Incidence and analysis of characteristics of sarcopenia in patients with knee osteoarthritis

doi:10.3877/cma.j.issn.1674-134X.2024.01.005

Abstract

Abstract:

Objective

To analyze the incidence and characteristics of sarcopenia (SP) in the population of knee osteoarthritis (KOA) patients and explore common features between the two conditions.

Methods

A total of 129 KOA patients (215 lower limbs) treated at the Joint Center of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine from November 2022 to July 2023 were included based on specific criteria. Inclusion criteria: knee joint pain within the past month, age≥50 years, morning stiffness≤30 min, and X-ray evidence of narrowed knee joint space, subchondral bone sclerosis, and/or cystic changes, and osteophyte formation. Exclusion criteria: other types of arthritis, concurrent lower limb impairing conditions, and inability to cooperate with data collection. General information [gender, age, height, weight, body mass index (BMI)], and relevant data such as appendicular skeletal muscle mass index (ASMI), hip-knee-ankle angle (HKA), joint line convergence angle (JLCA), medial joint space width (MJSW), and lateral joint space width (LJSW) were collected. According to the criteria proposed by the Asian Working Group for Sarcopenia, patients were categorized into the SP-KOA group and KOA group. Group analysis was conducted using rank-sum tests, independent sample t tests, and chi-square tests. Logistic regression analysis was performed to identify risk factors for SP in KOA patients. A nomogram model was constructed using R language based on logistic regression-selected influencing factors, and the model's discriminative ability and accuracy were assessed.

Results

Among the 129 KOA patients, 28 had concomitant SP, resulting in a sarcopenia incidence rate of 21.7%. The overall analysis showed that the lower limb alignment was better in the SP-KOA group (Z=2.901, P<0.05), KOA severity was milder (χ²=10.290, P<0.05), BMI was lower (Z=7.175, P<0.05), and the proportion of males was higher (χ²=7.224, P<0.05). Binary logistic regression analysis indicated that BMI in male KOA patients [odds ratio (OR)=0.254, 95% confidence interval (CI) (0.087, 0.747)], and in female KOA patients BMI [OR=0.782, 95%CI (0.679, 0.899)], LJSW [OR=0.596, 95%CI (0.396, 0.897)], and age [OR=1.066, 95%CI (1.003, 1.132)] had statistically significant impacts on the incidence of SP (all P<0.05).

Conclusions

This study suggests that among KOA patients, male KOA patients and those with lower BMI may be more prone to concomitant SP. This emphasizes the importance of promoting a balanced diet, correcting low body weight, and engaging in non-weight-bearing exercises in the early stages of knee osteoarthritis to improve skeletal muscle mass, strength, and reduce the risk of developing sarcopenia.

Key words: Sarcopenia, Osteoarthritis, knee, Cross-sectional studies, Risk factors, Nomograms

Fangming Yao, Yingying Jiao, Mincong He, Zijun Zeng, Xiaoming He, Liangyan Liu, Wei He, Qiushi Wei, Wengang Liu. Incidence and analysis of characteristics of sarcopenia in patients with knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(01): 30-38.

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https://zhgjwkzz.cma-cmc.com.cn/EN/Y2024/V18/I01/30

Figures/Tables 8

Figure 1 Comparison of baseline information and radiographic parameters between the SP-KOA group and the KOA group. A is age comparison(Z＝1.917); B is gender comparison(χ²＝7.224); C is height comparison(Z＝1.874); D is body weight comparison (t＝7.122); E is BMI comparison(Z＝7.175); F is HKA comparison(Z＝2.901); G is JLCA comparison(Z＝3.664); H is MJSW comparison(Z＝2.215); I is LJSW comparison(Z＝4.036); J is K-L grading comparison(χ²＝10.290) Note：^*-P<0.05；^**-P<0.01；ns-meaningless；HKA-hip-knee-ankle angle；JLCA-joint line convergence angle；MJSW-medial joint space width；LJSW-lateral joint space width；BMI-body mass index；KL-Kellgren & Lawrence grade

Figure 2 Group analysis of BMI between mild and severe KOA patients

Table 1 Logistic regression analysis on risk factors for SP disease in KOA patients

