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Case–control study of knee osteoarthritis and lifestyle factors considering their interaction with physical workload

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An Erratum to this article was published on 06 May 2010

Abstract

Aims

The aim of this study is to examine the dose–response relationships between age, “lifestyle factors” (body mass index, tobacco smoking, sports), and symptomatic knee osteoarthritis in a population-based case–control study. Additionally, the study aims to investigate the mode of interaction between body mass index (BMI) and physical workload (occupational kneeling/squatting and lifting/carrying of loads) with respect to the risk of symptomatic knee osteoarthritis.

Methods

In five orthopedic clinics and five practices, 295 male patients aged 25–70 with radiographically confirmed knee osteoarthritis associated with chronic complaints were recruited. The control group comprised 327 male control subjects. In a structured personal interview, body weight at different ages, body height, cumulative amount of smoking, and cumulative duration of different sports activities until the date of first diagnosis of knee osteoarthritis were elicited. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression analysis. An interaction analysis for the parameters BMI and kneeling/squatting respective lifting/carrying of loads was performed. Population attributable risks (PAR) for knee osteoarthritis were determined for BMI solely and for the combination of BMI with occupational kneeling/squatting and lifting/carrying of loads, respectively.

Results

Age and overweight were strongly associated with the diagnosis of knee osteoarthritis. Compared with persons less than 35 years old, persons who were at least 65 years old had an odds ratio (OR) of 19.0 (95% CI 6.1–58.7) for knee osteoarthritis. Persons with a BMI ≥ 28.41 kg/m2 had a strongly elevated risk of knee osteoarthritis (OR 10.8; 95% CI 4.8–24.3) compared to persons with a BMI < 22.86 kg/m2. Heavy tobacco smoking (≥55.5 pack years) was associated with a decreased knee osteoarthritis risk in comparison with never-smoking (OR 0.2; 95% CI 0.1–0.5). Ball games (handball, volleyball, basketball) and cycling were associated with symptomatic knee osteoarthritis (OR 4.0; 95% CI 1.8–8.9 and OR 3.7; 95% CI 1.7–7.8 in the highest category of cumulative duration, respectively); to a weaker degree jogging, swimming, and soccer also were positively related to symptomatic knee osteoarthritis. Combining the two parameters, BMI and kneeling/squatting into one variable led to a multiplicative interaction mode for symptomatic knee osteoarthritis. For persons with elevated BMI in combination with moderate to high exposure to occupational kneeling/squatting, the population attributable risk (PAR) was 4%. The PAR for elevated BMI in combination with moderate to high exposure to occupational lifting/carrying of loads was 7%.

Conclusions

In accordance with the literature, we find a strong association between BMI and knee osteoarthritis risk. Considering the relatively high prevalence of occupational manual materials handling, prevention of knee osteoarthritis should not only focus on body weight reduction, but should also take into account work organizational measures particularly aiming to reduce occupational lifting and carrying of loads.

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Acknowledgments

This work was supported by a grant from the Hans–Böckler Foundation and the industrial union IG BAU. We would like to thank the following persons for their valuable contributions to this study: Akan Gül, Sebastian Ridder, Dimitrios Bechtsis, Leif Reefschläger, and Elke Ball, who were performing the interviews; Winfried Beck, Adalbert Missalla, Christian Hanusa, Reinhard Hoffmann, Louis Hovy, Alwin Jäger, Andreas Misko, Annette Oboth, Richard Rehm, Wolfgang Schaub, Andrzej Sztulman, Thomas Vogl, Hannes Wacha, and Ludwig Zichner, who were responsible for recruitment of study participants (cases).

Conflict of interest statement

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Cyprus International Institute for Environmental and Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Corner of Athinon Road & N. **outa Street, 3041, Lemesos, Cyprus

    Ilias Vrezas

  2. Institute of Occupational Medicine, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Gine Elsner

  3. Labour Inspection, Division of Occupational Health, Simone-Veil-Str. 5, 65197 Wiesbaden, Germany, and Associated Professor of Occupational Health, Giessen University, Giessen, Germany

    Ulrich Bolm-Audorff

  4. Institute of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Nasreddin Abolmaali

  5. OncoRay, Center for Radiation Research in Oncology, Fetscherstraße 74, P.O. Box 86, 01307, Dresden, Germany

    Nasreddin Abolmaali

  6. Federal Institute of Occupational Safety and Health, Nöldnerstr. 40-42, 10317, Berlin, Germany

    Andreas Seidler

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  1. Ilias Vrezas
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  2. Gine Elsner
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  3. Ulrich Bolm-Audorff
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  4. Nasreddin Abolmaali
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Corresponding author

Correspondence to Andreas Seidler.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00420-010-0536-0

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Vrezas, I., Elsner, G., Bolm-Audorff, U. et al. Case–control study of knee osteoarthritis and lifestyle factors considering their interaction with physical workload. Int Arch Occup Environ Health 83, 291–300 (2010). https://doi.org/10.1007/s00420-009-0486-6

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  • DOI: https://doi.org/10.1007/s00420-009-0486-6

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