Objective To examine use of magnetic resonance imaging (MRI) of knees with no radiographic evidence of osteoarthritis to determine the prevalence of structural lesions associated with osteoarthritis and their relation to age, sex, and obesity.Design Population based observational study. Setting Community cohort in Framingham, MA, United States (Framingham osteoarthritis study).Participants 710 people aged >50 who had no radiographic evidence of knee osteoarthritis (Kellgren-Lawrence grade 0) and who underwent MRI of the knee. Main outcome measuresPrevalence of MRI findings that are suggestive of knee osteoarthritis (osteophytes, cartilage damage, bone marrow lesions, subchondral cysts, meniscal lesions, synovitis, attrition, and ligamentous lesions) in all participants and after stratification by age, sex, body mass index (BMI), and the presence or absence of knee pain. Pain was assessed by three different questions and also by WOMAC questionnaire. ResultsOf the 710 participants, 393 (55%) were women, 660 (93%) were white, and 206 (29%) had knee pain in the past month. The mean age was 62.3 years and mean BMI was 27.9. Prevalence of "any abnormality" was 89% (631/710) overall. Osteophytes were the most common abnormality among all participants (74%, 524/710), followed by cartilage damage (69%, 492/710) and bone marrow lesions (52%, 371/710). The higher the age, the higher the prevalence of all types of abnormalities detectable by MRI. There were no significant differences in the prevalence of any of the features between BMI groups. The prevalence of at least one type of pathology ("any abnormality") was high in both painful (90-97%, depending on pain definition) and painless (86-88%) knees.Conclusions MRI shows lesions in the tibiofemoral joint in most middle aged and elderly people in whom knee radiographs do not show any features of osteoarthritis, regardless of pain. IntroductionAgeing of the population and increasing obesity contribute to morbidity worldwide. Osteoarthritis is the most prevalent medically treated arthritic condition worldwide (for example, 3532 per 100 000 people in the United States).1 2 Diagnosis of osteoarthritis is made on the basis of clinical examination or radiography. Population based longitudinal studies in the US 3 and the United Kingdom 4 showed the lifetime risk of knee osteoarthritis increases with age, 3 with the risk highest in obese people.3 4 Other prevalence surveys showed that radiographic osteoarthritis of the knee is common in middle aged and older adults. Although many publications have reported structural changes in people with radiographic knee osteoarthritis, few data are available regarding what structural changes are present in knees without any radiographic features of osteoarthritis. About half of people with knee pain have no radiographic osteoarthritis. In clinical practice, it is unclear how to investigate and manage such people and whether additional imaging with magnetic resonance imaging would be of clinical value. Such data can be collected only i...

Our findings confirm substantial racial and ethnic group differences in BMD and serum 25(OH)D in men. Serum 25(OH)D and BMD are significantly related to one another in White men only. This may have implications for evaluation of bone health and supplementation in men with low levels of 25(OH)D. Further understanding of the biological mechanisms for these differences between race and ethnic groups is needed.

Objective. Bone marrow lesions are associated with pain and compartment-specific progression of joint space narrowing in patients with knee osteoarthritis (OA). Bone marrow lesions occur in regions under increased loading, and excess loading produces increased bone mineral density (BMD). The ratio of BMD in the medial tibial plateau compared with that in the lateral tibial plateau (M:L BMD ratio) reflects loading in the knee. Therefore, we hypothesized that a higher M:L BMD ratio would be associated with medial bone marrow lesions, and that lower ratios would be associated with lateral bone marrow lesions. Conclusion. Medial bone marrow lesions occur in knees with relatively higher local medial tibial bone density, and lateral bone marrow lesions occur in knees with relatively higher lateral tibial bone density, supporting the hypothesis that local BMD reflects loading within the knee. Our findings emphasize the importance of loading in the pathophysiology of OA.The presence of bone marrow lesions in the subchondral bone have been identified as a new feature of osteoarthritis (OA) that is not seen using plain radiography. On magnetic resonance imaging (MRI), these lesions are irregular-shaped areas of signal that are hypointense on T1-weighted images and hyperintense on T2-weighted fat-suppressed images, unlike normal bone marrow, which is hyperintense on T1-weighted images and hypointense on T2-weighted fat-suppressed MR images (1) (Figure 1).The presence of bone marrow lesions on knee MRI in patients with OA is strongly associated with the occurrence of knee pain. Among patients with radiographic knee OA, those with knee pain have a higher frequency of large bone marrow lesions than do those Dr.

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