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Abstract
The classical view of the pathogenesis of osteoarthritis (OA) is that subchondral sclerosis is associated with, and perhaps causes, age-related joint degeneration. Recent observations have demonstrated that OA is associated with early loss of bone owing to increased bone remodelling, followed by slow turnover leading to densification of the subchondral plate and complete loss of cartilage. Subchondral densification is a late event in OA that involves only the subchondral plate and calcified cartilage; the subchondral cancellous bone beneath the subchondral plate may remain osteopenic. In experimental models, inducing subchondral sclerosis without allowing the prior stage of increased bone remodelling to occur does not lead to progressive OA. Therefore, both early-stage increased remodelling and bone loss, and the late-stage slow remodelling and subchondral densification are important components of the pathogenetic process that leads to OA. The apparent paradoxical observations that OA is associated with both increased remodelling and osteopenia, as well as decreased remodelling and sclerosis, are consistent with the spatial and temporal separation of these processes during joint degeneration. This Review provides an overview of current knowledge on OA and discusses the role of subchondral bone in the initiation and progression of OA. A hypothetical model of OA pathogenesis is proposed.
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Affiliation(s)
- David B Burr
- Department of Anatomy and Cell Biology, MS 5035, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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152
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Humphries JM, Kuliwaba JS, Gibson RJ, Fazzalari NL. In situ fatty acid profile of femoral cancellous subchondral bone in osteoarthritic and fragility fracture females: implications for bone remodelling. Bone 2012; 51:218-23. [PMID: 22521433 DOI: 10.1016/j.bone.2012.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/18/2012] [Accepted: 04/03/2012] [Indexed: 01/15/2023]
Abstract
We report here differences in the fatty acid profile of cancellous bone matrix, including n-3, n-6, mono- and poly-unsaturated, as well as saturated fats, between femoral heads from female OA (n=8, aged 68-88years), fractured neck of femur (#NOF) (n=19, 67-88years) and autopsy controls (CTRL) (n=4, 85-97years). Femoral heads were collected from individuals undergoing orthopaedic surgery for OA or #NOF; the fatty acid profile of sub-samples from the superior principal compressive and superior principal tensile regions were determined by gas chromatography. A total of 42 individual fatty acids were detected at varying concentrations with significant differences between subchondral bone from OA subjects, subchondral bone from #NOF subjects and subchondral bone from CTRL subjects, as well as between the superior principal compressive and superior principal tensile regions (for saturated fats only). Subchondral bone from OA subjects had higher total n-6 (OA=10.89±3.17, #NOF=11.11±1.83, CTRL=8.32±2.05, p=0.008) and total n-3 (OA=1.34±0.38, #NOF=1.19±0.18, CTRL=1.15±0.48, p=0.011) percentages than subchondral bone from #NOF subjects and subchondral bone from CTRL subjects, and there was no difference in the n-6:n-3 ratio, nor within the percentage of n-9 fatty acids. Arachidonic acid (OA=0.42±0.16, #NOF=0.26±0.06, CTRL=0.28±0.06, p=0.01), and γ-linolenic acid (OA=0.11±0.03, #NOF=0.05±0.02, CTRL=0.04±0.02, p<0.001) were higher in subchondral bone from OA subjects than subchondral bone from #NOF subjects and subchondral bone from CTRL subjects. In conclusion, there is a wide diversity of fatty acids in cancellous bone matrix from the femoral heads of OA and #NOF, suggesting they may have regulatory effects on inflammatory processes, and their metabolites. This article is part of a Special Issue entitled "Osteoarthritis".
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Affiliation(s)
- J M Humphries
- Bone and Joint Research Laboratory, Directorate of Surgical Pathology, SA Pathology (IMVS) and Hanson Institute, PO Box 14 Rundle Mall, Adelaide, SA, 5000, Australia.
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153
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Recent findings on the role of gelatinases (matrix metalloproteinase-2 and -9) in osteoarthritis. Adv Orthop 2012; 2012:834208. [PMID: 22900195 PMCID: PMC3412089 DOI: 10.1155/2012/834208] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 05/27/2012] [Indexed: 01/08/2023] Open
Abstract
Several studies dealing with the pathomechanisms of OA refer to MMP-1, -3, -7, -8, and -13 whereas a smaller number of investigations have pointed out the pathogenic role of gelatinases in OA. These gelatinases are best known for their involvement in pulmonary, myocardial, and neoplastic disease but they are emerging as important proteases implicated in the OA progression. This paper highlights the role of the gelatinases as emerging factors in OA pathogenesis through the regulation of subchondral bone resorption and microvascular invasion. The most significant new findings over the last year that add to our knowledge of the activity of these proteins in OA have been reported.
