Associations between systemic bone mineral density, knee
cartilage defects and bone marrow lesions in patients with
and Changhai DING
Department of Rheumatology and Immunology, Arthritis Research Institute, the First Afﬁliated Hospital of Anhui Medical
University, Hefei, China, and
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Aim: The relationship between bone mineral density (BMD) and osteoarthritis (OA) remains controversial. This
study aimed to explore the cross-sectional associations between BMD at the total body, hip and spine and joint
structural abnormalities including cartilage defects and bone marrow lesions (BMLs) in patients with knee OA.
Method: One hundred and eight-ﬁve subjects with symptomatic knee OA were included in this study.
T2-weighted fast spin echo magnetic resonance imaging was used to assess knee cartilage defects and BMLs.
Total body, hip and spine BMD were measured using dual-energy X-ray absorptiometry.
Results: After adjustment for potential confounders, total hip BMD was negatively associated with medial tibial
cartilage defects, lateral femoral cartilage defects, medial tibial BMLs and lateral tibial BMLs. Spine and total
body BMD were negatively associated with lateral femoral cartilage defects, but not with BMLs.
Conclusion: We concluded that BMD particularly at the hip was negatively associated with knee cartilage defects
Key words: osteoarthritis, bone mineral density, knee, magnetic resonance imaging.
Osteoarthritis (OA) and osteoporosis (OP) are two
major age-related chronic diseases.
between these two diseases remains conﬂicting despite
decades of research.
Prevalent radiographic knee OA,
especially deﬁned using osteophytes, is associated with
increased bone mineral density (BMD).
increases risk of incident knee OA, which is mainly
through its inﬂuence on osteophytes but decreases the
risk of progression of knee radiographic OA (ROA)
which is mainly through reduction of joint space nar-
Some studies evaluated cartilage loss by
JSN and reported that higher BMD was associated with
greater cartilage loss in knee OA.
graphs only provide an indirect assessment of cartilage
loss and are subject to measurement errors due to varia-
tions in position.
Using magnetic resonance imaging (MRI), multiple
morphological tissue changes in the joint can be
detected before emergence of radiographic changes.
Morphological abnormalities such as cartilage loss, car-
tilage defects and bone marrow lesions (BMLs) are visu-
alized and can be measured directly using MRI. Recent
studies reported that the loss of bone mass was posi-
tively correlated with loss of cartilage volume in
patients with knee OA
and high baseline BMD was
Correspondence: Professor Changhai Ding, PhD, Menzies Insti-
tute for Medical Research, University of Tasmania, Private Bag
23, Hobart, Tasmania 7000, Australia.
© 2017 Asia Paciﬁc League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd
International Journal of Rheumatic Diseases 2018; 21: 1202–1210