The long-term risk of knee and hip joint replacements attributable to overweight and obesity in the community: the Atherosclerosis Risk in Communities (ARIC) Study
Abstract Body: Background: The number of joint replacements due to osteoarthritis has grown recently, likely reflecting the obesity epidemic, demanding substantial medical expenditure (over $20 billion for knee and hip replacements). However, data on joint-specific replacements attributable to overweight/obesity and their lifetime risk are limited. Methods: In 15,287 ARIC study participants (age 45-64 years) at visit 1 (1987-89), we assessed the association of body mass index (BMI) at mid-life with knee/hip joint replacements due to osteoarthritis based on discharge diagnosis using multivariable Cox models. We calculated a population-attributable fraction for BMI ≥25 kg/m2. We also estimated the residual lifetime risk from age 50 through 95 years, accounting for the competing risk of death. Results: Over a median follow-up of 25.4 years, 1,874 participants (12%) underwent osteoarthritis-related knee or hip replacements (1,380 and 699 cases, respectively). In adjusted Cox models, participants with obesity (BMI ≥30.0 kg/m2) and overweight (25.0-29.9 kg/m2) had a 4- and 2-fold higher risk of joint replacements compared to participants with normal weight (<25.0 kg/m2). The association was stronger for knee vs. hip replacements (hazard ratios 4.58 [95% CI 3.85, 5.44] vs. 2.40 [1.87, 3.07] for BMI 30+ kg/m2 compared to <25 kg/m2). 47% of knee/hip replacements were attributed to overweight and obesity. The residual risk of osteoarthritis-related joint replacements after age of 50 was highest in White women (17%), followed by Black women (12%), White men (11%), and Black men (4%). The residual lifetime risk within the same race and sex varied by ~2-fold according to obesity status (e.g., White women with obesity vs. normal weight: 25% vs. 12%) (Figure). Conclusions: Obesity and overweight are attributed to half of knee and hip replacements, and one in five to ten Whites and Blacks with obesity/overweight require joint replacements after age 50. Our findings emphasize the importance of weight management, such as increased physical activity.
Mok, Yejin
( Johns Hopkins Bloomberg School of Public Health
, Baltimore
, Maryland
, United States
)
Lutsey, Pamela
( University of Minnesota
, Minneapolis
, Minnesota
, United States
)
Palta, Priya
( UNC Chapel Hill
, Chapel Hill
, North Carolina
, United States
)
Ndumele, Chiadi
( Johns Hopkins University
, Baltimore
, Maryland
, United States
)
Blaha, Michael
( Johns Hopkins University
, Baltimore
, Maryland
, United States
)
Best, Matthew
( Johns Hopkins University
, Baltimore
, Maryland
, United States
)
Matsushita, Kunihiro
( Johns Hopkins Bloomberg School of Public Health
, Baltimore
, Maryland
, United States
)
Author Disclosures:
Yejin Mok:DO NOT have relevant financial relationships
| Pamela Lutsey:DO NOT have relevant financial relationships
| Priya Palta:DO NOT have relevant financial relationships
| Chiadi Ndumele:No Answer
| Michael Blaha:DO have relevant financial relationships
;
Research Funding (PI or named investigator):Novo Nordisk:Active (exists now)
; Advisor:New Amsterdam:Active (exists now)
; Advisor:Genentech:Active (exists now)
; Advisor:Idorsia:Active (exists now)
; Advisor:Vectura:Active (exists now)
; Advisor:Agepha:Active (exists now)
; Advisor:Boehringer Ingelheim:Active (exists now)
; Advisor:Astra Zeneca:Active (exists now)
; Advisor:Eli Lilly:Active (exists now)
; Advisor:Merck:Active (exists now)
; Advisor:Novartis:Active (exists now)
; Advisor:Bayer:Active (exists now)
; Advisor:Novo Nordisk:Active (exists now)
; Research Funding (PI or named investigator):Bayer:Active (exists now)
| Matthew Best:No Answer
| Kunihiro Matsushita:No Answer
