Use of dual-energy X-ray absorptiometry to evaluate variation in bone shape and alignment associated with radiographic knee osteoarthritis: findings from a study of 19,053 individuals in UK Biobank
Use of dual-energy X-ray absorptiometry to evaluate variation in bone shape and alignment associated with radiographic knee osteoarthritis: findings from a study of 19,053 individuals in UK Biobank
Objective: lower limb alignment may predispose to, or exacerbate, symptoms of knee osteoarthritis. To examine the role of this and other joint shape variation, we conducted a cross-sectional study investigating relationships between radiographic knee osteoarthritis (rKOA) and knee shape in dual-energy X-ray absorptiometry (DXA) images from UK Biobank (UKB).
Methods: associations between the first ten knee shape modes (KSMs), derived from statistical shape modelling, and rKOA grade were analysed using logistic regression, adjusting for age, sex, height, weight, and ethnicity. An additional model included adjustment for hip-knee-ankle (HKA) angle, derived from total body DXA scans, to reflect knee alignment. Composite figures illustrate knee shape characteristics associated with each rKOA grade.
Results: 19,053 individuals were included (mean 63.7 years, 48 % males), of whom 80.7 %, 14.6 %, 3.6 % and 1.2 % had rKOA grades 0, 1, 2 and 3-4, respectively. Several KSMs were associated with rKOA in confounder-adjusted analyses, with higher grades showing stronger relationships. These associations were attenuated by adjustment for HKA. As expected, composite shape models revealed that higher rKOA grades were associated with greater varus malalignment. After HKA adjustment, composite shape models showed less varus alignment, with other shape differences, such as altered proximal tibial metaphysis and lateral patella displacement, emerging in higher-grade rKOA.
Conclusions: our cross-sectional analyses between joint shape and DXA-derived rKOA grade showed expected relationships with varus malalignment, which were attenuated after adjusting for HKA. Other shape differences, particularly in higher-grade rKOA, emerged independently of alignment, warranting further investigation.
Dual-energy X-ray absorptiometry, Knee alignment, Knee osteoarthritis, Statistical shape modelling
Beynon, Rhona A.
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Alomar, Faten
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Saunders, Fiona R.
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Ebsim, Raja
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Faber, Benjamin G.
8639d027-09db-48fe-8213-0ab271f9701c
Jung, Mijin
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Gregory, Jennifer S.
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Lindner, Claudia
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Abram, Simon G.F.
b647e99f-bc68-44d2-993e-41f07f1298dc
Aspden, Richard M.
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Harvey, Nicholas C.
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Cootes, Timothy
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Tobias, Jonathan H.
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3 September 2025
Beynon, Rhona A.
3f5146c8-a3ea-4e9c-a983-0595b269b485
Alomar, Faten
e1de1f70-fbb8-4738-bd24-faea8d73d5e5
Saunders, Fiona R.
a51cc79d-0928-4ab6-a479-3972c974670b
Ebsim, Raja
fa3d2f2c-9d77-4b95-b0ff-c34b57142381
Faber, Benjamin G.
8639d027-09db-48fe-8213-0ab271f9701c
Jung, Mijin
de4a22aa-777b-47e8-8384-5b18b48b64a2
Gregory, Jennifer S.
6995d8fa-b32b-4f7c-aa15-8146acb4fd67
Lindner, Claudia
9a4bb424-5446-40eb-9e44-adc5280e5846
Abram, Simon G.F.
b647e99f-bc68-44d2-993e-41f07f1298dc
Aspden, Richard M.
71d1c790-5d9f-40b4-9130-bf7781b0e0dd
Harvey, Nicholas C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Cootes, Timothy
f82f878a-ab1d-426c-9510-afa3f6de7aef
Tobias, Jonathan H.
514342d7-3491-4a7b-bbeb-b00dcf244daa
Beynon, Rhona A., Alomar, Faten, Saunders, Fiona R., Ebsim, Raja, Faber, Benjamin G., Jung, Mijin, Gregory, Jennifer S., Lindner, Claudia, Abram, Simon G.F., Aspden, Richard M., Harvey, Nicholas C., Cootes, Timothy and Tobias, Jonathan H.
(2025)
Use of dual-energy X-ray absorptiometry to evaluate variation in bone shape and alignment associated with radiographic knee osteoarthritis: findings from a study of 19,053 individuals in UK Biobank.
Osteoarthritis and Cartilage Open, 7 (4), [100667].
(doi:10.1016/j.ocarto.2025.100667).
Abstract
Objective: lower limb alignment may predispose to, or exacerbate, symptoms of knee osteoarthritis. To examine the role of this and other joint shape variation, we conducted a cross-sectional study investigating relationships between radiographic knee osteoarthritis (rKOA) and knee shape in dual-energy X-ray absorptiometry (DXA) images from UK Biobank (UKB).
Methods: associations between the first ten knee shape modes (KSMs), derived from statistical shape modelling, and rKOA grade were analysed using logistic regression, adjusting for age, sex, height, weight, and ethnicity. An additional model included adjustment for hip-knee-ankle (HKA) angle, derived from total body DXA scans, to reflect knee alignment. Composite figures illustrate knee shape characteristics associated with each rKOA grade.
Results: 19,053 individuals were included (mean 63.7 years, 48 % males), of whom 80.7 %, 14.6 %, 3.6 % and 1.2 % had rKOA grades 0, 1, 2 and 3-4, respectively. Several KSMs were associated with rKOA in confounder-adjusted analyses, with higher grades showing stronger relationships. These associations were attenuated by adjustment for HKA. As expected, composite shape models revealed that higher rKOA grades were associated with greater varus malalignment. After HKA adjustment, composite shape models showed less varus alignment, with other shape differences, such as altered proximal tibial metaphysis and lateral patella displacement, emerging in higher-grade rKOA.
Conclusions: our cross-sectional analyses between joint shape and DXA-derived rKOA grade showed expected relationships with varus malalignment, which were attenuated after adjusting for HKA. Other shape differences, particularly in higher-grade rKOA, emerged independently of alignment, warranting further investigation.
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Accepted/In Press date: 14 August 2025
e-pub ahead of print date: 21 August 2025
Published date: 3 September 2025
Keywords:
Dual-energy X-ray absorptiometry, Knee alignment, Knee osteoarthritis, Statistical shape modelling
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Local EPrints ID: 506659
URI: http://eprints.soton.ac.uk/id/eprint/506659
ISSN: 2665-9131
PURE UUID: f34e8f15-2990-4beb-b6c8-a18996488304
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Date deposited: 13 Nov 2025 17:39
Last modified: 14 Nov 2025 02:38
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Contributors
Author:
Rhona A. Beynon
Author:
Faten Alomar
Author:
Fiona R. Saunders
Author:
Raja Ebsim
Author:
Benjamin G. Faber
Author:
Mijin Jung
Author:
Jennifer S. Gregory
Author:
Claudia Lindner
Author:
Simon G.F. Abram
Author:
Richard M. Aspden
Author:
Timothy Cootes
Author:
Jonathan H. Tobias
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