As concluded from the results of an Osteoarthritis Initiative (OAI), issued online in July, 2020, the use of bisphosphonates may be protective against radiographic knee osteoarthritis (OA) progression in the initial stages, especially those who are not obese, nevertheless not as much for those with more advanced disease or added weight‐bearing joint stress.

The use of antiresporptive medicines for treatment of knee OA is not new, but not information is available concerning more potent nitrogen‐containing oral bisphosphonates on radiographic disease‐progression in patients with changing disease‐severity, especially those who are not overweight.

This study focused to determine if use of bisphosphonates is protective against 2‐year radiographic‐progression of knee OA in OAI patients, stratified by baseline radiographic disease‐status and assess effects in non‐overweight patients (BMI < 25 kg/m2) and cumulative bisphosphonate exposure effects.

Women patients aged ≥50 years were recognized and excepted those missing baseline radiograph readings, bisphosphonate use data, or all clinical survey information at baseline. These women participants with bisphosphonate use (69% alendronate) were propensity‐matched 1:1 to non‐bisphosphonate‐users. They were followed till first radiographic knee OA‐progression (1‐unit surge in Kellgren and Lawrence i.e. KL grade) or data were amended (first missed visit or end of 2‐year follow‐up). The hazard‐ratios between bisphosphonate‐users versus non‐users, with an interaction term for baseline KL grade (KL < 2 or KL≥2) were evaluated via discrete‐time logistic regression models.

On the whole, 346 bisphosphonate‐users were recognized in a total of 1,977 eligible women. 

As shown in the table, Bisphosphonate‐users with KL grade < 2 were safe against progression, whereas bisphosphonate use was not linked with radiographic progression in those with KL grade ≥ 2. When limiting the analysis to those patients with BMI < 25 kg/m2, effects were reinforced. The bisphosphonate use period did not affect progression, though sample size was limited.