M. A. Karsdal, M. Sc. , Ph. D. , D. J. Leeming, M. Sc. , E. B. Dam, M

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Presentation transcript:

Should subchondral bone turnover be targeted when treating osteoarthritis? M.A. Karsdal, M.Sc., Ph.D., D.J. Leeming, M.Sc., E.B. Dam, M.Sc., Ph.D., K. Henriksen, M.Sc., Ph.D., P. Alexandersen, M.Sc., Ph.D., P. Pastoureau, Ph.D., R.D. Altman, M.D., C. Christiansen, M.D. Osteoarthritis and Cartilage Volume 16, Issue 6, Pages 638-646 (June 2008) DOI: 10.1016/j.joca.2008.01.014 Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Schematic illustration of the alterations in the subchondral area. Right panel A: normal tibial plateau. Left panel B: osteoarthritic tibial plateau, showing loss of cartilage, increased bone turnover, sclerosis of the subchondral plate, thinning of the trabeculae, and osteophytes. Osteoarthritis and Cartilage 2008 16, 638-646DOI: (10.1016/j.joca.2008.01.014) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Biomechanical coupling: medial cartilage loss is correlated to loss of lateral trabecular structure65 revealing a potential biomechanical coupling between bone and cartilage. Illustration inspired by Lindsey et al.65 Osteoarthritis and Cartilage 2008 16, 638-646DOI: (10.1016/j.joca.2008.01.014) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Schematic figure showing the coupling/uncoupling relationship between cartilage and bone. Under normal physiological conditions, bone and cartilage turnover are coupled (lower left quadrant). In bone metastasis where pathologically increased bone turnover is observed, cartilage turnover is only minimally affected. In contrast, in postmenopausal OA both bone and cartilage are increased, probably due to increased metabolic activity in subchondral bone. Some anti-resorptive agents, such as estrogens, SERMs, bisphosphonates, and calcitonin inhibit increased bone turnover and also the increased cartilage turnover, in part through direct interaction of attenuating subchondral bone turnover, and possibly by direct action receptors activated action on chondrocytes. Additional data on anti-RANKL and strontium ranelate are needed in order to correctly incorporate them into this model. Osteoarthritis and Cartilage 2008 16, 638-646DOI: (10.1016/j.joca.2008.01.014) Copyright © 2008 Osteoarthritis Research Society International Terms and Conditions