{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T15:08:44Z","timestamp":1780672124329,"version":"3.54.1"},"reference-count":28,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Regional periarticular bone mineral density may influence fixation and survivorship in total knee arthroplasty, but its relationship to coronal alignment remains unclear. This study assessed the association between coronal knee alignment and osteoporosis using CT Hounsfield Unit (HU)-based thresholds. Methods: Patients aged \u2265 50 years with standing long-leg radiographs and phantomless knee-CT (2008\u20132025) were retrospectively identified. Exclusion criteria included &gt;12 months between studies, incomplete CT, non-120 kV acquisition, prior fracture or surgery, or metabolic bone disease other than osteopenia or osteoporosis. Mean trabecular attenuation was measured over 15 mm of epiphyseal bone in the distal femur and proximal tibia. Osteoporosis was defined using CT-HU thresholds. Coronal alignment was measured using hip\u2013knee\u2013ankle angle (HKAA) and categorized as varus (&lt;178\u00b0), neutral (178\u2013182\u00b0), or valgus (&gt;182\u00b0). Measurements were performed by a reviewer blinded to osteoporosis classification. Multivariable logistic regression adjusted for age, sex, body mass index, and Kellgren\u2013Lawrence grade. Results: Among 306 patients (mean age 66.9 \u00b1 9.0 years; 51.3% female), 99.3% underwent CT for arthroplasty planning. Osteoporosis prevalence was 34.3% of varus, 58.2% of neutral, and 68.6% of valgus knees. Increasing valgus alignment was associated with higher osteoporosis odds, whereas varus alignment showed lower odds. Female sex (OR 3.06; p &lt; 0.001), age (OR 1.06\/year; p &lt; 0.001), and HKAA (OR 1.05\/degree; p = 0.042) remained independently associated with osteoporosis, whereas Kellgren\u2013Lawrence grade was nonsignificant. Conclusions: Coronal alignment was associated with CT-defined regional knee osteoporosis. Valgus alignment showed increased odds of osteoporosis, whereas varus alignment showed lower prevalence.<\/jats:p>","DOI":"10.3390\/diagnostics16111747","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T14:10:42Z","timestamp":1780668642000},"page":"1747","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional Differences in Knee Osteoporosis Based on Coronal Alignment Phenotype in Patients Undergoing Preoperative CT Imaging"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0154-8276","authenticated-orcid":false,"given":"Craig E.","family":"Klinger","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6456-9518","authenticated-orcid":false,"given":"Maximilian M.","family":"Mueller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10021, USA"},{"name":"Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, 21033 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6650-3166","authenticated-orcid":false,"given":"Robert E.","family":"Bilodeau","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10021, USA"},{"name":"School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1686-3911","authenticated-orcid":false,"given":"Joseph T.","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7940-5152","authenticated-orcid":false,"given":"Jelle P.","family":"van der List","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA"},{"name":"Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6662-5570","authenticated-orcid":false,"given":"Thomas P.","family":"Sculco","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7050-5571","authenticated-orcid":false,"given":"Peter K.","family":"Sculco","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1001\/jama.286.2.188","article-title":"The role of knee alignment in disease progression and functional decline in knee osteoarthritis","volume":"286","author":"Sharma","year":"2001","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/j.joca.2006.04.010","article-title":"The ratio of medial to lateral tibial plateau bone mineral density and compartment-specific tibiofemoral osteoarthritis","volume":"14","author":"Lo","year":"2006","journal-title":"Osteoarthr. 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