Evidence map›Paper›PMID 41954820›Full record

ArticleClinical rheumatology2026

Subchondral bone density and trabecular morphometry mediate the association between knee malalignment and osteophyte progression in osteoarthritis: data from the osteoarthritis initiative.

Shiwen Yuan, Guangfeng Ruan, Xiaodong Wang, Grace H Lo, Cuicui Wang, Zhaohua Zhu, Siqi Xu, Weinian Li, Xiaoyan Cai, David J Hunter

Abstract read
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In one paragraph

Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Shiwen Yuan *Department of Rheumatology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.ORCID http://orcid.org/0000-0002-0919-6252
Guangfeng Ruan *Clinical Research Centre, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.ORCID http://orcid.org/0000-0002-1471-7358
Xiaodong Wang *Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.ORCID http://orcid.org/0009-0003-3694-4601
Grace H LoDepartment of Medicine, Baylor College of Medicine, and Medical Care Line, Research Care Line and Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.ORCID http://orcid.org/0000-0003-3142-1839
Cuicui WangDepartment of Rheumatology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.ORCID http://orcid.org/0009-0007-1096-200X
Zhaohua ZhuFaculty of Medicine and Health, Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-3913-2564
Siqi XuClinical Research Centre, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.ORCID http://orcid.org/0000-0002-6352-2645
Weinian LiDepartment of Rheumatology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China.ORCID http://orcid.org/0000-0001-8452-5098
Xiaoyan CaiDepartment of Rheumatology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China. caixytracy@126.com.ORCID http://orcid.org/0009-0008-3186-7113
David J HunterFaculty of Medicine and Health, Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia.ORCID http://orcid.org/0000-0003-3197-752X

Funding

Guangdong Medical Science and Research Foundation C2023089Guangzhou Science and Technology Program 202206010047Special Fund for Scientific Innovation Strategy-Construction of High-level Academy of Agriculture Science GZYDG2024G04
6 · The paper itself

Abstract

objectiveTo investigate whether subchondral bone mediates the relationship between knee malalignment and osteophyte progression.

designData were obtained from the Osteoarthritis Initiative (OAI) and two ancillary imaging studies. Two analytic cohorts were defined by mediator type: a DXA cohort (periarticular bone mineral density [paBMD]) and an MRI cohort (trabecular morphometry: aBVF, aTb.N, aTb.Sp, aTb.Th). Alignment (hip-knee-ankle [HKA] angle) was assessed at either 12 or 24 months under the Lower Limb Alignment study; bone measures were obtained at either 30 or 36 months through the Bone Ancillary Study; and radiographic osteophyte scores were evaluated at baseline and 48 months. Knees were categorized into five alignment groups (neutral, mild/severe varus, mild/severe valgus). Analyses used generalized estimating equations and multivariable linear regression with non-parametric bootstrapping.

resultsA total of 826 knees (DXA cohort) [ (mean age 61.9 years (SD 9.1), BMI 29.8 kg/m

conclusionsCompartment-specific bone measures partly mediate the association between static malalignment and osteophyte progression, suggesting that targeting bone may modify this longitudinal relationship. Key Points • Compartment-specific paBMD mediates the relationship between malalignment and osteophyte progression, with the M:L BMD ratio strengthening this effect more than either medial or lateral paBMD alone. • Medial trabecular morphometry partially mediates the varus alignment-osteophyte progression relationship. • Subchondral bone remodeling is locally driven by mechanical stress, as systemic measures like femoral neck BMD do not mediate the malalignment-osteophyte link.

Indexed as

Bone DensityBone MalalignmentCancellous BoneKnee JointOsteoarthritis, KneeOsteophyteAbsorptiometry, PhotonAgedDisease ProgressionFemaleFemurHumansMagnetic Resonance ImagingMaleMiddle AgedTibiaKnee malalignmentMediation analysisOsteoarthritisOsteophyteSubchondral bone densityTrabecular morphometry

Identifiers

PMID41954820

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.