Session Title: Osteoarthritis - Clinical Aspects
Session Type: Abstract Submissions (ACR)
Background/Purpose: Bone marrow lesions (BMLs) have been identified one of the key pathologic features in knee osteoarthritis (OA) 1. However, there is limited data on hip BMLs and their relation to bone mass. The aim of this study was to examine the cross-sectional and longitudinal association between hip BMLs and BMD at three different sites.
Methods: 198 subjects in the Tasmanian Older Adult Cohort (TASOAC) study (average age 64 yrs) with a right hip MRI and dual-energy x-ray absorptiometry (DXA) scans conducted at two time points, approx. 2.6 years apart, were included in this study. MR images were used to assess femoral and acetabular hip BML presence and size (cm2) by manually drawing contours around the outer edges of the BML using Osiris X (Geneva) software. DEXA scans were used to determine total hip, femoral neck and spine BMD.
Results: Fifty-five subjects (28 %) had either femoral and/or acetabular BMLs. In cross-sectional analysis, femoral BMLs were not associated with either hip or femoral neck BMD whereas acetabular BMLs were associated with lower hip BMD and femoral neck BMD (mean diff: -0.05 g/cm2, p=0.009 & mean diff: -0.06 g/cm2, p<0.001 resp.). Neither was associated with spine BMD. Longitudinally, resolving acetabular BMLs were associated with an increase in BMD at both hip (mean diff: +0.02 g/cm2, p=0.05) and femoral neck (mean diff: +0.01 g/cm2, p=0.02) sites while incident femoral BMLs were associated with an increase (mean diff: +0.03 g/cm2, p<0.001) and resolving femoral BMLs with a decrease in femoral neck BMD (mean diff: -0.04 g/cm2, p=0.04). Finally, change in femoral BML size was associated with change in femoral neck BMD (βeta: +0.03, p<0.001) and change in acetabular BML size was associated with change in femoral neck BMD (βeta: -0.01, p=0.004).
Hip BMLs are associated with site-specific changes but not distant changes in bone mass. These results, especially in the longitudinal data, suggest this is a combination of changes related directly to the underlying BML pathology as well as changes adjacent to the disease process perhaps due to pain, disuse or paracrine effects.
1) Dawn Dore et al. Arthritis Research and Therapy 12(6): R222, 2010
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