Changes in bone marrow lesions in response to weight-loss in obese knee osteoarthritis patients: a prospective cohort study

Abstract

BackgroundPatients are susceptible for knee osteoarthritis (KOA) with increasing age and obesity and KOA is expected to become a major disabling disease in the future. An important feature of KOA on magnetic resonance imaging (MRI) is changes in the subchondral bone, bone marrow lesions (BMLs), which are related to the future degeneration of the knee joint as well as prevalent clinical symptoms. The aim of this study was to investigate the changes in BMLs after a 16-week weight-loss period in obese subjects with KOA and relate changes in BMLs to the effects of weight-loss on clinical symptoms.MethodsThis prospective cohort study included patients with a body mass index ≥ 30 kg/m2, an age ≥ 50 years and primary KOA. Patients underwent a 16 weeks supervised diet program which included formula products and dietetic counselling (ClinicalTrials.gov: NCT00655941). BMLs in tibia and femur were assessed on MRI before and after the weight-loss using the Boston-Leeds Osteoarthritis Knee Score. Response to weight-loss in BML scores was dichotomised to patients experiencing a decrease in BML scores (responders) and patients who did not (non-responders). The association of BMLs to weight-loss was assessed by logistic regressions and correlation analyses.Results39 patients (23%) were classified as responders in the sum of all BML size scores whereas 130 patients (77%) deteriorated or remained stable and were categorized as non-responders. Logistic regression analyses revealed no association between weight-loss < or ≥ 10% and response in BMLs in the most affected compartment (OR 1.86 [CI 0.66 to 5.26, p=0.24]). There was no association between weight-loss and response in maximum BML score (OR 1.13 [CI 0.39 to 3.28, p=0.81]). The relationship between changes in BMLs and clinical symptoms revealed that an equal proportion of patients classified as BML responders and non-responders experienced an OMERACT-OARSI response (69 vs. 71%, p=0.86).ConclusionsWeight-loss did not improve the sum of tibiofemoral BML size scores or the maximum tibiofemoral BML score, suggesting that BMLs do not respond to a rapidly decreased body weight. The missing relationship between clinical symptoms and BMLs calls for further investigation.

Increasing synovitis and bone marrow lesions are associated with incident joint tenderness in hand osteoarthritis

“…Our results are also in line with previous longitudinal studies on both BMLs25 27–28 34 and synovitis in knee OA,35 although the findings are not consistent across all studies 29 36 37. In line with our results, Zhang et al 27 showed that worsening of synovitis and effusion was associated with an increased risk of pain.…”

The Influence of Joint Loading on Bone Marrow Lesions in the Knee

“…4,9,10,19,[29][30][31]43,45,73 Four studies reported on body weight. 4,29,31,43 Combined data from 3 of them showed a significantly increased risk for BMLs with a higher body weight (overall OR, 1.03; 95% confidence interval [CI], 1.01-1.05; P = .007) ( Figure 2). No significant heterogeneity was observed (I 2 = 3%, P .…”

“…Most studies (n = 23) obtained the BML scores from quantitative or semiquantitative methods. Consequently, these scores were dichotomized for References 7,10,19,20,23,29,32,35,37,40,44,45,57 4,9,10,31,57 One study did not provide information on how progression was determined. 44 Quality of Evidence.…”

Is there crosstalk between subchondral bone, cartilage, and meniscus in the pathogenesis of osteoarthritis?

“…[10] Necrotic bone fragments may be phagocytosed by osteoclasts, creating the cyst cavity. A study by Gudbergsen et al [11] did not show any association between weightloss and response in BML scores and failed to connect a positive BML response to clinical improvements. Eventually, these may all result in OA by playing a key role in the initiation and progression of cartilage erosion.…”