Statin use and MRI subchondral bone marrow lesion worsening in generalized osteoarthritis: longitudinal analysis from Osteoarthritis Initiative data

Objectives: To determine the association between statin therapy and knee MRI-detected subchondral bone marrow lesion (BML) longitudinal worsening in patients with Heberden’s nodes (HNs) as the hallmark of generalized osteoarthritis (OA) phenotype. Methods: All participants gave informed consent, and IRB approved HIPAA-compliant protocol. We assessed the worsening in BML volume and number of affected subregions in the Osteoarthritis Initiative (OAI) participants with HNs at baseline clinical examination (HN⁺), using the semi-quantitative MRI Osteoarthritis Knee Scores at baseline and 24 months. Participants were classified according to baseline BML involvement as “no/minimal” (≤ 2/14 knee subregions affected and maximum BML score ≤ 1) or “moderate/severe.” Statin users and non-users were selected using 1:1 propensity-score (PS) matching for OA and cardiovascular disease (CVD)–related potential confounding variables. We assessed the association between statin use and increasing BML score and affected subregions using adjusted mixed-effect regression models. Results: The PS-matched HN⁺ participants (63% female, aged 63.5 ± 8.5-year-old) with no/minimal and moderate/severe BML cohorts consisted of 332 (166:166, statin users: non-users) and 380 (190:190) knees, respectively. In the HN⁺ participants with no/minimal BML, statin use was associated with lower odds of both BML score worsening (odds ratio, 95% confidence interval: 0.62, 0.39–0.98) and increased number of affected subregions (0.54, 0.33–0.88). There was no such association in HN^– participants or those HN⁺ participants with baseline moderate/severe BML. Conclusion: In patients with CVD indications for statin therapy and generalized OA phenotype (HN⁺), statin use may be protective against the OA-related subchondral bone damage only in the subgroup of participants with no/minimal baseline BML. Key Points: • Statin use may reduce the risk of subchondral bone damage in specific osteoarthritis patients with a generalized phenotype, minimal subchondral bone damage, and cardiovascular statin indications.