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Statin Use and Longitudinal Bone Marrow Lesion Burden: Analysis of Knees Without Osteoarthritis From the Osteoarthritis Initiative Study Publisher



Moradi K1 ; Mohajer B1 ; Guermazi A2 ; Hadidchi R1 ; Mohammadi S3 ; Cao X4 ; Wan M4 ; Roemer FW2, 5 ; Demehri S1
Authors

Source: Skeletal Radiology Published:2025


Abstract

Objectives: Knee subchondral bone marrow lesions (BMLs) are one of the hallmark features of structural osteoarthritis (OA) and are potential targets for statins’ disease-modifying effect. We aimed to determine the association between statin use and longitudinal changes in magnetic resonance imaging (MRI)-based BML volume in participants without radiographic knee OA at baseline. Methods: Using the Osteoarthritis Initiative (OAI) cohort, we classified participants’ knees into two categories: statin users (those who consistently used statins from baseline to the fourth year of the cohort) and non-users. We employed a 1:1 ratio propensity score (PS) matching method, adjusting for factors including age, sex, race, BMI, smoking, alcohol use, physical activity, abdominal obesity, and diabetes mellitus. We measured quantitative BML volume using a validated deep learning (DL) algorithm, applied to baseline, year-2, and year-4 intermediate-weighted fat-saturated knee MRIs. The outcome was determined by the differences in the BML volume change between statin users and non-users over the 4-year period. Results: After adjusting for potential confounders, 1502 knees were included (751 statin users and 751 non-users; mean age 63.5 ± 8.7 years, 44.5% female). A Multilevel linear mixed-effects regression model showed that statin use is associated with a smaller increase in BML volume over 4 years (time–treatment interaction effect estimates, 95% confidence interval (CI) − 14.88 mm3/year, − 23.04 to − 6.72, P < 0.001). Conclusion: In participants without baseline knee OA, continuous statin use is associated with a reduced longitudinal worsening of BML volume in the tibiofemoral joint, a known structural damage marker linked to downstream OA incidence. © The Author(s), under exclusive licence to International Skeletal Society (ISS) 2025.
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