Association of Bone Marrow Lesions with Knee Structures and Risk Factors for Bone Marrow Lesions in the Knees of Clinically Healthy, Community-Based Adults

doi:10.1016/j.semarthrit.2007.01.008

Seminars in Arthritis and Rheumatism

Volume 37, Issue 2, October 2007, Pages 112-118

https://doi.org/10.1016/j.semarthrit.2007.01.008 Get rights and content

Objectives

Subchondral bone marrow lesions (BML) are involved in pain and progression of knee osteoarthritis (OA). Little is known about their role in the knee in those without clinical OA. Our aim was to examine the prevalence and risk factors for BML, and their relationship with other knee structures in community-based adults without clinical OA.

Methods

Two hundred ninety-seven healthy subjects without knee pain or injury were recruited from an existing community-based cohort recruited at baseline in 1990-1994. Subjects with a single magnetic resonance imaging (MRI) of their dominant knee at follow-up were studied in 2003-2004. BML, cartilage defects, cartilage volume, and bone area of the knee were assessed using MRI.

Results

Thirty-nine subjects (13%) had evidence of BML. BML were associated with the presence of cartilage defects in the medial (odds ratio (OR) 1.80, P = 0.004) and lateral (OR 1.45, P = 0.04) tibiofemoral compartments, but not cartilage volume. BML were positively associated with total tibial bone area (OR 1.22, P = 0.02). Increasing age (OR 1.10, P < 0.001), male gender (OR 3.86, P = 0.01), and increasing body height (OR 1.07, P = 0.03) were independently associated with BML in the total tibiofemoral compartment.

Conclusions

BML are present in the knees of community-based adults without clinical OA and are strongly associated with tibiofemoral cartilage defects. Risk factors for BML were age, male gender, and body height. Longitudinal studies will be needed to clarify the role of BML in structural change of the knee and how this relates to the pathogenesis of symptomatic knee OA.

Section snippets

Subjects

This study was conducted within the Melbourne Collaborative Cohort Study (MCCS), which is a prospective cohort study of 41,528 community-based people (24,479 women), aged 40 to 69 years at recruitment, which occurred between 1990 and 1994, with the aim of examining the role of lifestyle factors in the risk of cancer and heart disease (9). Participants for this current study were recruited from the MCCS. As our intent was to investigate subjects with no clinical knee OA as defined by the

Results

Two hundred ninety-seven participants, 63% women, aged 58.0 ± 5.5 years with BMI 25.2 ± 3.8 kg/m², took part in this study (Table 1). There were no significant differences between this population and the original MCCS population which has the following profile: 61% women, aged 57.8 ± 3.0 years, and BMI 25.7 ± 3.8 kg/m². Thirty-nine (13.1%) subjects had BML in the subchondral bone of the knee: 14 males and 25 females. Five subjects had lesions in both medial and lateral compartments.

The

Discussion

In this study of community-based adults without clinical OA, BML were present in 13% of subjects. BML prevalence was similar in the lateral and medial tibiofemoral compartments, although there was an inverse relationship between BML in the 2 compartments. Large BML were positively associated with cartilage defects in both the medial and lateral compartments but not cartilage volume. Large BML were also positively associated with tibial plateau bone area in total tibiofemoral compartment.

Acknowledgments

The Melbourne Collaborative Cohort Study recruitment was funded by VicHealth and The Cancer Council of Victoria. We especially thank the study participants who made this study possible.

