Open Access Open Badges Research article

Evaluation of bone marrow lesion volume as a knee osteoarthritis biomarker - longitudinal relationships with pain and structural changes: data from the Osteoarthritis Initiative

Jeffrey B Driban1*, Lori Lyn Price2, Grace H Lo34, Jincheng Pang5, David J Hunter6, Eric Miller5, Robert J Ward7, Charles B Eaton8, John A Lynch9 and Timothy E McAlindon1

Author Affiliations

1 Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box No 406, Boston, MA 02111, USA

2 The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington Street, Box No 63, Boston, MA 02111, USA

3 Medical Care Line and Research Care Line; Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, 2002 Holcombe Boulevard, Houston, TX 77030, USA

4 Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA

5 Department of Electrical and Computer Engineering, Tufts University, 101A Halligan Hall, Medford, MA 02155, USA

6 Royal North Shore Hospital, Rheumatology Department and University of Sydney, Reserve Road, St Leonards, NSW 2065, Australia

7 Department of Radiology, Tufts Medical Center, 800 Washington Street, Box No 299, Boston, MA 02111, USA

8 Center for Primary Care and Prevention, Alpert Medical School of Brown University, 111 Brewster St, Pawtucket, RI 02860, USA

9 Department of Epidemiology and Biostatistics, University of California at San Francisco, 185 Berry Street, San Francisco, CA 94107, USA

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Arthritis Research & Therapy 2013, 15:R112  doi:10.1186/ar4292

Published: 10 September 2013



Bone marrow lesion (BML) size may be an important imaging biomarker for osteoarthritis-related clinical trials and reducing BML size may be an important therapeutic goal. However, data on the interrelationships between BML size, pain, and structural progression are inconsistent and rarely examined in the same cohort. Therefore, we evaluated the cross-sectional and longitudinal associations of BML volume with knee pain and joint space narrowing (JSN).


A BML volume assessment was performed on magnetic resonance images of the knee collected at the 24- and 48-month Osteoarthritis Initiative visits from a convenience sample of 404 participants in the progression cohort. During the same visits, knee pain was assessed with WOMAC pain scores and knee radiographs were acquired and scored for JSN. BML volume was summed to generate a total knee volume and an index tibiofemoral compartment volume (compartment with greater baseline JSN). Primary analyses included multiple linear regressions (outcome = pain, predictor = total knee BML volume) and logistic regressions (outcome = JSN, predictor = index tibiofemoral compartment BML volume).


This sample was 49% female with a mean age of 63 (9.2 standard deviation (SD)) years, and 71% had radiographic osteoarthritis in the study knee. Larger baseline BMLs were associated with greater baseline knee pain (P = 0.01), the presence of JSN at baseline (odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.23 to 1.83), and JSN progression (OR = 1.27, 95%CI = 1.11 to 1.46). Changes in total knee BML volume had a positive association with changes in knee pain severity (P = 0.004) and this association may be driven by knees that were progressing from no or small baseline BMLs to larger BMLs. In contrast, we found no linear positive relationship between BML volume change and JSN progression. Instead, regression of medial tibiofemoral BML volume was associated with JSN progression compared to knees with no or minimal changes in BML volume (OR = 3.36, 95%CI = 1.55 to 7.28). However, follow-up analyses indicated that the association between JSN progression and BML volume change may primarily be influenced by baseline BML volume.


Large baseline BMLs are associated with greater baseline knee pain, the presence of JSN at baseline, and disease progression. Additionally, BML regression is associated with decreased knee pain but not a reduced risk of concurrent JSN progression.

Magnetic resonance imaging; symptoms; radiographs; joint space narrowing