Dolan, et al: Hypermobility, OA, and BMD 799 2002-256-1 From the Department of Rheumatology, Queen Elizabeth Hospital; Twin Research and Genetic Epidemiology Unit, St. Thomas’ Hospital; Whipps Cross Hospital; and University College London Hospitals, London, UK. A.L. Dolan, MA, FRCP, Department of Rheumatology, Queen Elizabeth Hospital; D.J. Hart, PhD; T.D. Spector, MD, FRCP, Twin Research and Genetic Epidemiology Unit, St. Thomas’Hospital; D.V. Doyle, FRCP, Whipps Cross Hospital; R. Grahame, MD, FRCP, University College London Hospitals. Address reprint requests to Dr. A.L. Dolan, Department of Rheumatology, Queen Elizabeth Hospital, Stadium Road, London, SE18 4QH, UK. E-mail: Ldolan@btinternet.com Submitted March 20, 2002; revision accepted September 19, 2002. A hypermobile joint is one whose range of movement exceeds that which is normal for that individual, taking into consideration age, sex, and ethnic background 1 . A joint’s range is determined by the tightness or laxity of its liga- ments, and joint laxity can be considered to be a prerequisite for hypermobility. In general, joint laxity is greatest at birth, declining rapidly through childhood, less rapidly during the teens, and more slowly during adult life 1 . Females are generally more lax jointed than males at all ages and there is a wide ethnic variation. Epidemiological studies using a variety of defini- tions have suggested hypermobility is seen in up to 10% of Western populations and may be up to 25% in other racial groups 2-4 . The extent to which joint hypermobility is symp- tomatic in the general population is unclear. Many studies of symptomatic joint hypermobility have been based on clinic populations, with likely attendant selection bias. In one such study, 15% of a rheumatology clinic population were hyper- mobile 5 . The prevalence of hypermobility and its conse- quences in an older postmenopausal community population has not previously been studied. Hypermobility is seen as a common unifying feature in the hereditary diseases of connective tissue (HDCT) such as Ehlers Danlos syndrome (EDS) 6 , Marfan’s syndrome 7 , and osteogenesis imperfecta 8 . It is also recognized as a feature of the benign joint hypermobility syndrome (BJHS) 9 , said to exist when a hypermobile joint (or joints) becomes sympto- matic. It is not known whether women in the community who manifest osteoarthritis (OA) and/or reduced bone density have other features to suggest an underlying HDCT. We examined the occurrence of hypermobility in a general population to determine whether women with OA or osteoporosis might share phenotypic features of a genetic The Relationship of Joint Hypermobility, Bone Mineral Density, and Osteoarthritis in the General Population: The Chingford Study A. LOUISE DOLAN, DEBBIE J. HART, DAVID V. DOYLE, RODNEYGRAHAME, and TIM D. SPECTOR ABSTRACT. Objective. The prevalence of hypermobility and its consequence in an aging female population is unknown. Case studies of patients with the benign joint hypermobility syndrome suggest both a tendency toward osteopenia and an association with premature osteoarthritis (OA). We assessed hypermobility and its relationship to bone mineral density (BMD) and OA in a postmenopausal female community population. Methods. Joint hypermobility was assessed by the Beighton and the (more quantitative) Contompasis scores in 716 female subjects under followup in the Chingford Study (age range 53–72, mean 61 yrs, SD 5.8). Results. We found 79 of 716 subjects (11%) had a hypermobility score > 1/9 on the Beighton scale (spine in 75/79); 82/716 had a Contompasis score > 22 (normal < 18). Only one had a 4/9 Beighton score indicative of generalized joint hypermobility. Subjects with Contompasis > 22 were more physically active and less likely to smoke. They had a reduced risk of knee OA (joint space narrowing) (OR 0.48, 95% CI 0.27–0.83, after adjusting for age, height, weight, and activity), but no change in risk of OA in spine or hands. Hip BMD was increased by 3% in this more hypermo- bile subgroup (p < 0.05). A similar effect was seen for knee OA, but not BMD in those with a Beighton score > 1. Conclusion. Our data suggest that in this postmenopausal population the tendency to joint hyper- mobility may be a marker for fitness, manifested by reduced knee OA and increased hip BMD. The incidence of generalized hypermobility (Beighton > 4/9) was very low (0.14%) compared with the localized form (seen in 11%) and other studies. Those with mild degrees of hypermobility showed no evidence of premature OA or reduced BMD, as reported in some of the rarer heritable disorders of connective tissue. (J Rheumatol 2003;30:799–803) Key Indexing Terms: HYPERMOBILITY OSTEOPOROSIS OSTEOARTHRITIS Personal, non-commercial use only. The Journal of Rheumatology Copyright © 2003. All rights reserved. www.jrheum.org Downloaded on December 28, 2022 from