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Association of bone attrition with knee pain, stiffness and disability: a cross-sectional study
  1. Stephan Reichenbach1,2,
  2. Paul A Dieppe3,
  3. Eveline Nüesch1,4,
  4. Susan Williams5,
  5. Peter M Villiger2,
  6. Peter Jüni1,4
  1. 1Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Switzerland
  2. 2Department of Rheumatology, Clinical Immunology, and Allergology, Bern University Hospital, Switzerland
  3. 3Institute of Clinical Education Research, Peninsula Medical School, Universities of Exeter and Plymouth, UK
  4. 4CTU Bern, Bern University Hospital, Switzerland
  5. 5Department of Social Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Stephan Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012 Bern, Switzerland; rbach{at}


Objectives Bone pathologies as detected on MRI are associated with the presence of pain in knee osteoarthritis (OA). The authors examined whether bone attrition assessed on x-rays was associated with pain, stiffness and disability.

Methods The authors analysed x-rays of 1326 knees with OA from 783 individuals participating in the cross-sectional population-based Somerset and Avon Survey of Health. The diagnosis of OA was defined by the presence of osteophytes in anteroposterior (AP) or lateral views. Bone attrition was graded from 0 (no attrition) to 3 (severe attrition >10 mm) and Kellgren and Lawrence (K/L) scores were assigned on AP views. Logistic regression models adjusted for gender, age, body mass index, effusion and K/L scores were used to determine whether bone attrition was associated with pain, stiffness and disability.

Results Pain was reported in 84 knees (74%) with radiographic bone attrition compared with 505 (42%) without bone attrition (adjusted OR 2.22, 95% CI 1.29 to 3.80). The adjusted OR was increased for day pain but not for night pain (p for interaction <0.001). Stiffness was reported for 85 knees with bone attrition (75%) and 437 knees without (36%) (adjusted OR 3.23, 95% CI 1.85 to 5.64). Disability was reported by 40 individuals with bone attrition (50%) and 140 individuals without (24%) (adjusted OR 2.09, 95% CI 1.19 to 3.68).

Conclusions Bone attrition detected on conventional x-rays using a simple cheap technique is strongly associated with the presence of day pain, stiffness and disability in knee OA.

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  • Funding The Somerset and Avon Survey of Health was originally funded by the Department of Health and the South and West NHS Research and Development Directorate. This work was funded by the Swiss National Science Foundation (grants nos 3233-066377 and 3200-066378) and by the British Arthritis Research Campaign. The funding bodies had no role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript. SR is the recipient of a Research Fellowship from the Swiss National Science Foundation (grant number PBBEB-115067) and of an educational grant from the Swiss Society of Rheumatology.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the local research ethics committees of Somerset and Avon and all participants provided written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.