• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jepicomhInstructions for authorsCurrent TOCJournal of Epidemiology and Community Health
J Epidemiol Community Health. Oct 2003; 57(10): 823–830.
PMCID: PMC1732289

An investigation of risk factors for symptomatic osteoarthritis of the knee in women using a life course approach

Abstract

Study objective: To explore risk factors for symptomatic knee osteoarthritis (OAK) in women, which included wearing high heeled shoes.

Design: Matched case-control study. Exposure information obtained by interview, included details about past footwear. Self reported weight and height data obtained representing when women left school, were aged 36–40 and were aged 51–55. Regular work activities (including periods when homemaker or carer), smoking, and hormone related data gathered using a life-grid.

Setting: Interviews in participants' homes. Cases identified from orthopaedic hospital surgical waiting list, controls identified by general practitioners (GPs)

Participants: Women aged 50 to 70 years. Cases awaiting knee replacement surgery. Controls, who had no past knee surgery and no knee pain in the past three years, were matched for age and GP. Altogether 111 eligible women were interviewed (29 cases, 82 controls).

Main results: Univariate analyses identified several significant associations with OAK including past knee injury, arthritis of the feet, heavy smoking, being overweight (BMI 25 or above) and various occupational activities. Virtually all measures of high heeled shoes use were associated with reduced risk of OAK, although none of these findings were statistically significant. In multivariate analysis only BMI 25 or above at age 36–40 remained significantly associated with OAK (OR 36.4, 95% CI 3.07 to 432, p=0.004), although weak evidence suggested certain occupational activities might increase risk. Weight gain in early adult life was particularly pronounced among cases.

Conclusions: Being overweight before the age of 40 considerably increased the risk of subsequent symptomatic OAK in women. Wearing high heeled shoes did not.

Full Text

The Full Text of this article is available as a PDF (331K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Tennant A, Fear J, Pickering A, Hillman M, Cutts A, Chamberlain MA. Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty. BMJ. 1995 May 20;310(6990):1291–1293. [PMC free article] [PubMed]
  • Croft P. Review of UK data on the rheumatic diseases--3. Osteoarthritis. Br J Rheumatol. 1990 Oct;29(5):391–395. [PubMed]
  • McAlindon TE, Cooper C, Kirwan JR, Dieppe PA. Knee pain and disability in the community. Br J Rheumatol. 1992 Mar;31(3):189–192. [PubMed]
  • Keen RW, Hart DJ, Lanchbury JS, Spector TD. Association of early osteoarthritis of the knee with a Taq I polymorphism of the vitamin D receptor gene. Arthritis Rheum. 1997 Aug;40(8):1444–1449. [PubMed]
  • Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol. 1993 Feb;20(2):331–335. [PubMed]
  • Felson DT. The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum. 1990 Dec;20(3 Suppl 1):42–50. [PubMed]
  • Spector TD, Harris PA, Hart DJ, Cicuttini FM, Nandra D, Etherington J, Wolman RL, Doyle DV. Risk of osteoarthritis associated with long-term weight-bearing sports: a radiologic survey of the hips and knees in female ex-athletes and population controls. Arthritis Rheum. 1996 Jun;39(6):988–995. [PubMed]
  • Lequesne MG, Dang N, Lane NE. Sport practice and osteoarthritis of the limbs. Osteoarthritis Cartilage. 1997 Mar;5(2):75–86. [PubMed]
  • McAlindon TE, Wilson PW, Aliabadi P, Weissman B, Felson DT. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999 Feb;106(2):151–157. [PubMed]
  • Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage. 1995 Dec;3(4):261–267. [PubMed]
  • Sutton AJ, Muir KR, Mockett S, Fentem P. A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Ann Rheum Dis. 2001 Aug;60(8):756–764. [PMC free article] [PubMed]
  • Coggon D, Croft P, Kellingray S, Barrett D, McLaren M, Cooper C. Occupational physical activities and osteoarthritis of the knee. Arthritis Rheum. 2000 Jul;43(7):1443–1449. [PubMed]
  • Felson DT, Hannan MT, Naimark A, Berkeley J, Gordon G, Wilson PW, Anderson J. Occupational physical demands, knee bending, and knee osteoarthritis: results from the Framingham Study. J Rheumatol. 1991 Oct;18(10):1587–1592. [PubMed]
  • Felson DT, Nevitt MC. The effects of estrogen on osteoarthritis. Curr Opin Rheumatol. 1998 May;10(3):269–272. [PubMed]
  • Zhang Y, McAlindon TE, Hannan MT, Chaisson CE, Klein R, Wilson PW, Felson DT. Estrogen replacement therapy and worsening of radiographic knee osteoarthritis: the Framingham Study. Arthritis Rheum. 1998 Oct;41(10):1867–1873. [PubMed]
  • Gibson T, Hameed K, Kadir M, Sultana S, Fatima Z, Syed A. Knee pain amongst the poor and affluent in Pakistan. Br J Rheumatol. 1996 Feb;35(2):146–149. [PubMed]
  • Chaturvedi N, Ben-Shlomo Y. From the surgery to the surgeon: does deprivation influence consultation and operation rates? Br J Gen Pract. 1995 Mar;45(392):127–131. [PMC free article] [PubMed]
  • Leigh JP, Fries JF. Correlations between education and arthritis in the 1971-1975 NHANES I. Soc Sci Med. 1994 Feb;38(4):575–583. [PubMed]
  • Kerrigan DC, Todd MK, Riley PO. Knee osteoarthritis and high-heeled shoes. Lancet. 1998 May 9;351(9113):1399–1401. [PubMed]
  • Adrian MJ, Karpovich PV. Foot instability during walking in shoes with high heels. Res Q. 1966 May;37(2):168–175. [PubMed]
  • Berney LR, Blane DB. Collecting retrospective data: accuracy of recall after 50 years judged against historical records. Soc Sci Med. 1997 Nov;45(10):1519–1525. [PubMed]
  • Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat Metab Disord. 1998 Jan;22(1):39–47. [PubMed]
  • Bartley M. Measuring women's social position: the importance of theory. J Epidemiol Community Health. 1999 Oct;53(10):601–602. [PMC free article] [PubMed]
  • Jensen CH, Rofail S. Knee injury and obesity in patients undergoing total knee replacement: a retrospective study in 115 patients. J Orthop Sci. 1999;4(1):5–7. [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...