Bone loss at subchondral plate in knee osteoarthritis patients with hypertension and type 2 diabetes mellitus C.Y. Wen, Y. Chen, H.L. Tang, C.H. Yan,

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Bone loss at subchondral plate in knee osteoarthritis patients with hypertension and type 2 diabetes mellitus C.Y. Wen, Y. Chen, H.L. Tang, C.H. Yan, W.W. Lu, K.Y. Chiu Osteoarthritis and Cartilage Volume 21, Issue 11, Pages 1716-1723 (November 2013) DOI: 10.1016/j.joca.2013.06.027 Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Micro-CT images of subchondral bone damages in different groups of knee OA patients (A ∼ D: patient without hypertension or T2DM; E ∼ H: patient with hypertension but no T2DM; I ∼ L: patient with both hypertension and T2DM). As compared to the knee OA patients without the comorbidities (A ∼ D), subchondral bone plate was severely damaged at medial tibial plateau in the patients with hypertension and T2DM (I ∼ L). BMD, which was coded by different colors, also significantly decreased on both medial and lateral sides in these patients (J). Moreover, the thickness of subchondral plate on lateral tibial plateau turned to be thinner in the subjects with the comorbidities (H, L). (A, E, I: top views of tibial plateau of OA knee; B, F, J: BMD distribution at coronal section view of tibial plateau of OA knee, which are coded in color bar on right corner: red – high BMD 0.55 ∼ 1.16 g/mm3; pink – medium BMD 0.35 ∼ 0.55 g/mm3 and yellow – low BMD 0.16 ∼ 0.35 g/mm3; C, G, K: cubic regions of interest (ROI) from medial tibial plateau, D, H, L: cubic regions of interest from lateral tibial plateau). Osteoarthritis and Cartilage 2013 21, 1716-1723DOI: (10.1016/j.joca.2013.06.027) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Comparisons of BMD and porosity of medial subchondral bone plate between knee OA patients in presence or absence of hypertension and T2DM. In comparison with the subjects without the comorbidities, knee OA patients with hypertension and T2DM showed significantly lower BMD (A, P = 0.034) and higher porosity (B, P = 0.032) at subchondral plate on medial tibial plateau. Similar trend was also found in BMD (C, P = 0.042) and total porosity (D, P = 0.088) of subchondral plate at lateral tibial plateau. The comparisons among the groups were performed using one-way ANOVA and the significance level was set at P < 0.05. Osteoarthritis and Cartilage 2013 21, 1716-1723DOI: (10.1016/j.joca.2013.06.027) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Histological images of osteochondral junction at lateral (A, C, E) and medial (B, D, F) tibial plateau in knee osteoarthritis (OA) patients (A ∼ B: patients without hypertension and T2DM; C ∼ D: patients with hypertension only; E ∼ F: patients with both hypertension and T2DM). As compared to the subjects without these comorbid diseases (B), subchondral bone was severely damaged on medial tibial plateau in patients with hypertension and diabetes, which was accompanied by wearing away the full-thickness of overlying articular cartilage (D, F). Furthermore, the thickness of subchondral bone plate on lateral tibial plateau was also obviously thinner in these patients with the comorbidities together with the elevated porosity (C, E) (Hematoxylin–Eosin staining). Osteoarthritis and Cartilage 2013 21, 1716-1723DOI: (10.1016/j.joca.2013.06.027) Copyright © 2013 Osteoarthritis Research Society International Terms and Conditions