Predicting Incident Radiographic Knee Osteoarthritis in Middle‐Aged Women Within Four Years: The Importance of Knee‐Level Prognostic Factors

Objective To develop and internally validate risk models and a clinical risk score tool to predict incident radiographic knee osteoarthritis ( RKOA ) in middle‐aged women. Methods We analyzed 649 women in the Chingford 1,000 Women study. The outcome was incident RKOA , defined as Kellgren/Lawrence grade 0–1 at baseline and ≥2 at year 5. We estimated predictors’ effects on the outcome using logistic regression models. Two models were generated. The clinical model considered patient characteristics, medication, biomarkers, and knee symptoms. The radiographic model considered the same factors, plus radiographic factors (e.g., angle between the acetabular roof and the ilium's vertical cortex [hip α‐angle]). The models were internally validated. Model performance was assessed using calibration and discrimination (area under the receiver characteristic curve [ AUC ]). Results The clinical model contained age, quadriceps circumference, and a cartilage degradation marker (C‐terminal telopeptide of type II collagen) as predictors ( AUC = 0.692). The radiographic model contained older age, greater quadriceps circumference, knee pain, knee baseline Kellgren/Lawrence grade 1 (versus 0), greater hip α‐angle, greater spinal bone mineral density, and contralateral RKOA at baseline as predictors ( AUC = 0.797). Calibration tests showed good agreement between the observed and predicted incident RKOA . A clinical risk score tool was developed from the clinical model. Conclusion Two models predicting incident RKOA within 4 years were developed, including radiographic variables that improved model performance. First‐time predictor hip α‐angle and contralateral RKOA suggest OA origins beyond the knee. The clinical tool has the potential to help physicians identify patients at risk of RKOA in routine practice, but the tool should be externally validated.