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154
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Anetzberger H, Mayer A, Schulz C, Müller-Gerbl M. Computed Tomography Osteoabsorptiometry Is Reliable for the Determination of the Subchondral Bone Mineralization Distribution in the Rabbit Knee. Eur Surg Res 2012; 48:208-14. [DOI: 10.1159/000339307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 04/22/2012] [Indexed: 11/19/2022]
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155
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Funck-Brentano T, Lin H, Hay E, Ah Kioon MD, Schiltz C, Hannouche D, Nizard R, Lioté F, Orcel P, de Vernejoul MC, Cohen-Solal ME. Targeting bone alleviates osteoarthritis in osteopenic mice and modulates cartilage catabolism. PLoS One 2012; 7:e33543. [PMID: 22432033 PMCID: PMC3303845 DOI: 10.1371/journal.pone.0033543] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 02/11/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Subchondral bone modifications occur early in the development of osteoarthritis (OA). The level of bone resorption might impact cartilage remodeling. We therefore assessed the in vivo and in vitro effects of targeting bone resorption in OA and cartilage metabolism. METHODS OA was induced by meniscectomy (MNX) in ovariectomized osteopenic mice (OP) treated with estradiol (E2), pamidronate (PAM), or phosphate buffered saline (PBS) for 6 weeks. We assessed the subchondral bone and cartilage structure and the expression of cartilage matrix proteases. To assess the involvement of bone soluble factors in cartilage metabolism, supernatant of human bone explants pre-treated with E2 or PAM were transferred to cartilage explants to assess proteoglycan release and aggrecan cleavage. OPG/RANKL mRNA expression was assessed in bone explants by real-time quantitative PCR. The role of osteoprotegerin (OPG) in the bone-cartilage crosstalk was tested using an OPG neutralizing antibody. RESULTS Bone mineral density of OP mice and osteoclast number were restored by E2 and PAM (p<0.05). In OP mice, E2 and PAM decreased ADAMTS-4 and -5 expression, while only PAM markedly reduced OA compared to PBS (2.0±0.63 vs 5.2±0.95; p<0.05). OPG/RANKL mRNA was increased in human bone explants treated with both drugs (2.2-3.7-fold). Moreover, supernatants from bone explants cultured with E2 or PAM reduced aggrecan cleavage and cartilage proteoglycan release (73±8.0% and 80±22% of control, respectively, p<0.05). This effect was reversed with osteoprotegerin blockade. CONCLUSION The inhibition of bone resorption by pamidronate in osteopenic mice alleviates the histological OA score with a reduction in the expression of aggrecanases. Bone soluble factors, such as osteoprotegerin, impact the cartilage response to catabolic factors. This study further highlights the importance of subchondral bone in the regulation of joint cartilage damage in OA.
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Affiliation(s)
- Thomas Funck-Brentano
- INSERM U606, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Hilène Lin
- INSERM U606, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Eric Hay
- INSERM U606, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Marie-Dominique Ah Kioon
- INSERM U606, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Corinne Schiltz
- INSERM U606, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Didier Hannouche
- Department of Orthopedics, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Rémy Nizard
- Department of Orthopedics, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Frédéric Lioté
- INSERM U606, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | - Philippe Orcel
- Department of Rheumatology, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
| | | | - Martine Esther Cohen-Solal
- INSERM U606, Centre Viggo Petersen and Université Paris-Diderot Paris 7, Hôpital Lariboisière, Paris, France
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156
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Madry H, Luyten FP, Facchini A. Biological aspects of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2012; 20:407-22. [PMID: 22009557 DOI: 10.1007/s00167-011-1705-8] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 10/04/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE Early OA primarily affects articular cartilage and involves the entire joint, including the subchondral bone, synovial membrane, menisci and periarticular structures. The aim of this review is to highlight the molecular basis and histopathological features of early OA. METHODS Selective review of literature. RESULTS Risk factors for developing early OA include, but are not limited to, a genetic predisposition, mechanical factors such as axial malalignment, and aging. In early OA, the articular cartilage surface is progressively becoming discontinuous, showing fibrillation and vertical fissures that extend not deeper than into the mid-zone of the articular cartilage, reflective of OARSI grades 1.0-3.0. Early changes in the subchondral bone comprise a progressive increase in subchondral plate and subarticular spongiosa thickness. Early OA affects not only the articular cartilage and the subchondral bone but also other structures of the joint, such as the menisci, the synovial membrane, the joint capsule, ligaments, muscles and the infrapatellar fat pad. Genetic markers or marker combinations may become useful in the future to identify early OA and patients at risk. CONCLUSION The high socioeconomic impact of OA suggests that a better insight into the mechanisms of early OA may be a key to develop more targeted reconstructive therapies at this first stage of the disease. LEVEL OF EVIDENCE Systematic review, Level II.
