Abstract
Objective: To describe the associations between age, knee cartilage morphology, and bone size in adults.
Methods: A cross sectional convenience sample of 372 male and female subjects (mean age 45 years, range 26–61) was studied. Knee measures included a cartilage defect five site score (0–4 respectively) and prevalence (defect score of ⩾2 at any site), cartilage volume and thickness, and bone surface area and/or volume. These were determined at the patellar, medial, and lateral tibial and femoral sites using T1 weighted fat saturation MRI. Height, weight, and radiographic osteoarthritis (ROA) were measured by standard protocols.
Results: In multivariate analysis, age was significantly associated with knee cartilage defect scores (ß = +0.016 to +0.073/year, all p<0.01) and prevalence (OR = 1.05–1.10/year, all p<0.05) in all compartments. Additionally, age was negatively associated with knee cartilage thickness at all sites (ß = –0.013 to –0.035 mm/year, all p<0.05), and with patellar (ß = –11.5 µl/year, p<0.01) but not tibial cartilage volume. Lastly, age was significantly positively associated with medial and lateral tibial surface bone area (ß = +3.0 to +4.7 mm2/year, all p<0.05) and patellar bone volume (ß = +34.4 µl/year, p<0.05). Associations between age and tibiofemoral cartilage defect score, cartilage thickness, and bone size decreased in magnitude after adjustment for ROA, suggesting these changes are directly relevant to OA.
Conclusion: The most consistent knee structural changes with increasing age are increase in cartilage defect severity and prevalence, cartilage thinning, and increase in bone size with inconsistent change in cartilage volume. Longitudinal studies are needed to determine which of these changes are primary and confirm their relevance to knee OA.
Full Text
The Full Text of this article is available as a PDF (301.0 KB).
Figure 1.
Correlation between age and knee cartilage defects. There were significant positive associations between age and knee cartilage defect score in the medial and lateral tibiofemoral and patellar compartments. T, total sample; F, female subjects; M, male subjects.
Figure 2.
Correlation between age and knee cartilage thickness. There were significant negative associations between age and knee cartilage thickness at all three sites. T, total sample; F, female subjects; M, male subjects.
Figure 3.
Correlation between age and knee cartilage volume. There were significant negative correlations between age and patellar cartilage volume in the total population and lateral cartilage volume in women only. T, total sample; F, female subjects; M, male subjects.
Figure 4.
Correlation between age and knee bone size. There were no significant positive associations between age and knee bone size except that at the lateral tibial site in men. T, total sample; F, female subjects; M, male subjects.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Altman R. D., Hochberg M., Murphy W. A., Jr, Wolfe F., Lequesne M. Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage. 1995 Sep;3 (Suppl A):3–70. [PubMed] [Google Scholar]
- Bank R. A., Bayliss M. T., Lafeber F. P., Maroudas A., Tekoppele J. M. Ageing and zonal variation in post-translational modification of collagen in normal human articular cartilage. The age-related increase in non-enzymatic glycation affects biomechanical properties of cartilage. Biochem J. 1998 Feb 15;330(Pt 1):345–351. doi: 10.1042/bj3300345. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Boegård T., Rudling O., Petersson I. F., Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the tibiofemoral joint. Ann Rheum Dis. 1998 Jul;57(7):401–407. doi: 10.1136/ard.57.7.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brandt K. D., Fife R. S. Ageing in relation to the pathogenesis of osteoarthritis. Clin Rheum Dis. 1986 Apr;12(1):117–130. [PubMed] [Google Scholar]
- Cicuttini F. M., Wluka A. E., Stuckey S. L. Tibial and femoral cartilage changes in knee osteoarthritis. Ann Rheum Dis. 2001 Oct;60(10):977–980. doi: 10.1136/ard.60.10.977. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cicuttini F. M., Wluka A., Bailey M., O'Sullivan R., Poon C., Yeung S., Ebeling P. R. Factors affecting knee cartilage volume in healthy men. Rheumatology (Oxford) 2003 Feb;42(2):258–262. doi: 10.1093/rheumatology/keg073. [DOI] [PubMed] [Google Scholar]
