CT-derived proximal tibial bone density imbalance is associated with knee osteoarthritis.

Publisher: BioMed Central Country of Publication: England NLM ID: 101265112 Publication Model: Electronic Cited Medium: Internet ISSN: 1749-799X (Electronic) Linking ISSN: 1749799X NLM ISO Abbreviation: J Orthop Surg Res Subsets: MEDLINE

Original Publication: London : BioMed Central, 2006-

Osteoarthritis, Knee*/diagnostic imaging ; Osteoarthritis, Knee*/physiopathology ; Tibia*/diagnostic imaging ; Tibia*/physiopathology ; Tomography, X-Ray Computed*/methods ; Bone Density*/physiology; Humans ; Male ; Female ; Cross-Sectional Studies ; Middle Aged ; Retrospective Studies ; Aged

Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of CHA Bundang Medical Center (IRB No. 2022-12-025). The requirement for informed consent was waived because of the retrospective design and use of anonymized clinical data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
Background: Compartmental imbalance in proximal tibial bone density may contribute to the structural progression of knee osteoarthritis (OA), yet remains underexplored using quantitative imaging. This study investigated the association between compartmental proximal tibial bone density, measured using CT-derived Hounsfield units (HU), and knee OA.
Methods: This retrospective cross-sectional study analyzed 753 knees from patients who underwent lower-extremity CT, knee radiography, and orthoradiogram between 1995 and 2024 at a single tertiary center. The knees were categorized as OA (N = 238) or non-OA (N = 515) based on expert image review. The HU values were measured in three compartments: the medial plateau, lateral plateau, and central metaphysis. The absolute and relative HU differences between compartments (e.g., medial to lateral) were calculated. Associations with OA were assessed using multivariate logistic regression, adjusted for age and sex. The diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis.
Results: In unadjusted comparison, OA-affected knees showed lower HU across proximal tibial subregions than non-OA knees. Higher medial HU values (OR per 100 HU: 1.49; p = 0.016) and greater medial-to-lateral HU differences (OR: 1.27; p = 0.089) were associated with OA. These relative differences were exaggerated with advancing age. Medial HU values showed moderate discriminative power (area under the curve [AUC] = 0.682), whereas medial-to-lateral differences had limited standalone performance (AUC = 0.553).
Conclusions: Knees with OA were associated with asymmetric remodeling patterns of the proximal tibia, including higher medial subchondral density and lower metaphyseal bone density, suggestive of a compartmental imbalance. CT-derived HU values, along with absolute and relative compartmental differences, may serve as exploratory radiologic markers to support OA risk stratification.
(© 2025. The Author(s).)

Clin Nucl Med. 2001 Nov;26(11):916-8. (PMID: 11595843)
J Foot Ankle Surg. 2023 Jan-Feb;62(1):120-124. (PMID: 35705456)
Clin Biomech (Bristol). 2023 Jan;101:105855. (PMID: 36563543)
Arthritis Res Ther. 2015 Sep 01;17:207. (PMID: 26324398)
Menopause. 2007 Nov-Dec;14(6):1025-30. (PMID: 17549037)
J Orthop Res. 2013 Feb;31(2):268-74. (PMID: 22886713)
Arthritis Rheum. 2008 Nov 15;59(11):1563-70. (PMID: 18975356)
Lancet Rheumatol. 2023 Aug 21;5(9):e508-e522. (PMID: 37675071)
Rheumatology (Oxford). 2001 May;40(5):499-505. (PMID: 11371657)
J Orthop Surg Res. 2021 Nov 13;16(1):669. (PMID: 34774085)
J Foot Ankle Surg. 2022 May-Jun;61(3):562-566. (PMID: 34819267)
Knee. 2014 Jun;21(3):688-93. (PMID: 24725590)
Calcif Tissue Int. 2002 Oct;71(4):315-22. (PMID: 12202957)
Skeletal Radiol. 2010 Sep;39(9):867-76. (PMID: 20635177)
Arthritis Rheum. 2006 May;54(5):1529-35. (PMID: 16646037)
J Bone Miner Res. 2005 Mar;20(3):529-35. (PMID: 15746999)
Bonekey Rep. 2015 Jan 21;4:624. (PMID: 25628884)
World Neurosurg. 2024 Mar;183:e261-e267. (PMID: 38159603)
Am J Orthop (Belle Mead NJ). 1996 Jan;25(1):18-26. (PMID: 8722125)
Arthritis Rheum. 2002 Oct;46(10):2632-6. (PMID: 12384921)
Open Med (Wars). 2019 Jul 19;14:545-551. (PMID: 31410366)
EFORT Open Rev. 2021 Feb 1;6(2):113-117. (PMID: 33828854)
Knee. 2024 Dec;51:58-64. (PMID: 39236638)
Osteoarthritis Cartilage. 2017 Nov;25(11):1850-1857. (PMID: 28743608)
J Bone Joint Surg Am. 2011 Jun 1;93(11):1057-63. (PMID: 21655899)
Nat Rev Dis Primers. 2016 Sep 29;2:16069. (PMID: 27681935)
Arthritis Rheum. 2011 Apr;63(4):1002-9. (PMID: 21225680)
Osteoporos Int. 2012 Dec;23 Suppl 8:S861-5. (PMID: 23179574)
Bone. 2023 Mar;168:116673. (PMID: 36623756)
Front Cell Dev Biol. 2021 Jan 21;8:607764. (PMID: 33553146)
Osteoarthritis Cartilage. 2012 Nov;20(11):1227-33. (PMID: 22874524)
Osteoarthritis Cartilage. 2006 Oct;14(10):984-90. (PMID: 16765066)
J Magn Reson Imaging. 2022 Jul;56(1):11-34. (PMID: 35044717)
Biomedicines. 2024 Apr 11;12(4):. (PMID: 38672197)
Rheumatology (Oxford). 2014 Mar;53(3):540-6. (PMID: 24292347)
Coll Antropol. 2011 Sep;35 Suppl 2:19-23. (PMID: 22220398)
Sci Rep. 2023 Apr 21;13(1):6516. (PMID: 37085519)
Z Orthop Unfall. 2015 Oct;153(5):553-64; quiz 565-6. (PMID: 26451864)
Ann Rheum Dis. 2011 Sep;70(9):1523-5. (PMID: 21742638)
Bioengineering (Basel). 2025 Feb 08;12(2):. (PMID: 40001684)
Physiol Rev. 2017 Jan;97(1):135-187. (PMID: 27807202)

BDCHA RND 2024-008 CHA Bundang Medical Center; RS-2022-NR070174 Korean Government (MSIT)

Keywords: Bone density; Genu varum; Hounsfield unit; Knee osteoarthritis; Proximal tibia

Date Created: 20251022 Date Completed: 20251022 Latest Revision: 20251024

20251024

PMC12542229

10.1186/s13018-025-06302-0

41121338