Bone marrow edema and its relation to progression of knee osteoarthritis

Article Abstract:

Background: While factors affecting the course of knee osteoarthritis are mostly unknown, lesions on bone scan and mechanical malalignment increase risk for radiographic deterioration. Bone marrow edema lesions on magnetic resonance imaging correspond to bone scan lesions. Objective: To determine whether edema lesions in the subarticular bone in patients with knee osteoarthritis identify knees at high risk for radiographic progression and whether these lesions are associated with limb malalignment. Design: Natural history study. Setting: A Veterans Administration hospital in Boston, Massachusetts. Patients: Persons 45 years of age and older with symptomatic knee osteoarthritis. Measurements: Baseline assessments included magnetic resonance imaging of the knee and fluoroscopically positioned radiography. During follow-up at 15 and 30 months, patients underwent repeated radiography; at 15 months, long-limb films were obtained to assess mechanical alignment. Progression was defined as an increase over follow-up in medial or lateral joint space narrowing, based on a semi-quantitative grading. Generalized estimating equations were used to evaluate the relation of medial bone marrow edema lesions to medial progression and lateral lesions to lateral progression, before and after adjustment for limb alignment. Results: Of 256 patients, 223 (87.1%) participated in at least one follow-up examination. Medial bone marrow lesions were seen mostly in patients with varus limbs, and lateral lesions were seen mostly in those with valgus limbs. Twenty-seven of 75 knees with medial lesions (36.0%) showed medial progression versus 12 of 148 knees without lesions (8.1%) (odds ratio for progression, 6.5 [95% CI, 3.0 to 14.0]). Approximately 69% of knees that progressed medially had medial lesions, and lateral lesions conferred a marked risk for lateral progression. These increased risks were attenuated by 37% to 53% after adjustment for limb alignment. Conclusion: Bone marrow edema is a potent risk factor for structural deterioration in knee osteoarthritis, and its relation to progression is explained in part by its association with limb alignment.

Knee, Edema, Dropsy, Author Abstract

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Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham study

Article Abstract:

Patients with osteoarthritis of the knee who eat a diet low in vitamin D or have low blood levels of vitamin D seem to be at greater risk for progressively worsening disease. Doctors identified 75 patients with knee osteoarthritis by X-ray, evaluated their vitamin D consumption both by self-report and blood testing, and X-rayed the knees again five years later. Patients with low vitamin D blood levels and self-reported vitamin D consumption were more likely to have a loss of knee cartilage and were three times more likely to have worsening disease.

Health aspects, Vitamin D deficiency

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Association of bone marrow changes with worsening of knee osteoarthritis

Article Abstract:

Abnormal changes in the bone marrow inside leg bones may indicate that a patient's knee osteoarthritis may get worse, according to a study of 223 people. However, it is not clear whether patients with knee osteoarthritis should have regular MRI scans of their bones. MRI scans are expensive, and more research is needed to determine whether regular MRI scans would improve a patient's outcome.

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