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Affiliation(s)
- Henning Madry
- Experimental Orthopaedics and Osteoarthritis Research, Saarland University, Kirrbergerstrasse, Building 37, 66421, Homburg, Germany.
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157
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Castañeda S, Roman-Blas JA, Largo R, Herrero-Beaumont G. Subchondral bone as a key target for osteoarthritis treatment. Biochem Pharmacol 2012; 83:315-23. [DOI: 10.1016/j.bcp.2011.09.018] [Citation(s) in RCA: 170] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/14/2011] [Accepted: 09/15/2011] [Indexed: 01/05/2023]
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158
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Bellido M, Lugo L, Roman-Blas JA, Castañeda S, Calvo E, Largo R, Herrero-Beaumont G. Improving subchondral bone integrity reduces progression of cartilage damage in experimental osteoarthritis preceded by osteoporosis. Osteoarthritis Cartilage 2011; 19:1228-36. [PMID: 21820069 DOI: 10.1016/j.joca.2011.07.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/07/2011] [Accepted: 07/12/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Impairment of subchondral bone density and quality aggravates cartilage damage in osteoarthritis (OA). Accordingly, we assessed whether improving microstructure and quality at subchondral bone by the bone-forming agent parathyroid hormone (PTH) [1-34] prevent cartilage damage progression in a rabbit model of OA preceded by osteoporosis (OP). METHODS OP was induced in 20 female rabbits. At week 7, these rabbits underwent knee surgery to induce OA and, at week 12, they started either saline vehicle (n=10) or PTH (n=10) for 10 weeks. Ten healthy animals were used as controls. At week 22, microstructure was assessed by micro-computed tomography and bone remodelling by protein expression of alkaline phosphatase (ALP), metalloproteinase-9 (MMP9), osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) at subchondral bone. Cartilage damage was evaluated using Mankin score. RESULTS PTH reversed the decrease of bone area/tissue area, trabecular thickness, plate thickness, polar moment of inertia, ALP expression and OPG/RANKL ratio, as well as counteracted the increase of fractal dimension and MMP9 expression at subchondral bone of osteoarthritis preceded by osteoporosis (OPOA) rabbits compared to vehicle administration (P<0.05). Likewise, PTH decreased cartilage damage severity in OPOA rabbits. Good correlations were observed between subchondral bone structure or remodelling parameters, and cartilage Mankin score. CONCLUSIONS Improvement of microstructural and remodelling parameters at subchondral bone by PTH [1-34] contributed to prevent cartilage damage progression in rabbits with early OPOA. These findings support the role of subchondral bone in OA. Further studies are warranted to establish the place of bone-forming agents as potential treatment in OA.
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Affiliation(s)
- M Bellido
- Bone and Joint Research Unit, Service of Rheumatology, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
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160
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Goldring SR, Goldring MB. Bone and cartilage in osteoarthritis: is what's best for one good or bad for the other? Arthritis Res Ther 2010; 12:143. [PMID: 21044355 PMCID: PMC2991002 DOI: 10.1186/ar3135] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 09/17/2010] [Indexed: 11/23/2022] Open
Abstract
The interest in the relationship between articular cartilage and the structural and functional properties of peri-articular bone relates to the intimate contact that exists between these tissues in joints that are susceptible to the development of osteoarthritis (OA). The demonstration in several animal models that osteoporosis and decreased bone tissue modulus leads to an increased propensity for the development of post-traumatic OA is paradoxical in light of the extensive epidemiological literature indicating that individuals with high systemic bone mass, assessed by bone mineral density, are at increased risk for OA. These observations underscore the need for further studies to define the pathophysiological mechanisms involved in the interaction between subchondral bone and articular cartilage and for applying this information to the development of therapeutic interventions to improve the outcomes in patients with OA.
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