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Obesity And Osteoarthritis: How Strong Is The Connection?

Last modified 2014-03-25 18:33

is a degenerative disease of the joints, affecting 27 million Americans or 12.1% of the adult population in the United States. Because OA is the most common type of joint disease, it entails a high economic burden in the form of direct costs from joint replacement surgery and indirect costs, such as work-related or home-care expenditures. There are also immeasurable negative effects on quality of life.

The foremost symptom of OA is joint pain caused by the loss of articular cartilage, a protein matrix responsible for lubricating and cushioning the joint. Typical progression of the disease follows this sequence: pain while the joint is under stress; pain when the joint has been held in one position for a period of time (the so-called movie-goer's knee); and finally, pain even while the joint is at rest, during sleep. The joints most affected by OA are the knees, hands and hips.

OA therapy involves procedures that are either surgical (the replacement of the joint by plastic or metal parts) or non-surgical. Joint replacement (arthroplasty) is a major surgery and is the treatment of last resort, when all other therapies have failed to provide relief. Because of the danger to individuals with underlying risk factors, arthroplasty is often not available to the elderly or the obese, the two groups most commonly affected by OA.

Painkillers are often prescribed to alleviate the pain that accompanies OA. Tylenol, Ibuprofen and Non-Steroidal-Anti-Inflammatory-Drugs (NSAIDs) are common pharmacological treatments. Such medications carry the risk of liver damage and gastro-intestinal side effects, including internal bleeding.

Alternative treatments include physical therapy such as low-impact exercise designed to improve the strength of muscles surrounding the joint. can be an effective alternative treatment when used in conjunction with diet and lifestyle changes, as well as a course of natural supplements.

Natural remedies that go beyond pain relief and actually help repair the joint have gained in popularity as a treatment for OA. Independent studies have shown promise for the combination of glucosamine and chondroitin sulphate. Currently, over 5 million Americans take these substances as a means of relieving the symptoms of OA.


Does Obesity Cause Osteoarthritis?

has become one of the most dire public health issues of the 21st century and is one of the primary causes of preventable death worldwide. It is estimated that one third of the American population is obese and the percentage is rising. Studies have shown that obesity is strongly linked to musculoskeletal disorders, including OA.

A 2001 population-based conducted in Victoria, Australia showed that increased body mass index (BMI) was a strong predictor of OA for both men and women.


Obesity and Knee OA

Surveys conducted worldwide have shown that obesity has a consistent association with lower limb joint pain, particularly of the knee . One plausible causative agent is the amount of force exerted upon the knee joint by excess weight.

A 2006 survey conducted in Scotland collected information from 858 participants. The findings showed that obese people were 2.42 times as likely to have knee pain related to osteoarthritis.

Another study used data collected from 5,193 American participants during the HANES 1 survey of 1975. It was shown that the risk of developing knee OA doubled for each 5-unit increase in body mass index (BMI) .

The Chingford Study, conducted in the UK in 1999, took data from 840 middle-aged women over a period of 4 years. The findings showed that women with a BMI greater than 26.4 were twice as likely to develop osteophytes, or bone spurs, on arthritic joints than women with a BMI less than 23.4.

Obesity and Hip OA

The hip joint receives an exerted force that is more evenly distributed and lighter than that felt by the knees. While the connection between obesity and hip OA is not as pronounced as with knee OA, studies have shown that obese people are still at higher risk of developing osteoarthritis of the hip .

The Nurses' Health Study has collected data from 121,700 female registered nurses, providing a wealth of information since the study's commencement in the mid 1970s. Data analyzed from that study has shown that being overweight early in life corresponded to a greater likelihood of having to undergo a hip replacement (arthroplasty) due to the effects of OA.

A Norwegian cohort study of 1.2 million people compared BMI data collected between 1963-1975 with arthroplasty data from 1987-2003. Around 28,000 hip replacements were due to hip OA. The study found that a BMI over 32 translated to a greater likelihood (3.4 times) for a total hip replacement as compared to a BMI lower than 21 .

Obesity and Hand OA

It is perhaps in the area of osteoarthritis of the hand that scientific studies create the strongest correlation between obesity and OA. This is because hand joints are non-weight-bearing and the force exerted upon them is not greater in obese individuals than in people of normal weight.

And yet, a longitudinal study of 1,276 participants conducted in Michigan over a period of 23 years showed obesity to be a strong predictor of hand OA, implying that factors other than pressure exerted on the joints could be the cause. Scientists suggest that a systemic factor secreted in the blood of obese subjects may alter the metabolism of articular cartilage, accelerating its breakdown. Obese postmenopausal women, the group suffering from the greatest incidence of hand OA, may have an endocrine factor caused by excess adipose tissue.

Which Causes Which; Obesity or OA?

The connection between obesity and OA raises questions of causality; which one came first? While it is possible that joint pain leads to reduced activity and ultimately to weight gain, the Framingham Heart Study, a longitudinal study conducted in Framingham, England from 1949 to 1985, shows that it is obesity that leads to osteoarthritis, not vice versa. The study collected data from 1420 subjects. Those who were overweight at the age of 37, exhibiting no signs of OA, showed an increased likelihood of developing the disease by the age of 73. This clearly shows that excess weight precedes the development of OA.

Summation

Obesity is an important risk factor for developing OA of the knee, hand and hip. Knee OA is the type of osteoarthritis most commonly found in conjunction with obesity. Unlike genetic causes of disease, being overweight is a modifiable health issue. Therefore, weight reduction is recommended as the first line of defence and treatment against OA. Weight loss has been shown to be especially effective at reducing the symptoms of osteoarthritis of the knee.

References

  1.  Insurer and out-of-pocket costs of osteoarthritis in the US: evidence from national survey data.Kotlarz H, Gunnarsson CL, Fang H, Rizzo JA.Arthritis Rheum. 2009 Dec;60(12):3546-53
  2.  Cooper C, Snow S, McAlindon TE, et al. Risk factors for the incidence and progression of radiogradiographic knee osteoarthritis. Arthritis Rheum 2000;43:995–1000
  3.  Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol 1988;128:179–89
  4.  BMI Independently Predicts Younger Age at Hip and Knee Replacement. Gandhi R, Wasserstein D, Razak F, Davey JR, Mahomed NN. Obesity (Silver Spring). 2010 Apr 8.
  5.  The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: a cohort study in 1.2 million persons. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE. Arthritis Rheum. 2006 Mar;54(3):802-7.



 

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