- Dacre J. E., Scott D. L., Da Silva J. A., Welsh G., Huskisson E. C. Joint space in radiologically normal knees. Br J Rheumatol. 1991 Dec;30(6):426–428. doi: 10.1093/rheumatology/30.6.426. [DOI] [PubMed] [Google Scholar]
- Drapé J. L., Pessis E., Auleley G. R., Chevrot A., Dougados M., Ayral X. Quantitative MR imaging evaluation of chondropathy in osteoarthritic knees. Radiology. 1998 Jul;208(1):49–55. doi: 10.1148/radiology.208.1.9646792. [DOI] [PubMed] [Google Scholar]
- Eckstein F., Schnier M., Haubner M., Priebsch J., Glaser C., Englmeier K. H., Reiser M. Accuracy of cartilage volume and thickness measurements with magnetic resonance imaging. Clin Orthop Relat Res. 1998 Jul;(352):137–148. [PubMed] [Google Scholar]
- Eckstein F., Winzheimer M., Hohe J., Englmeier K. H., Reiser M. Interindividual variability and correlation among morphological parameters of knee joint cartilage plates: analysis with three-dimensional MR imaging. Osteoarthritis Cartilage. 2001 Feb;9(2):101–111. doi: 10.1053/joca.2000.0365. [DOI] [PubMed] [Google Scholar]
- Felson D. T., Lawrence R. C., Dieppe P. A., Hirsch R., Helmick C. G., Jordan J. M., Kington R. S., Lane N. E., Nevitt M. C., Zhang Y. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000 Oct 17;133(8):635–646. doi: 10.7326/0003-4819-133-8-200010170-00016. [DOI] [PubMed] [Google Scholar]
- Hart D. J., Doyle D. V., Spector T. D. Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. Arthritis Rheum. 1999 Jan;42(1):17–24. doi: 10.1002/1529-0131(199901)42:1<17::AID-ANR2>3.0.CO;2-E. [DOI] [PubMed] [Google Scholar]
- Hudelmaier M., Glaser C., Hohe J., Englmeier K. H., Reiser M., Putz R., Eckstein F. Age-related changes in the morphology and deformational behavior of knee joint cartilage. Arthritis Rheum. 2001 Nov;44(11):2556–2561. doi: 10.1002/1529-0131(200111)44:11<2556::aid-art436>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
- Joensen A. M., Hahn T., Gelineck J., Overvad K., Ingemann-Hansen T. Articular cartilage lesions and anterior knee pain. Scand J Med Sci Sports. 2001 Apr;11(2):115–119. doi: 10.1034/j.1600-0838.2001.011002115.x. [DOI] [PubMed] [Google Scholar]
- Jones G., Ding C., Scott F., Cicuttini F. Genetic mechanisms of knee osteoarthritis: a population based case-control study. Ann Rheum Dis. 2004 Oct;63(10):1255–1259. doi: 10.1136/ard.2003.015875. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jones G., Ding Changhai, Scott F., Glisson M., Cicuttini F. Early radiographic osteoarthritis is associated with substantial changes in cartilage volume and tibial bone surface area in both males and females. Osteoarthritis Cartilage. 2004 Feb;12(2):169–174. doi: 10.1016/j.joca.2003.08.010. [DOI] [PubMed] [Google Scholar]
- Jones G., Glisson M., Hynes K., Cicuttini F. Sex and site differences in cartilage development: a possible explanation for variations in knee osteoarthritis in later life. Arthritis Rheum. 2000 Nov;43(11):2543–2549. doi: 10.1002/1529-0131(200011)43:11<2543::AID-ANR23>3.0.CO;2-K. [DOI] [PubMed] [Google Scholar]
- Jordan Joanne M., Luta Gheorghe, Stabler Thomas, Renner Jordan B., Dragomir Anca D., Vilim Vladimir, Hochberg Marc C., Helmick Charles G., Kraus Virginia B. Ethnic and sex differences in serum levels of cartilage oligomeric matrix protein: the Johnston County Osteoarthritis Project. Arthritis Rheum. 2003 Mar;48(3):675–681. doi: 10.1002/art.10822. [DOI] [PubMed] [Google Scholar]
- Karvonen R. L., Negendank W. G., Teitge R. A., Reed A. H., Miller P. R., Fernandez-Madrid F. Factors affecting articular cartilage thickness in osteoarthritis and aging. J Rheumatol. 1994 Jul;21(7):1310–1318. [PubMed] [Google Scholar]
- Kempson G. E. Age-related changes in the tensile properties of human articular cartilage: a comparative study between the femoral head of the hip joint and the talus of the ankle joint. Biochim Biophys Acta. 1991 Oct 31;1075(3):223–230. doi: 10.1016/0304-4165(91)90270-q. [DOI] [PubMed] [Google Scholar]
