zurück zum Zitat Thorpe JA, Steel SA. The alara metriscan phalangeal densitometer: evaluation and triage thresholds. Br J Radiol. 2008;81(970):778–83.CrossRefPubMed Thorpe JA, Steel SA. The alara metriscan phalangeal densitometer: evaluation and triage thresholds. Br J Radiol. 2008;81(970):778–83.CrossRefPubMed
52.
Zurück zum Zitat Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, et al. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995;38(7):907–16.CrossRefPubMed Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, et al. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum. 1995;38(7):907–16.CrossRefPubMed
53.
Zurück zum Zitat Sowers M, Zobel D, Weissfeld L, Hawthorne VM, Carman W. Progression of osteoarthritis of the hand and metacarpal bone loss. A twenty-year followup of incident cases. Arthritis Rheum. 1991;34(1):36–42.CrossRefPubMed Sowers M, Zobel D, Weissfeld L, Hawthorne VM, Carman W. Progression of osteoarthritis of the hand and metacarpal bone loss. A twenty-year followup of incident cases. Arthritis Rheum. 1991;34(1):36–42.CrossRefPubMed
54.
Zurück zum Zitat Burger H, van Daele PL, Odding E, Valkenburg HA, Hofman A, Grobbee DE, et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum. 1996;39(1):81–6.CrossRefPubMed Burger H, van Daele PL, Odding E, Valkenburg HA, Hofman A, Grobbee DE, et al. Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum. 1996;39(1):81–6.CrossRefPubMed
55.
Zurück zum Zitat Bruyere O, Dardenne C, Lejeune E, Zegels B, Pahaut A, Richy F, et al. Subchondral tibial bone mineral density predicts future joint space narrowing at the medial femoro-tibial compartment in patients with knee osteoarthritis. Bone. 2003;32(5):541–5.CrossRefPubMed Bruyere O, Dardenne C, Lejeune E, Zegels B, Pahaut A, Richy F, et al. Subchondral tibial bone mineral density predicts future joint space narrowing at the medial femoro-tibial compartment in patients with knee osteoarthritis. Bone. 2003;32(5):541–5.CrossRefPubMed
56.
Zurück zum Zitat Dequeker J, Mohan S, Finkelman RD, Aerssens J, Baylink DJ. Generalized osteoarthritis associated with increased insulin-like growth factor types I and II and transforming growth factor beta in cortical bone from the iliac crest. Possible mechanism of increased bone density and protection against osteoporosis. Arthritis Rheum. 1993;36(12):1702–8.CrossRefPubMed Dequeker J, Mohan S, Finkelman RD, Aerssens J, Baylink DJ. Generalized osteoarthritis associated with increased insulin-like growth factor types I and II and transforming growth factor beta in cortical bone from the iliac crest. Possible mechanism of increased bone density and protection against osteoporosis. Arthritis Rheum. 1993;36(12):1702–8.CrossRefPubMed
57.
Zurück zum Zitat Ding C, Cicuttini F, Boon C, Boon P, Srikanth V, Cooley H, et al. Knee and hip radiographic osteoarthritis predict total hip bone loss in older adults: a prospective study. J Bone Miner Res. 2010;25(4):858–65.PubMed Ding C, Cicuttini F, Boon C, Boon P, Srikanth V, Cooley H, et al. Knee and hip radiographic osteoarthritis predict total hip bone loss in older adults: a prospective study. J Bone Miner Res. 2010;25(4):858–65.PubMed
58.
Zurück zum Zitat Coster MC, Rosengren BE, Karlsson C, von Schevelow T, Magnusson H, Brudin L, et al. Bone mass and anthropometry in patients with osteoarthritis of the foot and ankle. Foot Ankle Surg. 2014;20(1):52–6.CrossRefPubMed Coster MC, Rosengren BE, Karlsson C, von Schevelow T, Magnusson H, Brudin L, et al. Bone mass and anthropometry in patients with osteoarthritis of the foot and ankle. Foot Ankle Surg. 2014;20(1):52–6.CrossRefPubMed
Metadaten
Titel
Relation between phalangeal bone mineral density and radiographic knee osteoarthritis: a cross-sectional study
verfasst von
Zhen-han Deng
Chao Zeng
Yu-sheng Li
Tuo Yang
Hui Li
Jie Wei
Guang-hua Lei
Publikationsdatum
01.12.2016
Verlag
BioMed Central
Erschienen in
BMC Musculoskeletal Disorders / Ausgabe 1/2016
Elektronische ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-0918-x

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