Epidemiology of Osteoarthritis
Section snippets
Defining osteoarthritis
Epidemiologic principles can be used to describe the distribution of disease in the population and to examine risk factors for its occurrence, its development, or its progression. For the purpose of epidemiologic investigation, OA can be defined pathologically, radiographically, or clinically. Radiographic OA has long been considered the reference standard, and multiple ways to define radiographic disease have been devised. The Kellgren-Lawrence radiographic grading scheme and atlas have been
Prevalence and incidence of osteoarthritis
The prevalence of OA (ie, the frequency of the disease in the population at a given time) varies according to the definition of OA, the specific joint(s) under study, and the characteristics of the study population. Recently, Lawrence and colleagues [3] summarized findings from several population-based studies and estimated the prevalence of radiographic and symptomatic knee, hand, and hip OA. The age-standardized prevalence of radiographic knee OA in adults over the age of 45 years was 19.2%
Risk factors for osteoarthritis
OA has a multifactorial etiology and can be considered the product of an interplay between systemic and local factors, as shown in Fig. 2 [1]. For example, a person may have an inherited predisposition to develop OA but may develop it only if an insult to the joint has occurred. The relative importance of risk factors may vary for different joints, for different stages of the disease, for the development as opposed to the progression of disease, and for radiographic versus symptomatic disease.
Age
Age is a one of the strongest risk factors for OA of all joints [1], [2], [3]. The increase in the incidence and prevalence of OA with age probably is a consequence of cumulative exposure to various risk factors and biologic changes that occur with aging.
Gender and hormones
Women are more likely to have OA than men, and they may have more severe OA, as well [15]. The definite increase in OA in women around the time of menopause has led to numerous investigations into the relationship between hormonal factors and
Obesity
Obesity and overweight have long been recognized as potent risk factors for OA, especially OA of the knee [1]. The results from the Framingham Study found that women who had lost about 5 kg had a 50% reduction in the risk of new symptomatic knee OA [47]. The same study also demonstrated that weight loss was strongly associated with a reduced risk of development of radiographic knee OA. Weight-loss interventions have been shown to decrease pain and disability in established knee OA [48], [49].
Risk factors for symptomatic osteoarthritis
Although symptomatic knee OA is common, causes substantial disability, and consumes tremendous medical resources, most previous studies have focused on the risk factors for radiographic OA [1]. Not all risk factors for radiographic OA are strong predictors of joint symptoms [1], [2]. Women who had radiographic knee OA were more likely to have symptoms than men [84], and African Americans generally reported more knee and hip symptoms than whites [85]. People who had severe radiographic OA were
Summary
Evolving definitions of OA and improvements in risk factor measurement that use advanced imaging, systemic and local biomarkers, and improved methods for measuring symptoms and their impact can help elucidate mechanisms and identify potential areas for intervention or prevention. The application of these new sources of knowledge about the OA process holds promise for the development of new, potentially disease-modifying pharmaceuticals and nonpharmacologic therapies.
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