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Proc Natl Acad Sci U S A. 2017 Aug 29;114(35):9332-9336. doi: 10.1073/pnas.1703856114. Epub 2017 Aug 14.

Knee osteoarthritis has doubled in prevalence since the mid-20th century.

Author information

1
Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138.
2
Institute for Quantitative Social Science, Harvard University, Cambridge, MA 02138.
3
Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA 02118.
4
Department of Anthropology, San Jose State University, San Jose, CA 95192.
5
Department of Anthropology, University of Tennessee, Knoxville, TN 37996.
6
Laboratory of Archeology, University of Oulu, Oulu 90014, Finland.
7
Battelle Memorial Institute, Natick, MA 01760.
8
Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138; danlieb@fas.harvard.edu.

Abstract

Knee osteoarthritis (OA) is believed to be highly prevalent today because of recent increases in life expectancy and body mass index (BMI), but this assumption has not been tested using long-term historical or evolutionary data. We analyzed long-term trends in knee OA prevalence in the United States using cadaver-derived skeletons of people aged ≥50 y whose BMI at death was documented and who lived during the early industrial era (1800s to early 1900s; n = 1,581) and the modern postindustrial era (late 1900s to early 2000s; n = 819). Knee OA among individuals estimated to be ≥50 y old was also assessed in archeologically derived skeletons of prehistoric hunter-gatherers and early farmers (6000-300 B.P.; n = 176). OA was diagnosed based on the presence of eburnation (polish from bone-on-bone contact). Overall, knee OA prevalence was found to be 16% among the postindustrial sample but only 6% and 8% among the early industrial and prehistoric samples, respectively. After controlling for age, BMI, and other variables, knee OA prevalence was 2.1-fold higher (95% confidence interval, 1.5-3.1) in the postindustrial sample than in the early industrial sample. Our results indicate that increases in longevity and BMI are insufficient to explain the approximate doubling of knee OA prevalence that has occurred in the United States since the mid-20th century. Knee OA is thus more preventable than is commonly assumed, but prevention will require research on additional independent risk factors that either arose or have become amplified in the postindustrial era.

KEYWORDS:

aging; arthritis; evolutionary medicine; mismatch disease; obesity

PMID:
28808025
PMCID:
PMC5584421
DOI:
10.1073/pnas.1703856114
[Indexed for MEDLINE]
Free PMC Article

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