Individuals with High Bone Mass have increased progression of radiographic and clinical features of knee osteoarthritis.

April Hartley*, Sarah A Hardcastle, Lavinia Paternoster, Eugene McCloskey, Kenneth E S Poole, Muhammad Kassim Javaid, Mo Aye, Katie Moss, Raquel Granell, Jenny Gregory, Martin Williams, Jonathan H Tobias, Celia L Gregson

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
26 Downloads (Pure)


OBJECTIVE: High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant.

DESIGN: A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering.

RESULTS: 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 []), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [] and 0.15 [], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 []), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation.

CONCLUSIONS: HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.

Original languageEnglish
Pages (from-to)1180-1190
Number of pages11
JournalOsteoarthritis and Cartilage
Early online date14 May 2020
Publication statusPublished - 1 Sept 2020

Bibliographical note

Copyright © 2020 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.


  • osteoarthritis
  • progression
  • high bone mass
  • BMD
  • health-related quality of life


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