H. Arita

Osteoarthritis as a Cause of Locomotive Syndrome: Its Influence on Functional Mobility and Activities of Daily Living

Abstract“Locomotive syndrome” is defined as a condition associated with restriction in one’s ability to walk or lead a normal life due to a dysfunction in one or more of the parts of the locomotion system, including the muscles, bones, joints, cartilage or intervertebral discs. This syndrome especially refers to individuals who have come to need nursing care services because of problems with the locomotive organs, or those who have conditions which may require them to need such services in the near future. Recent epidemiological studies revealed that the one-fourth of elderly individuals who require special assistance or nursing care have locomotive disorders in Japan. Osteoarthritis of the knee (knee OA) and hip (hip OA), and osteoporosis and spinal canal stenosis due to spondylosis are three major locomotive disorders that cause elderly individuals require special assistance or nursing care. In this review, we focus on the effects of knee and hip OA on the lives of elderly individuals and the recent advantages in clinical research on the pathophysiology and management of these diseases.

The MRI-detected osteophyte score is a predictor for undergoing joint replacement in patients with end-stage knee osteoarthritis

Abstract Objectives: The aim of this prospective cohort study was to examine whether MRI-detected osteoarthritis (OA)-structural changes at baseline could predict knee OA patients who would undergo total knee arthroplasty (TKA). Methods: In total, 128 end-stage medial-type knee OA patients were enrolled and followed up for 6 months. MRI using the whole-organ MRI scoring (WORMS) method, radiographic findings, visual analog scale (VAS) for pain and a patient-oriented outcome measure, and the Japanese Knee Osteoarthritis Measure (JKOM) were recorded at baseline. The area under the curve (AUC) was estimated to determine the discriminative value of the prediction models. Results: While 74 patients (57.8%) did not undergo TKA, the remaining 54 patients (42.2%) underwent TKA during this period. The AUCs of the receiver operating characteristic (ROC) curve for the activities of daily living (ADL) score evaluated by the JKOM ADL score [0.70 (95% CI: 0.60–0.79)] and osteophyte score [0.72 (0.64–0.81)] were 0.70 or greater. The JKOM ADL score (17/40) and the osteophyte score (30/98) showed relative risks (RR) of 2.61 (1.32–5.15) and 3.01 (1.39–6.52) for undergoing TKA, respectively. Conclusion: The osteophyte score detected by MRI, in addition to ADL score, was found to be an important factor in determining whether the patient should undergo TKA.

The increase in bone mineral density by bisphosphonate with active vitamin D analog is associated with the serum calcium level within the reference interval in postmenopausal osteoporosis

Abstract Objectives: To examine the factors associated with increase in lumbar spine bone mineral density (LS-BMD) by bisphosphonates (BPs) with active vitamin D analog (aVD). Methods: Two independent postmenopausal osteoporotic patients treated by BPs with aVD for 24 months (Study 1: n = 93, Study 2: n = 99) were retrospectively analyzed. Results: In Study 1, LS-BMD of the patients significantly increased for 24 m (5.4%, p < .001). A multiple regression analysis among baseline characteristics revealed that serum calcium (sCa: 8.5–10.5 mg/dL) was associated with an increased LS-BMD by treatment (r2: 0.088, p = .02). While average sCa of the patients was 9.2 mg/dL before treatment, it increased time-dependently to 9.6 mg/dL for 24 m by treatment. As each patient had their LS-BMD five times during the study, there were four instances of %LS-BMD in each patient, resulting in 372 instances of %LS-BMD in Study 1. The smallest Akaike’s information criterion value for the most appropriate cut-off levels of sCa for %LS-BMD by treatment every 6 m was 9.3 mg/dL. The %LS-BMD by treatment for 6 m during 24 m period in patients with sCa ≥9.3 mg/dL (1.5%) was significantly higher than that in patients with sCa <9.3 mg/dL (0.8%, p = .038). The results of Study 2 were similar to those of Study 1, confirming the phenomena observed. Conclusion: sCa was associated with an increased LS-BMD by BPs with aVD.