Abstract
IntroductionTo examine the relationship between development or resolution of bone marrow lesions (BMLs) and knee cartilage properties in a 2 year prospective study of asymptomatic middle-aged adults.Methods271 adults recruited from the Melbourne Collaborative Cohort Study, underwent a magnetic resonance imaging scan (MRI) of their dominant knee at baseline and again approximately 2 years later. Cartilage volume, cartilage defects and BMLs were determined at both time points.ResultsAmong 234 subjects free of BMLs at baseline, 33 developed BMLs over 2 years. The incidence of BMLs was associated with progression of tibiofemoral cartilage defects (OR 2.63 (95% CI 0.93, 7.44), P = 0.07 for medial compartment; OR 3.13 (95% CI 1.01, 9.68), P = 0.048 for lateral compartment). Among 37 subjects with BMLs at baseline, 17 resolved. Resolution of BMLs was associated with reduced annual loss of medial tibial cartilage volume (regression coefficient -35.9 (95%CI -65, -6.82), P = 0.02) and a trend for reduced progression of medial tibiofemoral cartilage defects (OR 0.2 (95% CI 0.04, 1.09), P = 0.06).ConclusionsIn this cohort study of asymptomatic middle-aged adults the development of new BMLs was associated with progressive knee cartilage pathology while resolution of BMLs prevalent at baseline was associated with reduced progression of cartilage pathology. Further work examining the relationship between changes and BML and cartilage may provide another important target for the prevention of knee osteoarthritis.
Highlights
To examine the relationship between development or resolution of bone marrow lesions (BMLs) and knee cartilage properties in a 2 year prospective study of asymptomatic middle-aged adults
Participants for the current study were recruited from this cohort in 2003-04 if they were aged between 50 and 79 years without any of the following exclusion criteria: a clinical diagnosis of knee OA as defined by American College of Rheumatology criteria [32]; knee pain lasting for more than 24 hours in the past five years; a previous knee injury requiring non-weight bearing treatment for more than 24 hours or surgery; a history of any form of arthritis diagnosed by a medical practitioner or a contraindication to magnetic resonance imaging (MRI), as previously described [33]
Among elderly participants with or at high risk of knee OA, development of new BMLs was associated with a worsening cartilage score as assessed using the WORMS (Whole organ MRI score) scale compared with knees where a BML remained stable; a comparison of cartilage loss with knees that remained BML free was not performed [29]
Summary
To examine the relationship between development or resolution of bone marrow lesions (BMLs) and knee cartilage properties in a 2 year prospective study of asymptomatic middle-aged adults. There is increasing interest in the role of bone marrow lesions (BMLs), detected by magnetic resonance imaging (MRI), in the pathogenesis of knee osteoarthritis (OA) [1,2]. Histological examination of BMLs in knees has reported that they may represent areas of osteonecrosis, oedema, trabecular abnormalities and bony remodeling [3]. BMLs are present in both symptomatic [4,5,6,7] and asymptomatic populations [8,9]. More recently systemic factors such as osteo-protective medications [18] and nutritional factors [19,20] have been reported to affect the risk of BMLs
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