High BMI may increase risk of shoulder adhesive capsulitis in younger patients
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Key takeaways:
- Risk of adhesive capsulitis increased with BMI among patients aged 20 to 40 years.
- No association was found between high BMI and risk of adhesive capsulitis among patients aged 40 years and older.
According to published results, younger patients with high BMI, diabetes or hyperlipidemia may be at increased risk for shoulder adhesive capsulitis, also known as frozen shoulder.
Researchers analyzed data from a national health insurance service which included 3,517,066 adults (aged 20 years and older) who received at least one medical evaluation from January 2009 to December 2009.
Among the cohort, 300,617 patients (9.34%) visited a hospital or private clinic for shoulder pain at least three times in 1 year and were diagnosed with shoulder adhesive capsulitis. According to the study, mean follow-up time was 8.3 years.
Among patients aged 40 years and older, researchers found no association between risk of adhesive capsulitis and patients with a BMI higher than 23 kg/m2, which signified overweight or obese status.
However, among patients aged20 to 40 years, researchers found the risk of adhesive capsulitis increased as BMI increased. Adjusted hazard ratios were 0.654 for patients with a BMI less than 18.5 kg/m2, 1 for patients with a BMI less than 23 kg/m2, 1.272 for patients with a BMI less than 25 kg/m2, 1.322 for patients with a BMI less than 30 kg/m2 and 1.332 for patients a BMI of 30 kg/m2 or higher.
After subgroup analysis of patients with a BMI higher than 23 kg/m2, researchers found patients with diabetes (aHR = 1.528) and hyperlipidemia (aHR = 1.212) were at increased risk for adhesive capsulitis.
“Young adults can demonstrate a highly sensitive inflammatory mechanism caused by increased BMI, because the incidence of systemic disease that can affect the incidence of [adhesive capsulitis] is lower than in the older population,” the researchers wrote in the study.
Perspective
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The authors demonstrate a strong association between obesity (defined as a BMI greater than 23 kg/m2) and adhesive capsulitis in a young population (aged 20 to 40 years). However, in the population older than 40 years, the triumvirate of obesity, hyperlipidemia and diabetes was needed to increase the risk for adhesive capsulitis. Because adhesive capsulitis can affect up to 5% of the population, may not be self-limiting and may not return a shoulder back to “baseline,” understanding risk factors — especially modifiable ones — is the key to treatment and, ultimately, prevention.
The study cohort may capture the entire Korean population, allowing the authors to make accurate conclusions; however, these conclusions may not be transferrable to Western populations due to differences in diet, treatment of the comorbidities and disease prevalence in poorer-tracked populations. Also, it is important to note that the inclusion criteria required a minimum of three visits for the specific diagnosis.
Overall, the authors found that patients with adhesive capsulitis were statistically older and had increased waist circumference, systolic and diastolic blood pressure, fasting glucose, total cholesterol, LDL cholesterol and triglyceride values. Furthermore, there was a higher proportion of female patients, incidence of obesity (BMI of 25 kg/m2 or greater) and chronic kidney disease.
There was a trend for younger patients to have an increased hazard risk with increasing BMI, so the greater the weight, the greater the chance of having adhesive capsulitis; interestingly, this did not hold true for the patients older than 40 years, but there was a greater association when the components of metabolic syndrome were present. The authors postulate that this could be the result of a greater adipose-linked inflammatory state in the younger population.
As the use of glucagon-like peptide-1 and other obesity treatments becomes more prevalent, will we observe a decline in the incidence of adhesive capsulitis?
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