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Epidemiology and Population Health

Weight loss is associated with reduced risk of knee and hip replacement: a survival analysis using Osteoarthritis Initiative data

Abstract

Objective

To describe the association between body weight change and the risk of knee replacement and hip replacement.

Design

Time-to-event survival analysis from a population-based cohort of participants who had or were at risk of clinically significant knee osteoarthritis at baseline.

Setting

Data from the Osteoarthritis Initiative (OAI), which collected data from four clinical centres in the United States.

Participants

A total of 8069 knees from 4081 participants, and 8076 hips from 4064 participants (59.3% female) aged 45–79 years, with mean ± SD body mass index (BMI) of 28.7 ± 4.8 kg/m2, were included in the knee and hip analyses, respectively.

Exposure

Body weight change from baseline as a percentage of baseline at repeated follow-up visits over 8 years.

Main outcome measure

Incidence of primary knee or hip replacement during 8-year follow-up.

Results

Body weight change had a small, positive, linear association with the risk of knee replacement (adjusted hazard ratio [HR] 1.02; 95% confidence interval [CI] 1.00–1.04). Body weight change was also positively and linearly associated with the risk of hip replacement in hips that were persistently painful at baseline (adjusted HR 1.03; 95% CI 1.01–1.05), but not in hips that were not persistently painful at baseline. There were no significant interactions between body weight change and baseline BMI in the association with knee or hip replacement.

Conclusions

In people with or at risk of clinically significant knee osteoarthritis, every 1% weight loss was associated with a 2% reduced risk of knee replacement and – in those people who also had one or more persistently painful hips – a 3% reduced risk of hip replacement, regardless of baseline BMI. Public health strategies that incorporate weight loss interventions have the potential to reduce the burden of knee and hip replacement surgery.

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Fig. 1: Selection of participants and knees and hips from the OAI data set for analyses.
Fig. 2: Histogram of body weight changes from baseline, as a percent of baseline body weight, that knees and hips were exposed to.
Fig. 3: Survival plots for knees and hips showing the probability of avoiding replacement over time.

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Acknowledgements

Data used in the preparation of this manuscript were obtained from the controlled access datasets distributed from the Osteoarthritis Initiative (OAI), a data repository housed within the National Institute of Mental Health (NIMH) Data Archive (NDA). OAI is a collaborative informatics system created by the NIMH and the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) to provide a worldwide resource to quicken the pace of biomarker identification, scientific investigation and osteoarthritis drug development. Dataset identifier(s): [NIMH Data Archive Digital Object Identifier (https://doi.org/10.15154/1521098)].

Funding

ZS is the recipient of an Australian Government Research Training Program Scholarship. This work was additionally supported by the National Health and Medical Research Council of Australia via a Senior Research Fellowship 1135897 to AS and an Early Career Research Fellowship 1143022 to XJ.

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Authors

Contributions

Conception and design: ZS, AS, XJ. Acquisition, analysis and interpretation of data: ZS, AS, XJ. Critical review of the results: ZS, AS, HK, BG, XJ. Critical review of the manuscript: ZS, AS, BG, XJ. Statistical analysis: ZS. Drafting the paper: ZS, AS, XJ.

Corresponding author

Correspondence to Zubeyir Salis.

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Competing interests

ZS and AS own 50% each of the shares in Zuman International, which receives royalties for books AS has written and payments for presentations. AS additionally reports receiving presentation fees and travel reimbursements from Eli Lilly and Co, the Pharmacy Guild of Australia, Novo Nordisk, the Dietitians Association of Australia, Shoalhaven Family Medical Centres, the Pharmaceutical Society of Australia, and Metagenics, and serving on the Nestlé Health Science Optifast VLCD advisory board from 2016 to 2018.

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Salis, Z., Sainsbury, A., I. Keen, H. et al. Weight loss is associated with reduced risk of knee and hip replacement: a survival analysis using Osteoarthritis Initiative data. Int J Obes 46, 874–884 (2022). https://doi.org/10.1038/s41366-021-01046-3

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