title: Dual-energy X-ray absorptiometry applied to the assessment of tibial subchondral bone mineral density in osteoarthritis of the knee.
abstract: OBJECTIVE
  Plain X-ray is an imprecise tool for monitoring the subchondral bony changes associated with the development of knee osteoarthritis (OA). Our objective was to develop and validate a technique for assessing tibial subchondral bone density (BMD) in knee OA using dual energy X-ray absorptiometry (DXA).
  
  
  METHODS
  Patients with OA of at least one knee underwent DXA scanning of both knees. Regions of interest (ROI) were placed in the lateral and medial compartments of tibial subchondral bone. Weight-bearing plain X-rays and Te (99m) scintiscans of both knees were obtained and scored.
  
  
  RESULTS
  One hundred and twelve patients (223 knees) underwent DXA and radiography. Intra-observer CV% was 2.4% and 1.0% for the medial and lateral ROI respectively. Definite OA (Kellgren and Lawrence Grade 2, 3 or 4) was correlated with age-related preservation of subchondral BMD compared to radiographically normal knees. Raised BMD was also associated with subchondral sclerosis, and positive scintigraphy.
  
  
  CONCLUSIONS
  DXA may provide a safe, rapid and reliable means of assessing knee OA. Cross-sectional age-related subchondral tibial BMD loss is attenuated by knee OA.
authors.affiliation: Academic Rheumatology, University Division of Medicine, Bristol Royal Infirmary, Bristol, BS2 8HW, UK. s.clarke@bristol.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Clarke
authors.forename: C
authors.initials: C
authors.lastname: Wakeley
authors.forename: J
authors.initials: J
authors.lastname: Duddy
authors.forename: M
authors.initials: M
authors.lastname: Sharif
authors.forename: I
authors.initials: I
authors.lastname: Watt
authors.forename: K
authors.initials: K
authors.lastname: Ellingham
authors.forename: C J
authors.initials: CJ
authors.lastname: Elson
authors.forename: G
authors.initials: G
authors.lastname: Nickols
authors.forename: J R
authors.initials: JR
authors.lastname: Kirwan
mesh_terms: D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D015519:Bone Density / Q000502:physiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010026:Osteosclerosis / Q000175:diagnosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012737:Sex Factors; D016037:Single-Blind Method; D013669:Technetium Tc 99m Medronate; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology*
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate