A pilot study of the reproducibility and validity of measuring knee subchondral bone density in the tibia

Abstract

Objective: To describe the reproducibility and validity of six different measurement techniques for knee subchondral bone mineral density (sBMD). Methods: A consecutive sample of 50 male and female participants from a population-based longitudinal study had sBMD assessed using dual energy X-ray absorptiometry scans. Anthropometric, knee pain, cartilage and bone measures by magnetic resonance imaging and radiographic osteoarthritis (OA) were assessed. The six methods were defined as: (1) the midpoint of one intercondylar spine, across the tibial surface and descending 10 mm; from the midpoint of the two intercondylar spines (2) the top of the spine descending 20 mm, (3) 10-20 mm beneath the top of the spine; from the tibial surface descending, (4) 10 mm, (5) 15 mm, and (6) 20 mm. Results: All six methods had excellent reproducibility (intra-class correlation coefficient 0.98-1.00). sBMD was higher in males (methods 2-4) and higher in those with medial tibial osteophytes (methods 1, 3 and 4). Medial tibial cartilage defects and overall cartilage defects correlated with sBMD (methods 3 and 4). Method 2, which includes the intercondylar spine, correlated with medial tibial bone size. Measuring sBMD using methods 3 and 4 produced the greatest number of associations with joint features of OA. Conclusions: These preliminary results need confirmation in larger longitudinal samples but suggest that sBMD can be accurately measured and plays a role in knee OA. Methods 3 and 4 had the best concurrent validity; however, method 2 adds additional information on tibial bone size, suggesting that two measures are necessary in clinical studies.