- Lanyon P., O'Reilly S., Jones A., Doherty M. Radiographic assessment of symptomatic knee osteoarthritis in the community: definitions and normal joint space. Ann Rheum Dis. 1998 Oct;57(10):595–601. doi: 10.1136/ard.57.10.595. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Link Thomas M., Steinbach Lynne S., Ghosh Srinka, Ries Michael, Lu Ying, Lane Nancy, Majumdar Sharmila. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology. 2003 Feb;226(2):373–381. doi: 10.1148/radiol.2262012190. [DOI] [PubMed] [Google Scholar]
- McGibbon Chris A., Trahan Carol A. Measurement accuracy of focal cartilage defects from MRI and correlation of MRI graded lesions with histology: a preliminary study. Osteoarthritis Cartilage. 2003 Jul;11(7):483–493. doi: 10.1016/s1063-4584(03)00078-5. [DOI] [PubMed] [Google Scholar]
- Meachim G., Bentley G., Baker R. Effect of age on thickness of adult patellar articular cartilage. Ann Rheum Dis. 1977 Dec;36(6):563–568. doi: 10.1136/ard.36.6.563. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mouritzen U., Christgau S., Lehmann H-J, Tankó L. B., Christiansen C. Cartilage turnover assessed with a newly developed assay measuring collagen type II degradation products: influence of age, sex, menopause, hormone replacement therapy, and body mass index. Ann Rheum Dis. 2003 Apr;62(4):332–336. doi: 10.1136/ard.62.4.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nicolas V., Prewett A., Bettica P., Mohan S., Finkelman R. D., Baylink D. J., Farley J. R. Age-related decreases in insulin-like growth factor-I and transforming growth factor-beta in femoral cortical bone from both men and women: implications for bone loss with aging. J Clin Endocrinol Metab. 1994 May;78(5):1011–1016. doi: 10.1210/jcem.78.5.8175953. [DOI] [PubMed] [Google Scholar]
- Oliveria S. A., Felson D. T., Reed J. I., Cirillo P. A., Walker A. M. Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum. 1995 Aug;38(8):1134–1141. doi: 10.1002/art.1780380817. [DOI] [PubMed] [Google Scholar]
- Pessis E., Drapé J-L, Ravaud P., Chevrot A., Dougados M., Ayral X. Assessment of progression in knee osteoarthritis: results of a 1 year study comparing arthroscopy and MRI. Osteoarthritis Cartilage. 2003 May;11(5):361–369. doi: 10.1016/s1063-4584(03)00049-9. [DOI] [PubMed] [Google Scholar]
- Peterfy C. G., van Dijke C. F., Janzen D. L., Glüer C. C., Namba R., Majumdar S., Lang P., Genant H. K. Quantification of articular cartilage in the knee with pulsed saturation transfer subtraction and fat-suppressed MR imaging: optimization and validation. Radiology. 1994 Aug;192(2):485–491. doi: 10.1148/radiology.192.2.8029420. [DOI] [PubMed] [Google Scholar]
- Pfeilschifter J., Diel I., Scheppach B., Bretz A., Krempien R., Erdmann J., Schmid G., Reske N., Bismar H., Seck T. Concentration of transforming growth factor beta in human bone tissue: relationship to age, menopause, bone turnover, and bone volume. J Bone Miner Res. 1998 Apr;13(4):716–730. doi: 10.1359/jbmr.1998.13.4.716. [DOI] [PubMed] [Google Scholar]
- Potter H. G., Linklater J. M., Allen A. A., Hannafin J. A., Haas S. B. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am. 1998 Sep;80(9):1276–1284. doi: 10.2106/00004623-199809000-00005. [DOI] [PubMed] [Google Scholar]
- Russo C. R., Lauretani F., Bandinelli S., Bartali B., Di Iorio A., Volpato S., Guralnik J. M., Harris T., Ferrucci L. Aging bone in men and women: beyond changes in bone mineral density. Osteoporos Int. 2003 Jun 24;14(7):531–538. doi: 10.1007/s00198-002-1322-y. [DOI] [PubMed] [Google Scholar]
- Sargon M. F., Taner D., Altintaş K. Examination of joint space by magnetic resonance imaging in anatomically normal knees. Clin Anat. 1996;9(6):386–390. doi: 10.1002/(SICI)1098-2353(1996)9:6<386::AID-CA5>3.0.CO;2-9. [DOI] [PubMed] [Google Scholar]
- Schouten J. S., van den Ouweland F. A., Valkenburg H. A. A 12 year follow up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee. Ann Rheum Dis. 1992 Aug;51(8):932–937. doi: 10.1136/ard.51.8.932. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Verzijl Nicole, Bank Ruud A., TeKoppele Johan M., DeGroot Jeroen. AGEing and osteoarthritis: a different perspective. Curr Opin Rheumatol. 2003 Sep;15(5):616–622. doi: 10.1097/00002281-200309000-00016. [DOI] [PubMed] [Google Scholar]