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Metabolic syndrome and subchondral bone alterations: The rise of osteoarthritis – A review
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Metabolic syndrome (MS) has become one of the top major health burdens for over three decades not only due to its effects on cardiovascular health but also its implications in orthopedics. Extensive research has shown that MS is tightly linked to osteoarthritis and inflammation, a process which appears to primarily occur in the subchondral bone via the incidence of bone-marrow lesions (BMLs). Numerous studies identify obesity, dyslipidemia, insulin resistance and hypertension as the top metabolic risk factors, the so-called “deadly quartet”. These factors are responsible for the disruptive physiological processes that culminate in detrimental alterations within the subchondral bone, cartilage damage and, overall, the predominant pro-inflammatory joint microenvironment. Although it has long been thought that osteoarthritis was limited to the cartilage component of the joint, other studies indicate that the disease may originate from the harmful alterations that occur primarily in the subchondral bone, especially via means of vascular pathology. Since metabolic risk factors are manageable to a certain extent, it is therefore possible to decelerate the progression of OA and mitigate its devastating effects on the subchondral bone and subsequent articular cartilage damage.
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Citation Excerpt :
In contrast, weight and BMI were not associated with the prevalence or progression of BMLs in 2 cross-sectional studies of asymptomatic populations [4,31] or in 4 cohort studies of asymptomatic populations [32,39], a population with 58% participants having radiographic OA [29], and a symptomatic OA population [40]. Height was associated with the prevalence of BMLs in 1 cross-sectional study of an asymptomatic population [4] but not the other [5]. Only 1 cross-sectional study examined the association between body composition and BMLs in an asymptomatic population with 16% having radiographic OA [31].
The objective of this study was to systematically review the literature to determine whether obesity and systemic factors, including age, gender, heritability, dietary factors, smoking, serum and urine biomarkers of cartilage or bone metabolism, bone-related factors, and medication, are associated with knee bone marrow lesions (BMLs) identified on magnetic resonance imaging in asymptomatic pre-osteoarthritis and osteoarthritis populations.
Electronic searches of MEDLINE and EMBASE were performed from January 1, 1996 to September 30, 2012 using the following keywords: bone marrow lesion(s), bone marrow (o)edema, osteoarthritis, and knee. Studies examining obesity and non-biomechanical factors in relation to the presence, incidence, or change in BMLs were included. Two independent reviewers extracted data and assessed methodological quality of selected studies. Due to the heterogeneity of the studies, we performed a best evidence synthesis.
Among 30 studies, 17 were considered high quality. The study populations were heterogeneous in terms of symptoms and radiographic knee osteoarthritis. There was strong evidence for an association between serum lipids and BMLs and no association between age and BMLs. There was moderate evidence for a relationship between obesity and BMLs. There was limited evidence for gender, smoking, C-telopeptide of type I collagen, anti-bone-resorptive treatments, licofelone, and chondroitin sulfate. There was a paucity of evidence for heritability and conflicting evidence for dietary fatty acids.
There is strong evidence for serum lipids and moderate evidence for obesity as risk factors for knee BMLs. Given the role of BMLs in the pathogenesis of knee osteoarthritis, identification of modifiable risk factors of BMLs and therapeutic interventions targeting BMLs has the potential to reduce the burden of knee osteoarthritis.
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: The authors have no conflict of interest to disclose.

: This study was funded by a program grant from the National Health and Medical Research Council (NHMRC; 209057) and was further supported by infrastructure provided by The Cancer Council of Victoria. We acknowledge the NHMRC (Project Grant 334150), Colonial Foundation, and Shepherd Foundation for support. Dr. Wang is the recipient of an NHMRC PhD Scholarship. Dr. Wluka is the recipient of an NHMRC Public Health (Australia) Fellowship (317840) and corecipient of the Cottrell Fellowship, Royal Australasian College of Physicians.

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Association of Bone Marrow Lesions with Knee Structures and Risk Factors for Bone Marrow Lesions in the Knees of Clinically Healthy, Community-Based Adults

Objectives

Methods

Results

Conclusions

Section snippets

Subjects

Results

Discussion

Acknowledgments

Clin Radiol

Osteoarthritis Cartilage

Osteoarthritis Cartilage

Osteoarthritis Cartilage

Osteoarthritis Cartilage

Prediction of the progression of joint space narrowing in osteoarthritis of the knee by bone scintigraphy

Ann Rheum Dis

Knee and shoulder fractures: association of fracture detection and marrow edema on MR images with mechanism of injury

Radiology

Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings

Radiology

Bone marrow edema and its relation to progression of knee osteoarthritis

Ann Intern Med

The association of bone marrow lesions with pain in knee osteoarthritis

Ann Intern Med

Magnetic resonance imaging in osteoarthritis of the knee: correlation with radiographic and scintigraphic findings

Ann Rheum Dis

Increase in bone marrow lesions associated with cartilage loss: a longitudinal magnetic resonance imaging study of knee osteoarthritis

Arthritis Rheum

The Melbourne Collaborative Cohort Study

IARC Sci Publ

Development of criteria for the classification and reporting of osteoarthritisClassification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association

Arthritis Rheum

The determinants of change in tibial cartilage volume in osteoarthritic knees

Arthritis Rheum

Comparison of tibial cartilage volume and radiologic grade of the tibiofemoral joint

Arthritis Rheum