因素Factors	赋值Assign	B值	SE	Wald值	OR	95%CI	P值
HKA	连续变量	0.110	0.063	3.058	1.116	(0.987，1.262)	0.080
JLCA	连续变量	0.188	0.176	1.149	1.207	(0.855，1.704)	0.284
MJSW	连续变量	－0.067	0.223	0.090	0.935	(0.604，1.449)	0.765
LJSW	连续变量	－0.381	0.206	3.408	0.683	(0.456，1.024)	0.065
KL分级	"1－2级"＝0，"3－4级"＝1	－0.355	0.634	0.313	0.701	(0.202，2.430)	0.576
性别	"男"＝0，"女"＝1	－1.642	0.501	10.722	0.194	(0.072，0.517)	0.001
BMI	连续变量	－0.363	0.070	27.244	0.695	(0.607，0.797)	<0.001
常量		－8.720	11.038	0.624	<0.001		0.430

Figure 3 Comparison of baseline information and radiographic parameters between the SP-KOA subgroup and the KOA subgroup of male KOA patients. A is age comparison(t＝1.040); B is height comparison(Z＝0.271); C is body weight comparison(Z＝5.285); D is BMI comparison(Z＝5.272); E is HKA comparison(t＝－2.832); F is JLCA comparison(t＝3.390); G is MJSW comparison(Z＝2.817); H is LJSW comparison(Z＝1.208); I is K-L grading comparison(χ²＝10.581) Note: M-male；^*-P<0.05；^**-P<0.01；ns-meaningless；HKA-hip-knee-ankle angle；JLCA-joint line convergence angle；MJSW-medial joint space width；LJSW-lateral joint space width；BMI-body mass index；KL-Kellgren & Lawrence grade

Table 2 Logistic regression analysis of risk factors for SP in male KOA patients

因素Factors	赋值Assign	B值	SE	Wald值	OR	95%CI	P值
HKA	连续变量	0.352	0.319	1.216	1.421	(0.761，2.656)	0.270
JLCA	连续变量	0.132	0.470	0.079	1.141	(0.454，2.868)	0.779
MJSW	连续变量	0.253	0.872	0.084	1.288	(0.233，7.115)	0.772
KL分级	"1－2级"＝0，"3－4级"＝1	3.546	2.139	2.748	34.665	(0.524，2 293.009)	0.097
BMI	连续变量	－1.369	0.550	6.204	0.254	(0.087，0.747)	0.013
常量		－31.446	52.741	0.355	<0.001		0.551

Figure 4 Comparison of baseline information and radiographic parameters between the SP-KOA subgroup and the KOA subgroup of female KOA patients. A is age comparison(Z＝－2.518); B is height comparison(Z＝－0.040); C is body weight comparison(t＝4.411); D is BMI comparison(t＝6.786); E is HKA comparison(Z＝－2.180); F is JLCA comparison(Z＝－1.948); G is MJSW comparison(Z＝－0.530); H is LJSW comparison(Z＝3.834); I is K-L grading comparison(χ²＝3.441) Note: F-Female；^*-P<0.05；^**-P<0.01；ns-meaningless；HKA-hip-knee-ankle angle；JLCA-joint line convergence angle；MJSW-medial joint space width；LJSW-lateral joint space width；BMI-body mass index；KL-Kellgren &Lawrence grades

Table 3 Logistic regression analysis of risk factors for SP in female KOA patients

因素Factors	赋值Assign	B值	SE	Wald值	OR	95%CI	P值
HKA	连续变量	0.033	0.054	0.362	1.033	(0.929，1.149)	0.547
LJSW	连续变量	－0.518	0.209	6.164	0.596	(0.396，0.897)	0.013
年龄	连续变量	0.064	0.031	4.276	1.066	(1.003，1.132)	0.039
KL分级	"1－2级"＝0，"3－4级"＝1	－0.188	0.555	0.114	0.829	(0.279，2.460)	0.735
BMI	连续变量	－0.246	0.072	11.846	0.782	(0.679，0.899)	0.001
常量		－2.900	10.414	0.078	0.055		0.781

Figure 5 Construction of a nomogram model of risk factors for SP in female KOA patients. A is risk prediction model of SP in female KOA patients; B is calibration curve analysis of nomogram model; C is ROC of SP incidence in female KOA patients Note: KOA-knee osteoarthritis；SP-sarcopenia；LJSW-lateral joint space width；BMI-body mass index

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