Sepriano Alexandre, Roman-Blas Jorge A, Little Robert D, Pimentel-Santos Fernando, Arribas Jose María, Largo Raquel, Branco Jaime C, Herrero-Beaumont Gabriel
Rheumatology Department, CHLO-Hospital Egas Moniz, Lisbon, Portugal; Chronic Diseases Study Center (CEDOC), NOVA Medical School, UNL, Lisbon, Portugal.
Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Av. Reyes Católicos 2, 28040 Madrid, Spain.
Semin Arthritis Rheum. 2015 Dec;45(3):275-83. doi: 10.1016/j.semarthrit.2015.06.012. Epub 2015 Jun 19.
Subchondral bone mineral density (sBMD) contributes to the initiation and progression of knee osteoarthritis (OA). Reliable methods to assess sBMD status may predict the response of specific OA phenotypes to targeted therapies. While dual-energy X-ray absorptiometry (DXA) of the knee can determine sBMD, no consensus exists regarding its methodology.
Construct a semi-standardized protocol for knee DXA to measure sBMD in patients with OA of the knee by evaluating the varying methodologies present in existing literature.
We performed a systematic review of original papers published in PubMed and Web of Science from their inception to July 2014 using the following search terms: subchondral bone, osteoarthritis, and bone mineral density.
DXA of the knee can be performed with similar reproducibility values to those proposed by the International Society for Clinical Densitometry for the hip and spine. We identified acquisition view, hip rotation, knee positioning and stabilization, ROI location and definition, and the type of analysis software as important sources of variation. A proposed knee DXA protocol was constructed taking into consideration the results of the review.
DXA of the knee can be reliably performed in patients with knee OA. Nevertheless, we found substantial methodological variation across previous studies. Methodological standardization may provide a foundation from which to establish DXA of the knee as a valid tool for identification of SB changes and as an outcome measure in clinical trials of disease modifying osteoarthritic drugs.
软骨下骨矿物质密度（sBMD）在膝关节骨关节炎（OA）的发生和发展过程中起作用。评估sBMD状态的可靠方法可能预测特定OA表型对靶向治疗的反应。虽然膝关节双能X线吸收法（DXA）可测定sBMD，但关于其方法尚无共识。
通过评估现有文献中存在的不同方法，构建一种半标准化的膝关节DXA方案，以测量膝关节OA患者的sBMD。
我们使用以下检索词对PubMed和Web of Science自创建至2014年7月发表的原始论文进行了系统评价：软骨下骨、骨关节炎和骨矿物质密度。
膝关节DXA的可重复性值与国际临床骨密度测量学会针对髋部和脊柱所提出的相似。我们确定采集视图、髋部旋转、膝关节定位和固定、感兴趣区（ROI）位置和定义以及分析软件类型是重要的变异来源。考虑到评价结果，构建了一个建议的膝关节DXA方案。
膝关节OA患者可可靠地进行膝关节DXA检查。然而，我们发现以往研究在方法上存在很大差异。方法标准化可为将膝关节DXA确立为识别软骨下骨变化的有效工具以及作为疾病修饰性骨关节炎药物临床试验的一项结局指标提供基础。
