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SERUM CALCIUM CONCENTRATION IS INVERSELY ASSOCIATED WITH RADIOGRAPHIC KNEE OSTEOARTHRITIS

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

Osteoarthritis (OA) is the most common form of arthritis, affecting millions of people worldwide. It is characterized by the progressive degeneration of joint cartilage, leading to pain, stiffness, and functional impairment. While age, obesity, and joint injury are known risk factors for OA, the exact etiology of the disease remains multifactorial and not fully understood. Emerging evidence suggests that systemic factors, such as metabolic and nutritional factors, may play a role in the pathogenesis of OA. One such factor that has gained attention in recent studies is serum calcium concentration.

Calcium is a vital mineral involved in numerous physiological processes, including bone formation, muscle contraction, and nerve function. It is well-established that calcium homeostasis is tightly regulated by the parathyroid hormone (PTH) and calcitriol (active form of vitamin D) in the body. Any disturbances in calcium metabolism can have significant implications for skeletal health and other physiological functions.

Recent studies have suggested that alterations in calcium metabolism, specifically serum calcium concentration, may be associated with the development and progression of OA. In particular, a growing body of evidence has shown an inverse relationship between serum calcium levels and the prevalence or severity of knee OA as determined by radiographic assessment. These findings have sparked interest in exploring the potential role of calcium in the pathogenesis of OA and its implications for clinical management.

The association between serum calcium concentration and knee OA can be explained by several plausible mechanisms. Firstly, calcium is an essential component of bone mineralization, and its deficiency may impair the structural integrity of the joint, leading to cartilage degradation and OA development. Secondly, calcium signaling pathways are involved in various cellular processes, including chondrocyte metabolism and apoptosis. Disruptions in calcium homeostasis may alter these pathways, resulting in the pathological changes observed in OA. Furthermore, calcium has been shown to have anti-inflammatory and antioxidative properties, and a deficiency in calcium may contribute to an inflammatory environment within the joint, promoting OA progression.

To date, several epidemiological studies have explored the relationship between serum calcium concentration and knee OA. While some studies have reported significant associations, others have yielded conflicting results, highlighting the need for further investigation. Moreover, the majority of existing studies have been limited by small sample sizes, cross-sectional designs, and inadequate adjustment for potential confounders, such as age, sex, body mass index (BMI), and physical activity. Therefore, a comprehensive analysis with a larger sample size and rigorous methodology is warranted to elucidate the true nature of the association between serum calcium concentration and knee OA.

The present study aims to address these gaps in the literature by conducting a cross-sectional analysis of a well-defined community-based population. The primary objective is to investigate the association between serum calcium concentration and radiographic knee OA, utilizing standardized criteria for OA diagnosis and rigorous statistical analysis. We hypothesize that lower serum calcium levels will be inversely associated with the presence and severity of knee OA. Additionally, we will explore potential effect modifiers and perform subgroup analyses to evaluate the consistency of the association across different demographic and clinical characteristics.

The findings of this study have the potential to provide valuable insights into the pathophysiology of knee OA and inform clinical management strategies. If a significant inverse association is confirmed, it may suggest that maintaining optimal serum calcium levels could have a preventive or therapeutic role in knee OA. This would have important implications for public health, as interventions targeted at optimizing calcium metabolism may help reduce the burden of knee OA and improve the quality of life for affected individuals.

STATEMENT OF THE PROBLEM

Knee osteoarthritis (OA) is a prevalent and debilitating condition characterized by the progressive degeneration of joint cartilage, leading to pain, stiffness, and functional impairment. While the etiology of knee OA is multifactorial, recent studies have suggested a potential association between