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Plain radiography is the most common modality to assess the stage ofosteoarthritis. Our aims were to assess the relationship of radiography-basedbone density and texture between radiographs with minimal and clinicalpost-processing, and to compare the differences in bone characteristics betweencontrols and subjects with knee osteoarthritis or medial tibial bone marrowlesions (BMLs). Tibial bone density and texture was evaluated from radiographswith both minimal and clinical post-processing in 109 subjects with and withoutosteoarthritis. Bone texture was evaluated using fractal signature analysis.Significant correlations (p<0.001) were found in all regions (between 0.94 and0.97) for calibrated bone density between radiographs with minimal and clinicalpost-processing. Correlations varied between 0.51 and 0.97 (p<0.001) for FD_Vertexture variable and between -0.10 and 0.97 for FD_Hor. Bone density andtexture were different (p<0.05) between controls and subjects withosteoarthritis or BMLs mainly in medial tibial regions. When classifyinghealthy and osteoarthritic subjects using a machine learning-based elastic netmodel with bone characteristics, area under the receiver operatingcharacteristics (ROCAUC) curve was 0.77. For classifying controls and subjectswith BMLs, ROCAUC was 0.85. In conclusion, differences in bone density andtexture can be assessed from knee radiographs when using minimalpost-processing.

Bone Density and Texture from Minimally Post-Processed Knee Radiographs in Subjects with Knee Osteoarthritis