The clinical significance, natural history and predictors of bone marrow lesion change over eight years.

Yi Foong,Leigh Blizzard,Flavia Cicuttini,Dawn Aitken,Hussain Khan,Graeme Jones,Changhai Ding

doi:10.1186/ar4611

Yi Foong, Leigh Blizzard + Show 5 more

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https://doi.org/10.1186/ar4611

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Abstract

IntroductionThere is increasing evidence to suggest that bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA). However, there is a lack of long term data. The aim of this study was to describe the natural history of knee BMLs, their association with knee pain and examine predictors of BML change over eight years.MethodsA total of 198 subjects (109 adult offspring of subjects who had a knee replacement and 89 community-based controls) were studied. Knee pain and BML size were assessed at two and ten year visits.ResultsAt the two year visit, 64% of participants (n = 127) had 229 BMLs (34% patella, 26% femoral and 40% tibial). Over eight years, 24% (55/229) increased in size, 55% (125/229) remained stable and 21% (49/229) decreased in size or resolved completely. Of the participants without BMLs at baseline, 52% (37/71) developed incident BMLs.After adjusting for confounders, eight year change in total BML size was associated with change in knee pain in offspring (β = 2.50, 95% confidence interval (CI) 0.96 to 4.05) but not controls. This association was stronger in males. Incident BMLs were associated with increase in pain (β = 3.60, 95% CI 1.14 to 6.05). Body mass index (BMI) and strenuous activity (but not radiographic osteoarthritis or smoking) were associated with an increase in BML size.ConclusionIn this midlife cohort, the proportion of BMLs increasing in size was similar to those decreasing in size with the majority remaining stable. Change in BMLs was predicted by BMI and strenuous activity. An increase in BML size or a new BML resulted in an increase in pain especially in males and those with a family history of OA.

Highlights

There is increasing evidence to suggest that bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA)
There were no significant differences in sex, age, Body mass index (BMI), offspring status, physical activity levels, height, weight, or change in pain, those with BMLs tended to have a higher proportion with radiographic osteoarthritis (ROA) compared with those with no BMLs
Whilst we found a significant association between strenuous physical activity and BML change, we did not find an association between light physical activity and BML change, suggesting intensity of activity may be important

Summary

Introduction

There is increasing evidence to suggest that bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA). Our group has previously reported that rates of incident BMLs were low (7%), with about one-quarter of BMLs showing an increase or a decrease in size over 2.7 years in a population-based cohort of older adults with and without OA [3]. The reasons behind these variations are unclear; it is worth noting that no study has looked at the natural history of BMLs beyond 3 years

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