By 2020 6.5 million Americans between the ages of 35 and 84 will be diagnosed with knee osteoarthritis. People as young as 45 to 54 will account for more than half of the newly diagnosed cases, according to a report compiled for TRFW News (http://news.therawfoodworld.com/knee-arthritis-rise-suggestions-reduce-risks/).
Pounds and High Heels Blamed for Osteoarthritis

Contributing factors in the spread of this ailment appear to be obesity, lack of exercise, diet and perhaps, in the case of women, their footwear. According to one piece of research cited, over 40% of men and 56% of women who have knee osteoarthritis were physically inactive. In one study cited, not one person was found to be participating in an exercise program—not even a ten minute routine a week.
Once believed to be detrimental, exercise has been found to benefit weight management, joints, joint tissues and bone density. The Framingham Heart Study (more information below) found that each pound lost reduces the knee pressure in every step taken. The risk of developing osteoarthritis dropped by 50% with each 11 pound weight loss experienced among younger obese women. The study concluded that if men and women could shift their bodies from the category of obese to merely being overweight, men would reduce their risk of osteoarthritis by one-fifth and women by one-third.
The problem with high heels comes from the changes they bring about in the dynamics of human walking. High heels add stress to the hips, lower back and knees. In one study cited, women wearing 3.75-inch heels may increase the stress placed on the knee joints by up to 90% when compared to those wearing only a half-inch heel.
The Framingham Heart Study
“The Framingham Heart Study is a long-term, ongoing cardiovascular study on residents of the town of Framingham, Massachusetts. The study began in 1948 with 5, 209 adult subjects from Framingham, and is now on its third generation of participants. Prior to it almost nothing was known about the “epidemiology of hypertensive or arteriosclerotic cardiovascular disease”. Much of the now-common knowledge concerning heart disease, such as the effects of diet, exercise, and common medications such as aspirin, is based on this longitudinal study. It is a project of the National Heart, Lung, and Blood Institute, in collaboration with (since 1971) Boston University. Various health professionals from the hospitals and universities of Greater Boston staff the project.” Source: Wikipedia. http://en.wikipedia.org/wiki/Framingham_Heart_Study.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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