Thigh Muscle Specific-Strength and the Risk of Incident Knee Osteoarthritis: The Influence of Sex and Greater Body Mass Index

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d6421675e175">Objective</h5> <p id="P1">To determine whether lower thigh muscle specific strength increases risk of incident radiographic knee osteoarthritis (RKOA), and whether there exists a sex-specific relationship between thigh muscle specific strength and BMI. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d6421675e180">Methods</h5> <p id="P2">161 Osteoarthritis Initiative participants (62% female) with incident RKOA (Kellgren-Lawrence grade 0/1 at baseline, developing an osteophyte and joint space narrowing grade ≥1 by year 4) were matched to 186 controls (58% female) without incident RKOA. Thigh muscle anatomical cross-sectional areas (ACSAs) were determined at baseline using axial MRI scans. Isometric extensor and flexor muscle strength were measured at baseline and specific strength (strength÷ACSA) calculated. Logistic regression assessed risk of incident RKOA associated with muscle specific strength (with and without adjustment for BMI). </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d6421675e185">Results</h5> <p id="P3">Lower knee extensor and flexor specific strength significantly increased the risk of incident RKOA in women (OR 1.47 [95%CI 1.10, 1.96] and 1.41 [1.06, 1.89], respectively) but not in men. The significant relationship in women was lost after adjustment for BMI. Lower specific strength was associated with higher BMI in women (r=−0.29, p<0.001), but not in men; whereas (absolute) strength was associated with BMI in men (r=0.28, p=0.001), but not in women. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d6421675e190">Conclusion</h5> <p id="P4">Lower thigh muscle specific strength predicts incident RKOA in women, with this relationship being confounded by BMI. The sex-specific relationship between muscle specific strength and BMI provides a possible explanation why women with muscle strength deficits typically have a poorer prognosis than men with similar strength deficits. </p> </div>

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Most cited references 14

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Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis.

B Oiestad, C B Juhl, I Eitzen … (2015)

The objective of this study was to perform a systematic review and meta-analysis on the association between knee extensor muscle weakness and the risk of developing knee osteoarthritis. A systematic review and meta-analysis was conducted with literature searches in Medline, SPORTDiscus, EMBASE, CINAHL, and AMED. Eligible studies had to include participants with no radiographic or symptomatic knee osteoarthritis at baseline; have a follow-up time of a minimum of 2 years, and include a measure of knee extensor muscle strength. Hierarchies for extracting data on knee osteoarthritis and knee extensor muscle strength were defined prior to data extraction. Meta-analysis was applied on the basis of the odds ratios (ORs) of developing symptomatic knee osteoarthritis or radiographic knee osteoarthritis in subjects with knee extensor muscle weakness. ORs for knee osteoarthritis and 95% confidence intervals (CI) were estimated and combined using a random effects model. Twelve studies were eligible for inclusion in the meta-analysis after the initial searches. Five cohort studies with a follow-up time between 2.5 and 14 years, and a total number of 5707 participants (3553 males and 2154 females), were finally included. The meta-analysis showed an overall increased risk of developing symptomatic knee osteoarthritis in participants with knee extensor muscle weakness (OR 1.65 95% CI 1.23, 2.21; I(2) = 50.5%). This systematic review and meta-analysis showed that knee extensor muscle weakness was associated with an increased risk of developing knee osteoarthritis in both men and women.

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The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis.

Annegret Mündermann, Thomas P Andriacchi (2006)

This review examines recent in-vivo studies of ambulation and discusses the fundamental role of mechanics of ambulation in the initiation and progression of osteoarthritis at the knee. Recent studies have supported earlier findings that a high adduction moment at the knee during ambulation was most frequently reported to influence the progression of medial compartment osteoarthritis. In contrast to previous findings in patients with osteoarthritis, recent work on healthy subjects reports that cartilage thickness increases with high ambulatory loads. Kinematic changes were associated with the initiation of osteoarthritis. Recent studies of subjects with high risk factors for knee osteoarthritis (obesity and anterior cruciate ligament injury) reported a relationship between kinematic changes during ambulation and the initiation of osteoarthritis at the knee. This review also contrasts the relative influence on osteoarthritis of knee mechanics measured during ambulatory and nonambulatory activities. The initiation of osteoarthritis occurs when healthy cartilage experiences some condition (traumatic or chronic) that causes kinematic changes during ambulation at the knee to shift the load-bearing contact location of the joint to a region not conditioned to the new loading. The rate of progression of osteoarthritis is associated with increased load during ambulation.

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Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women?

C Slemenda, D K Heilman, K D Brandt … (1998)

To determine whether baseline lower extremity muscle weakness is a risk factor for incident radiographic osteoarthritis (OA) of the knee. This prospective study involved 342 elderly community-dwelling subjects (178 women, 164 men) from central Indiana, for whom baseline and followup (mean interval 31.3 months) knee radiographs were available. Lower extremity muscle strength was measured by isokinetic dynamometry and lean tissue (i.e., muscle) mass in the lower extremities by dual x-ray absorptiometry. Knee OA was associated with an increase in body weight in women (P = 0.0014), but not in men. In both sexes, lower extremity muscle mass exhibited a strong positive correlation with body weight. In women, after adjustment for body weight, knee extensor strength was 18% lower at baseline among subjects who developed incident knee OA than among the controls (P = 0.053), whereas after adjustment for lower extremity muscle mass, knee extensor strength was 15% lower than in the controls (P not significant). In men, in contrast, adjusted knee extensor strength at baseline was comparable to that in the controls. Among the 13 women who developed incident OA, there was a strong, highly significant negative correlation between body weight and extensor strength (r = -0.740, P = 0.003), that is, the more obese the subject, the greater the reduction of quadriceps strength. In contrast, among the 14 men who developed incident OA, a modest positive correlation existed between weight and quadriceps strength (r = 0.455, P = 0.058). No correlation between knee flexor (hamstring) strength and knee OA was seen in either sex. Reduced quadriceps strength relative to body weight may be a risk factor for knee OA in women.