This study was an extension of the Prevention of knee Osteoarthritis in Overweight Females (PROOF) trial. 407 females, between the ages of 50 and 60, at high risk of developing knee osteoarthritis (OA) were included. Patients were randomized using a 2x2 factorial design into 4 groups, that received either glucosamine sulfate (1500mg orally per day) and a tailored diet and exercise program, glucosamine sulfate alone, a diet and exercise program and placebo, or just a placebo.This secondary analysis aimed to determine the effects of these treatments on the progression of MRI-confirmed knee osteoarthritis (OA) features. Results demonstrated that patients in a diet and exercise program had a significant reduction in the progression of meniscal extrusion when compared to placebo at two years. All other comparisons of MRI knee OA features (progression of bone marrow lesions (BMLs), cartilage defects, osteophytes, and meniscal abnormalities) made between active and control therapy groups revealed comparable results.