Prevalence of radiographic hip osteoarthritis is increased in high bone mass.

OBJECTIVE: Epidemiological studies have shown an association between increased bone mineral density (BMD) and osteoarthritis (OA), but whether this represents cause or effect remains unclear. In this study, we used a novel approach to investigate this question, determining whether individuals with High Bone Mass (HBM) have a higher prevalence of radiographic hip OA compared with controls. DESIGN: HBM cases came from the UK-based HBM study: HBM was defined by BMD Z-score. Unaffected relatives of index cases were recruited as family controls. Age-stratified random sampling was used to select further population controls from the Chingford and Hertfordshire cohort studies. Pelvic radiographs were pooled and assessed by a single observer blinded to case-control status. Analyses used logistic regression, adjusted for age, gender and body mass index (BMI). RESULTS: 530 HBM hips in 272 cases (mean age 62.9 years, 74% female) and 1702 control hips in 863 controls (mean age 64.8 years, 84% female) were analysed. The prevalence of radiographic OA, defined as Croft score ≥3, was higher in cases compared with controls (20.0% vs 13.6%), with adjusted odds ratio (OR) [95% CI] 1.52 [1.09, 2.11], P = 0.013. Osteophytes (OR 2.12 [1.61, 2.79], P < 0.001) and subchondral sclerosis (OR 2.78 [1.49, 5.18], P = 0.001) were more prevalent in cases. However, no difference in the prevalence of joint space narrowing (JSN) was seen (OR 0.97 [0.72, 1.33], P = 0.869). CONCLUSIONS: An increased prevalence of radiographic hip OA and osteophytosis was observed in HBM cases compared with controls, in keeping with a positive association between HBM and OA and suggesting that OA in HBM has a hypertrophic phenotype.

CT pulmonary angiography in elderly patients: outcomes in patients aged >85 years.

AIM: To assess the quality, safety, and outcomes following computed tomography pulmonary angiography (CTPA) performed in elderly patients. MATERIALS AND METHODS: CTPA examinations were performed in 140 patients aged >85 years in three UK acute National Health Service (NHS) hospitals. Images were assessed for quality, pulmonary emboli, and other disease entities. Patients were assessed for contrast medium-induced nephropathy (CIN), and short-term and long-term survival. Statistics included Fisher's exact, Mann-Whitney U, and logrank tests. RESULTS: The mean age of patients was 92 years with baseline creatinine ranging 57-310 µmol/l. CTPA was of good quality in 79% (110/140) of cases and pulmonary emboli were demonstrated in 16% (23/140). Warfarin or inferior vena cava (IVC) filter insertion was instigated in 70% (16/23) of patients with pulmonary emboli. No patient had an immediate contrast medium reaction or required renal replacement therapy. CIN was seen following 6% (8/140) of examinations but was not predicted by baseline renal function (p = 0.62). There was a trend towards increased patient mortality in the presence of CIN, although this did not reach statistical significance (p > 0.10). Patients with pulmonary emboli had improved median survival, although this did not reach significance (28 months versus 12 months, p = 0.16). Patients with other significant diseases reported on CTPA had significantly worse median survival (4 months versus 17 months, p = 0.025). CONCLUSIONS: Patients aged >85 years undergoing CTPA have a low (6%) rate of CIN: this was not predicted by baseline renal function and did not impact on survival. CTPA in elderly patients is safe, facilitates active management of pulmonary emboli, and the discovery of additional disease entities informs survival.