Subchondral insufficiency fractures and spontaneous osteonecrosis of the knee may not be related to osteoporosis

Abstract

The term insufficiency fracture implies inadequate bone and is applied to some subchondral knee magnetic resonance images. We reviewed bone mineral density, body mass index, meniscal extrusion, comorbidities, and demographics in 32 knee insufficiency fracture patients. Only five were osteoporotic. Meniscal extrusion was predominant.

Purpose: The literature supports systemic osteoporosis as a risk fracture for spontaneous osteonecrosis of the knee (SONK). SONK is also called a subchondral insufficiency fracture. Recognizing that insufficiency fracture and SONK are related, we designed this retrospective study to determine if knee subchondral insufficiency fractures were associated with osteoporosis based on bone mineral density.

Methods: Based on magnetic resonance imaging findings, 32 patients were diagnosed as having an insufficiency fracture by an orthopaedic surgeon with magnetic resonance imaging confirmation by a musculoskeletal radiologist. We reviewed body mass index, age, sex, comorbidities, demographics, and bone mineral density using both T-scores and Z-scores.

Results: The average age was 70, and only five patients were osteoporotic. Twenty-six of the 32 patients were female. The average age-related Z-score was 1 standard deviation above normal.

Conclusions: We conclude that osteoporosis is not the underlying cause of this disorder in the majority of patients.