Subregional statistical shape modelling identifies lesser trochanter size as a possible risk factor for radiographic hip osteoarthritis, a cross-sectional analysis from the Osteoporotic Fractures in Men Study

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Summary

Objective

Statistical shape modelling (SSM) of hip dual-energy X-ray absorptiometry (DXA) scans has identified relationships between hip shape and radiographic hip OA (rHOA). We aimed to further elucidate shape characteristics related to rHOA by focusing on subregions identified from whole-hip shape models.

Method

SSM was applied to hip DXAs obtained in the Osteoporotic Fractures in Men Study. Whole-hip shape modes (HSMs) associated with rHOA were combined to form a composite at-risk-shape. Subsequently, subregional HSMs (cam-type and lesser trochanter modes) were built, and associations with rHOA were examined by logistic regression. Subregional HSMs were further characterised, by examining associations with 3D-HSMs derived from concurrent hip CT scans.

Results

4,098 participants were identified with hip DXAs and radiographs. Composite shapes from whole-hip HSMs revealed that lesser trochanter size and cam-type femoral head are related to rHOA. From sub-regional models, lesser trochanter mode (LTM)1 [OR 0.74; 95%CI 0.63.0.87] and cam-type mode (CTM)3 [OR 1.27; 1.13.1.42] were associated with rHOA, associations being similar to those for whole hip HSMs. 515 MrOS participants had hip DXAs and 3D-HSMs derived from hip CT scans. LTM1 was associated with 3D-HSMs that also represented a larger lesser trochanter [3D-HSM7 (beta ( β)-0.23;-0.33,-0.14) and 3D-HSM9 (β0.36; 0.27.0.45)], and CTM3 with 3D-HSMs describing cam morphology [3D-HSM3 (β-0.16;-0.25,-0.07) and 3D-HSM6 ( β 0.19; 0.10.0.28)].

Conclusion

Subregional SSM of hip DXA scans suggested larger lesser trochanter and cam morphology underlie associations between overall hip shape and rHOA. 3D hip modelling suggests our subregional SSMs represent true anatomical variations in hip shape, warranting further investigation.

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Most cited references 30

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Femoroacetabular impingement: a cause for osteoarthritis of the hip.

Reinhold Ganz, Javad Parvizi, Martin Beck … (2003)

A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.

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Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study--a large observational study of the determinants of fracture in older men.

Eric S Orwoll, Janet Blank, Elizabeth Barrett-Connor … (2005)

Very little information is available to direct the prevention or management of osteoporosis in men. The Osteoporotic Fractures in Men (MrOS) Study is a prospective cohort study designed to examine the extent to which fracture risk is related to bone mass, bone geometry, lifestyle, anthropometric and neuromuscular measures, and fall propensity, as well as to determine how fractures affect quality of life in men. The study is also designed to understand how osteoporosis is related to prostate disease. At baseline, participants completed questionnaires regarding medical history, medications, physical activity, diet, alcohol intake, and cigarette smoking. Objective measures of anthropometric, neuromuscular, vision, strength, and cognitive variables were obtained. Skeletal assessments included DEXA, calcaneal ultrasound, and vertebral radiographs. Vertebral and proximal femoral QCT was performed on a subset (65%). Serum, urine, and DNA specimens were collected. After the baseline assessments, a questionnaire is mailed to participants every 4 months to ascertain incident falls, fractures, prostate cancer, and deaths. After an average of 4.5 years, participants are scheduled to return for a second comprehensive visit. Men were eligible if > or =65 years. 5995 men enrolled with a mean (+/-SD) age of 73.7 (+/-5.9) years, 11% of which were minorities. Most rated their health as good/excellent. Few were current smokers, although 59% had smoked previously, and 35% reported no alcohol intake, while 47% consumed at least 2 drinks per week. The mean (range) body mass index was 26.9 kg/m2 (17-56). A non-traumatic fracture after age 50 was reported by 17% of the cohort. The MrOS cohort should provide valuable information concerning the determinants of fracture in men and should help set the stage for the development of effective methods to identify those at risk.

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Overview of recruitment for the osteoporotic fractures in men study (MrOS).

Peter Blank, Eileen Mitson, Sherilee Harper … (2005)

Large, long term research studies present recruitment challenges that can be met with collaborative approaches to identify and enroll participants. The Osteoporotic Fractures in Men Study (MrOS), a multi-center observational study designed to determine risk factors for osteoporosis, fractures and prostate cancer in older men, recruited 5995 participants over a 25-month period. Enrolling a cohort that represented the race and age distribution of each community, and developing interest in an older male cohort about a condition commonly thought of as a "women's disease," were major recruitment challenges. During the start-up phase, recruitment challenges and strategies were analyzed and collective approaches were developed to address ways to motivate the target population. Key methods included mailings using community and provider contact lists; regional and senior newspaper advertisements; and presentations targeted to seniors. Sites used a centrally developed recruitment brochure. Response to mass mailings at some sites surpassed 10-15% and appointment show rates averaged above 85%. The final number enrolled in MrOS was 5% more than the original recruitment goal of 5700. Minority recruitment was enhanced through the use of the Health Care Financing Administration and other databases that allowed for targeted recruitment. Overall, minority enrollment was approximately 10.56% of the cohort (244 African American, 191 Asian). Men age>80 were enthusiastic and represent about 18% of enrollees. Through a coordinated approach of developing and refining recruitment strategies and materials, sites were able to adapt their original strategies and complete recruitment ahead of schedule.

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Author and article information

Contributors

B.G. Faber

Journal

Journal ID (nlm-ta): Osteoarthritis Cartilage

Journal ID (iso-abbrev): Osteoarthr. Cartil

Title: Osteoarthritis and Cartilage

Publisher: W.B. Saunders For The Osteoarthritis Research Society

ISSN (Print): 1063-4584

ISSN (Electronic): 1522-9653

Publication date PMC-release: 1 August 2020

Publication date (Print): August 2020

Volume: 28

Issue: 8

Pages: 1071-1078

Affiliations

[† ]Medical Research Council Clinical Research Fellow, Musculoskeletal Research Unit, University of Bristol, Bristol, UK

[‡ ]Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado, USA

[§ ]Integrative Epidemiology Unit, University of Bristol, Bristol, UK

[‖ ]Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK

[¶ ]Center for Musculoskeletal Health, U.C. Davis School of Medicine, Sacramento, CA 95817, USA

[# ]Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR, USA

[†† ]Musculoskeletal Research Unit, University of Bristol, Bristol, UK

Author notes

[∗ ]Address correspondence and reprint requests to: B.G. Faber, Musculoskeletal Research Unit, Southmead Hospital, Learning and Research Building, Bristol, BS10 5NB, UK. Tel: 44-0-117-414-7859. ben.faber@ 123456bristol.ac.uk

Article

Publisher ID: S1063-4584(20)30989-4

DOI: 10.1016/j.joca.2020.04.011

PMC ID: 7387228

PubMed ID: 32387760

SO-VID: a00c1266-807d-40b2-8689-b002d93d6154

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 22 November 2019

Date accepted : 27 April 2020

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Subregional statistical shape modelling identifies lesser trochanter size as a possible risk factor for radiographic hip osteoarthritis, a cross-sectional analysis from the Osteoporotic Fractures in Men Study

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Summary

Objective

Method

Results

Conclusion

Related collections

Core Readings in Statistical Mediation Analysis

Most cited references 30

Femoroacetabular impingement: a cause for osteoarthritis of the hip.

Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study--a large observational study of the determinants of fracture in older men.

Overview of recruitment for the osteoporotic fractures in men study (MrOS).

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