Abstract Objective. To examine the possible inverse relationship between osteoporosis and osteoarthritis (OA) by evaluating the association between bone mineral density (BMD) and knee OA in the Framingham Study cohort. Methods. Of the 1,154 Framingham Study cohort subjects in whom BMD measurements were obtained at biennial examination 20, 932 (81%) had had knee OA assessed during the Framingham Knee OA Study 4 years earlier. BMD of the proximal femur and radius was measured by densitometry. Knee OA was assessed from a weight‐bearing anteroposterior radiograph and graded on a scale of 0 (no OA) to 4 (severe OA). Osteophytes and joint space narrowing were also evaluated separately. Linear regression was used to test the association of BMD with knee OA, with osteophytes, and with joint space narrowing, after adjustment for age, body mass index, and mean number of cigarettes smoked per day. Results. The subjects included 572 women and 360 men with an age range of 63–91 years (mean 71 years). Of these, 351 had no OA, 269 had grade 1 OA, 170 had grade 2 OA, 93 had grade 3 OA, and 49 had grade 4 OA. Mean femoral BMD at the 3 proximal femur sites was 5–9% higher in men and women with either grade 1, grade 2, or grade 3 knee OA, compared with those with no knee OA ( P < 0.0001). Mean femoral BMD in those with grade 4 OA was not higher than in those with no OA. Radius BMD was not associated with knee OA in subjects of either sex. Women with osteophytes had higher BMD compared with women with no osteophytes. Mean BMD did not differ across levels of joint space narrowing. Conclusion. We conclude that, among women, femoral BMD is higher in those with osteophytosis of the knee, and BMD is not necessarily associated with joint space narrowing.
Objective To explore associations of joint hypermobility (a condition where range of motion is greater than normal) with ankle and foot radiographic osteoarthritis (OA) and symptoms in a large community‐based cohort of African American and white adults ages 55–94 years old. Methods Ankle and foot radiographs and joint hypermobility data (Beighton score for joint hypermobility criteria) were available for 848 participants (from 2003 to 2010) in this cross‐sectional study. General joint hypermobility was defined as a Beighton score ≥4 (range 0–9); knee hypermobility was defined as hyperextension of at least 1 knee. Standing anteroposterior and lateral foot radiographs were read with standard atlases for Kellgren‐Lawrence grade, osteophytes, and joint space narrowing (JSN) at the tibiotalar joint, and for osteophytes and JSN to define OA at 5 foot joints. Ankle or foot symptoms were self‐reported. Separate person‐based logistic regression models were used to estimate associations of ankle and foot OA and symptom outcomes with hypermobility measures, adjusting for age, sex, race, body mass index, and history of ankle/foot injury. Results This sample cohort included 577 women (68%) and 280 African Americans (33%). The mean age of the participants was 71 years, with a mean body mass index of 31 kg/m 2 . The general joint hypermobility of the participants was 7% and knee hypermobility was 4%. Having a history of ankle injury was 11.5%, and foot injury was 3.8%. Although general joint hypermobility was not associated with ankle and foot outcomes, knee hypermobility was associated with ankle symptoms, foot symptoms, and talonavicular OA (adjusted odds ratios of 4.4, 2.4, and 3.0, respectively). Conclusion Knee joint hypermobility may be related to talonavicular OA and to ankle and foot symptoms.
Associations between pain and depression are well known, yet foot pain, common in populations, has been understudied. This cross-sectional study examined foot pain and severity of foot pain with depressive symptoms in adults.Framingham Foot Study (2002-2008) participants completed questionnaires that included questions about foot pain (yes/no; none, mild, moderate, or severe pain) and the Center for Epidemiologic Studies Depression Scale (scores ≥16 indicated depressive symptoms). Age and body mass index (BMI) were also assessed. Sex-specific logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations of foot pain with depressive symptoms, adjusting for age and BMI. In a subset, further models adjusted for leg pain, back pain, or other joint pain.Of 1,464 men and 1,857 women, the mean ± SD age was 66 ± 10 years. Depressive symptoms were reported in 21% of men and 27% of women. Compared to those with no foot pain and independent of age and BMI, both men and women with moderate foot pain had approximately a 2-fold increased odds of depressive symptoms (men with severe foot pain OR of 4 [95% CI 2.26-8.48], women with severe foot pain OR of 3 [95% CI 2.02-4.68]). Considering other pain regions attenuated ORs, but the pattern of results remained unchanged.Even after we adjusted for age, BMI, and other regions of pain, those reporting worse foot pain were more likely to report depressive symptoms. These findings suggest that foot pain may be a part of a broader pain spectrum, with an impact beyond localized pain and discomfort.
