Osteoarthritis Bone Marrow Lesions

Assessment and treatment of Bone Marrow Lesions (BMLs) could ultimately make step changes to the lives of people with osteoarthritis (OA). We here review the imaging and pathological characteristics of OA-BMLs, their differential diagnosis and measurement, and cross-sectional and longitudinal associa-tions with pain and OA structural progression. We discuss how biomechanical and cellular factors may contribute to BML pathogenesis, and how pharmacological and non-pharmacological interventions that target BMLs might reduce pain and OA structural progression. We critically appraise semiquantitative and quantitative methods for assessing BMLs, and their potential utilities for identifying people at risk of symptomatic and structural OA progression, and evaluating treatment responses. New interventions that target OA-BMLs should both confirm their importance, and reduce the unacceptable burden of OA. (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).

Automated summary

Assessment and treatment of Bone Marrow Lesions (BMLs) have the potential to significantly improve the lives of people with osteoarthritis (OA). This review examines the characteristics of OA-BMLs, their diagnosis and measurement, and their associations with pain and OA structural progression. The article discusses the factors contributing to BML pathogenesis and the potential of interventions targeting BMLs to reduce pain and slow down OA progression. The evaluation methods for BMLs and their usefulness in identifying individuals at risk and evaluating treatment responses are critically appraised.