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Participants underwent radiographic assessments of the knees and lumbar spine, and urinary 4PA levels were measured using high-performance liquid chromatography. Logistic regression analyses were performed to evaluate the association between urinary 4PA levels and the Kellgren\u2013Lawrence (KL) grade of KOA and LS, adjusting for age, sex, body mass index (BMI), and lifestyle factors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Urinary 4PA levels were significantly higher in participants with KL grade 4 KOA compared to those with lower KL grades (p\u2009&lt;\u20090.001). This association remained significant after adjusting for confounding factors. In contrast, no significant differences in 4PA levels were observed across the KL grades for LS, although a slight increase in 4PA levels was noted in KL grade 4 cases.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Discussion and conclusions<\/jats:title>\n            <jats:p>These findings suggest that urinary 4PA could serve as a biomarker for assessing KOA severity, particularly in advanced stages. While the detection of early OA using 4PA remains challenging, the significant increase in KL grade 4 cases highlights its potential role in guiding treatment decisions, such as surgical intervention.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s40520-025-02944-6","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T16:34:34Z","timestamp":1740501274000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Urinary 4-pyridoxic acid as a non-invasive biomarker for evaluating osteoarthritis severity: findings from the ROAD study"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9206-4658","authenticated-orcid":false,"given":"Noriko","family":"Yoshimura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2087-7320","authenticated-orcid":false,"given":"Aiko","family":"Miyazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4662-4248","authenticated-orcid":false,"given":"Toshiko","family":"Iidaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1998-1240","authenticated-orcid":false,"given":"Nobuo","family":"Ando","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4010-9000","authenticated-orcid":false,"given":"Gaku","family":"Tanegashima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7282-6782","authenticated-orcid":false,"given":"Shigeyuki","family":"Muraki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5674-4875","authenticated-orcid":false,"given":"Horiyuki","family":"Oka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9210-9414","authenticated-orcid":false,"given":"Sakae","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"2944_CR1","unstructured":"Ministry of Health, Labour and Welfare (2024) Ministry of Health, Labour and Welfare, Overview of the 2023 Life Tables: https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/life\/life23\/dl\/life23-15.pdf. 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