Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study.
OBJECTIVE
The presence of bone marrow lesions (BMLs) has been linked to pain and progression of knee OA. The aim of this study was to determine the relationship between BMLs and longitudinal change in tibial cartilage volume and risk of knee joint replacement in subjects with knee OA.


METHODS
One hundred and nine men and women with symptomatic knee OA were recruited. The same knee was imaged using MRI at baseline and ∼2 years later. Tibial cartilage volume and BMLs were measured. Knee joint replacement over 4 years was determined.


RESULTS
The mean age of the subjects at baseline was 63.2 (s.d. 10.3) years. BMLs were present in 66% of the subjects. Cross-sectionally, BMLs were negatively associated with both medial (regression coefficient -121.4; 95% CI -183.8, -859.1; P<0.001) and lateral (regression coefficient -142.1; 95% CI -241.8, -42.4; P=0.01) tibial cartilage volume data. Longitudinally, for every 1-score increase in baseline BML severity (range 0-4), the annual total tibial cartilage loss was increased by 1.14% (95% CI 0.29%, 1.87%; P=0.01). The risk of knee joint replacement over 4 years increased with increasing BML score (odds ratio 1.57; 95% CI 1.04, 2.35; P=0.03).


CONCLUSIONS
The prevalence and severity of BMLs are associated with less tibial cartilage volume and greater cartilage loss over 2 years. Moreover, severity of BMLs was positively associated with risk of knee joint replacement over 4 years. This provides further support for the importance of BMLs in identifying those with OA most likely to progress. Identifying factors that prevent or reduce the severity of BMLs may provide an important target in the prevention of disease progression and treatment of OA, and the subsequent need for arthroplasty.
Tanamas
Stephanie K
SK
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Centre, Commercial Road, Melbourne 3004, Victoria, Australia.
Wluka
Anita E
AE
Pelletier
Jean-Pierre
JP
Pelletier
Johanne M
JM
Abram
François
F
Berry
Patricia A
PA
Wang
Yuanyuan
Y
Jones
Graeme
G
Cicuttini
Flavia M
FM
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001855:Bone Marrow Diseases / Q000473:pathology* / Q000601:surgery; D002358:Cartilage, Articular; D018450:Disease Progression; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D013223:Statistics as Topic