Imaging of osteoarthritis-related bone marrow lesions in clinical trials

Several human studies show positive signals, while research methods and sample sizes continue to develop.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Objective This narrative review aims to summarize current evidence regarding the imaging detection of bone marrow lesions (BMLs), their prognostic value for osteoarthritis (OA) progression and pain, as well as potential therapeutic interventions targeting BMLs in OA clinical trials. Design We performed a literature search in PubMed and Google Scholar for articles focusing on OA-related BMLs. Studies were included if they examined detection, pathophysiology, clinical significance, or treatments of knee BMLs. Non-OA etiologies (e.g., malignancy, rheumatologic diseases) were excluded. Results BMLs, present in approximately two-thirds of patients with knee OA, are considered key indicators of subchondral bone damage or microfracture. MRI is highly sensitive for detecting BMLs, using validated semi-quantitative and quantitative measurement methods. The lack of disease-modifying OA drugs has shifted interest toward targeting BMLs for potential therapeutic interventions. Clinical studies have shown that changes in BML volume can predict the subsequent incidence of OA in joints without established disease, and that their presence is associated with pain progression and structural deterioration when OA is already established. Potential treatments for OA-related BMLs include pharmacological agents that modify subchondral bone turnover, anti-inflammatory interventions, biomechanical stres

Evidence level

Several human studies show positive signals, while research methods and sample sizes continue to develop.

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