Objective Oxidative stress has been implicated as a central mechanism of age‐related decline in muscle. Vitamin C is important for skeletal muscle due to its dual role as an antioxidant and as an enzyme cofactor for collagen and carnitine biosynthesis. Carnitine plays a critical role in energy production by transporting long‐chain fatty acids into the mitochondria so they can be oxidized. Two non‐US studies of older adults have related higher vitamin C status or intake with higher physical strength and performance. Therefore, we determined the cross‐sectional association of dietary vitamin C with grip strength in men and women from the Framingham Offspring Cohort. Methods 2,184 men and women completed a Willett's food frequency questionnaire (in either 1996–1998 or 1999–2001) and had grip strength measured using an adjustable Jamar isometric hand‐held dynamometer in 1999–2001 (kg, max of 2 trials). We used sex‐specific linear regression to calculate beta coefficients and P values for the association between dietary vitamin C and grip strength adjusting for age, weight, height, total energy intake (residual method), physical activity and vitamin C supplement use (yes/no). Results Mean age was 58.4±8.8y (range 29–83y). Median vitamin C intake from diet was 184.5±326.3 mg/d (men) and 205.6±343.4 mg/d (women). Mean grip strength was 40.4±9.7 kg (men) and 23.4±6.0 kg (women). Higher dietary vitamin C was associated with higher grip strength after adjustment for relevant covariates [β±SE (P value) for men: 0.009±0.003 (P=0.007) and for women: 0.0035±0.002 (P=0.06)]. When examined in tertiles, women in highest tertile of dietary vitamin C (T3, median intake 219.7 mg/d) had higher grip strength compared to women in the lowest tertile (T1, median intake 75.4 mg/d) of intake (P trend=0.009). Similar patterns of results were seen in men [Median intake: 220.9 mg/d (T3) and 73.8 mg/d (T1), P trend=0.04]. Conclusions These findings suggest that higher dietary vitamin C may be beneficial for muscle strength in adult men and women. Future research should determine the most important mechanisms underlying these significant epidemiologic associations. Support or Funding Information The American Society for Bone and Mineral Research (ASBMR) Grants in Aid Program (GAP) Award, NIH AR # 053205, FHS HHSN268201500001I and R01AR041398. Adjusted least square mean grip strength (kg) by tertiles of dietary vitamin C (mg/d). Least square means of grip strength (kg) by tertiles of vitamin C intake (mg/d) P Trend Tertile 1 Tertile 2 Tertile 3 Men 39.82±0.49 40.16±0.47 41.32±0.49 † 0.04 Women 23.02±0.26 23.30±0.24 24.02±0.26 * 0.009 Adjusted for age, weight, height, total energy intake (residual method), physical activity and vitamin C supplement use (yes/no), P<0.05 compared to T1 and P<0.05 compared to T1.
Objective Hallux valgus (HV) is common in older adults, but limited studies of risk factors have reported conflicting results. This cross‐sectional analysis examined the association of HV with foot pain and other characteristics in older adults. Methods The population‐based Framingham Foot Study assessed HV, foot pain, foot structure (planus, rectus, and cavus), current and past high‐heeled shoe use, age, and body mass index (BMI). Sex‐specific logistic and multinomial logistic regression examined the association of HV and HV with pain with study variables. Results Of 1,352 men and 1,725 women (mean ± SD age 66 ± 10.5 years), 22% of men and 44% of women had HV, and 3% of men and 11% of women had HV with pain. Foot pain increased the odds of HV in both sexes ( P < 0.05). In women, older age and past high‐heeled shoe use increased the odds of HV by 27% and 47%, respectively ( P < 0.01), and cavus foot structure decreased the odds of HV by 26% ( P = 0.02). BMI >30 kg/m 2 decreased the odds of HV by 33% in men and 45% in women ( P < 0.05). In women only, odds of pain and HV versus no pain and no HV were greater with older age and planus foot structure. Conclusion Our work showed different associations in participants who had HV with pain compared to those without foot pain. In both men and women, strong associations were observed between HV and foot pain and inversely with BMI. Older age was associated with HV in women only, as were protective associations with cavus foot structure.
