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Objective: To assess the differential features of marrow adiposity between osteoarthritis (OA) and osteoporosis (OP) in postmenopausal women using water/fat MRI.

Methods: This cross-sectional study included 97 postmenopausal women (OA [n = 25], OA osteopenia [n = 27], OA OP [n = 23], and OP groups [n = 22]). Water/fat MRI, dual-energy x-ray absorptiometry and biochemical analysis were performed to assess vertebral marrow fat fraction, bone mineral density, and bone biomarkers, respectively. Harris Hip Score was recorded to evaluate hip function.

Results: There were significant differences in marrow fat content among the OA, OA osteopenia, and OA OP groups, between OP and OA participants with normal bone mass or osteopenia (all P < 0.05); no significant difference was observed between OA OP and OP groups. Serum levels of leptin and [beta]-Crosslaps in OA with normal bone mass and osteopenic OA groups were higher than in OP group. Marrow fat fraction was inversely correlated with Harris Hip Score (r = -0.371, P = 0.013), bone mineral density (r = -0.554, P = 0.009) and leptin levels (r = -0.610, P < 0.001). In multivariate regression analysis, marrow fat fraction was found to have a consistent and unchanged inverse association with leptin levels (S[beta] = -0.311, P = 0.002) and bone mineral density (S[beta] = -0.265, P = 0.006) after adjusting for age, years since menopause, and body mass index.

Conclusions: Postmenopausal OA with OP have a phenotype with higher marrow adiposity. OA and OP could coexist, for the presence of a specific subgroup of OA with increased marrow fat accumulation and high risk of developing OP.

(C) 2017 by The North American Menopause Society.