High Bone Mass is associated with bone-forming features of osteoarthritis in non-weight bearing joints independent of body mass index

C. L. Gregson, S. A. Hardcastle, A. Murphy, B. Faber, W. D. Fraser, M. Williams, G. Davey Smith, J. H. Tobias

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
6 Downloads (Pure)


Objectives: High Bone Mass (HBM) is associated with (a) radiographic knee osteoarthritis (OA), partly mediated by increased BMI, and (b) pelvic enthesophytes and hip osteophytes, suggestive of a bone-forming
phenotype. We aimed to establish whether HBM is associated with radiographic features of OA in non weight-bearing (hand) joints, and whether such OA demonstrates a bone-forming phenotype.

Methods: HBM cases (BMD Z-scores ≥+3.2) were compared with family controls. A blinded assessor graded all PA hand radiographs for: osteophytes (0-3), joint space narrowing (JSN)(0-3), subchondral sclerosis (0-1), at the index Distal Interphalangeal Joint (DIPJ) and 1st Carpometacarpal Joint (CMCJ), using an
established atlas. Analyses used a random effects logistic regression model, adjusting a priori for age and gender. Mediating roles of BMI and bone turnover markers (BTMs) were explored by further adjustment.

Results: 314 HBM cases (mean age 61.1years, 74% female) and 183 controls (54.3years, 46% female) were included. Osteophytes (grade≥1) were more common in HBM (DIPJ: 67% vs. 45%, CMCJ: 69% vs. 50%), with adjusted OR [95% CI] 1.82 [1.11, 2.97], p=0.017 and 1.89 [1.19, 3.01], p=0.007 respectively; no differences were seen in JSN. Further adjustment for BMI failed to attenuate ORs for osteophytes in HBM cases vs. controls; DIPJ 1.72 [1.05, 2.83], p=0.032, CMCJ 1.76 [1.00, 3.06], p=0.049. Adjustment for BTMs (concentrations lower amongst HBM cases) did not attenuate ORs.

Conclusions: HBM is positively associated with OA in non weight-bearing joints, independent of BMI. HBMassociated OA is characterised by osteophytes, consistent with a bone-forming phenotype, rather than JSN reflecting cartilage loss. Systemic factors (e.g. genetic architecture) which govern HBM may
also increase bone-forming OA risk.
Original languageEnglish
Pages (from-to)306–313
Number of pages8
Early online date7 Jan 2017
Publication statusPublished - Apr 2017


  • Osteoarthritis
  • Osteophyte
  • Bone
  • Hand
  • Epidemiology
  • X-Ray

Cite this