Statin use and longitudinal bone marrow lesion burden: analysis of knees without osteoarthritis from the Osteoarthritis Initiative study.

Abstract

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. 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. 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). 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.