Prevalence and determinants of sacroiliac joint bone marrow oedema in the general population in Germany: a population-based cross-sectional study.
Authors
Affiliations (16)
Affiliations (16)
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, TUM University Hospital, Munich, Germany; Department of Cardiovascular Radiology and Nuclear Medicine, Technical University of Munich, School of Medicine and Health, German Heart Center, TUM University Hospital, Munich, Germany; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. Electronic address: [email protected].
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.
- Department of Radiology, Immanuel Clinic Ruedersdorf, Brandenburg Medical School, Ruedersdorf bei Berlin, Germany.
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki School of Medicine, Hippokration University Hospital, Thessaloniki, Greece.
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Ruhr-University Bochum, Rheumazentrum Ruhrgebiet Herne, Germany.
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Artificial Intelligence in Medicine Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA; Department of Radiation Oncology, Brigham and Women's Hospital-Dana-Farber Cancer Institute, Boston, MA, USA; Radiology and Nuclear Medicine, GROW & CARIM, Maastricht University, Maastricht, Netherlands.
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany.
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; Biobank Technology Platform, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiberg, Freiburg, Germany.
- Diagnostic and Interventional Radiology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, TUM University Hospital, Munich, Germany.
- Department of Rheumatology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Division of Rheumatology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada.
Abstract
MRI-detected bone marrow oedema in sacroiliac joints is central to diagnosing axial spondyloarthritis, influencing treatment decisions including anti-inflammatory therapy initiation. However, the prevalence of bone marrow oedema in the general population remains unknown, restricting interpretation of MRI findings and potentially leading to overdiagnosis when imaging findings are considered without clinical context. We aimed to establish the prevalence and determinants of sacroiliac bone marrow oedema in the general adult population. In this national, population-based, cross-sectional study, we analysed adults aged 20-69 years from the German National Cohort who underwent whole-body MRI between May 1, 2014, and Dec 31, 2016. Three masked experts independently assessed randomly selected participants for sacroiliac bone marrow oedema. The remaining participants were evaluated using a validated deep-learning algorithm that automatically segments and quantifies bone marrow oedema volume from fat-suppressed proton density sequences. We examined associations between the presence of bone marrow oedema (primary outcome) and demographic, lifestyle, and reproductive factors using multivariable logistic regression with sex-stratified analyses to identify differential patterns. There was no patient or public involvement in this study. Of 11 163 participants (median age 53·0 years [IQR 45·0-61·0], 5432 [48·7%] women and 5731 [51·3%] men), sacroiliac bone marrow oedema was detected in 288 (28·9% [95% CI 26·2-31·9]) of 998 participants analysed by expert readers and 3131 (30·8% [29·9-31·7]) of 10 165 participants analysed by the deep-learning algorithm, approximately 50 times higher than the 0·6% prevalence of self-reported axial spondyloarthritis diagnosis. Bone marrow oedema prevalence was higher in women (33·9% [95% CI 32·6-35·3]) than in men (27·8% [26·6-29·1]; adjusted odds ratio [OR] 1·33 [95% CI 1·23-1·45]). In women, pregnancy history was associated with bone marrow oedema compared with nulliparous women (OR 1·43 [95% CI 1·21-1·71]). In men, age (OR 1·28 per decade [95% CI 1·21-1·35]) and intensive recreational physical activity (1·24 [1·08-1·42]) showed independent associations, whereas age effects were minimal in women (1·16 per decade [1·11-1·23]). Of modifiable risk factors, BMI of 25 kg/m<sup>2</sup> and above showed the highest OR (1·62 [1·47-1·79]). Physically demanding occupational work was associated with bone marrow oedema overall (OR 1·25 [95% CI 1·14-1·36]). Sacroiliac bone marrow oedema affects nearly one-third of adults, showing associations with pregnancy, overweight, and occupational physical stress rather than inflammatory disease. This prevalence exceeds self-reported axial spondyloarthritis by 50 times, providing essential population reference data for contextualising MRI findings. These findings show that bone marrow oedema, the key imaging marker for sacroiliitis in Assessment of Spondyloarthritis International Society criteria, commonly occurs from non-inflammatory causes. These population-based data can inform diagnostic interpretation and support development of more specific imaging thresholds to reduce misdiagnosis and inappropriate treatments. Max Kade Foundation and Novartis.