Bone in osteoarthritis: imaging and interventions

Purpose of review To review the recent literature on bone in osteoarthritis (OA), with a focus on imaging and intervention studies Recent findings Most studies focused on knee OA; hip and hand studies were uncommon. Bone shape studies demonstrated that shape changes precede radiographic OA, predict joint replacement, and have demonstrated high responsiveness. Novel quantitative 3D imaging markers (B-score) have better characterized OA severity, including preradiographic OA status. The addition of computerized tomography-derived 3D metrics has improved the prediction of hip joint replacement when compared to radiographs alone. Recent studies of bisphosphonates for knee OA have reported no benefits on pain or bone marrow lesion (BML) size. A meta-analysis on Vitamin D supplementation in knee OA suggested minimal symptom improvement and no benefits on the structure. Cathepsin K inhibition demonstrated reduction in OA bone change progression, but with no symptom benefit. Studies of injections of bone substitutes into BMLs (subchondroplasty) have generally been small and potential benefits remain unclear. Summary Subchondral bone features are associated with pain, incidence and progression of OA. Recent studies have validated quantitative bone shape as a biomarker for OA trials. Trials of bone-targeted OA therapies have been disappointing although cathepsin K inhibition may slow structural progression.

Automated summary

This review summarizes the recent literature on bone in osteoarthritis, focusing on imaging and intervention studies. Studies have shown that shape changes in bones precede radiographic osteoarthritis, predict joint replacement, and are highly responsive. Novel 3D imaging markers have better characterized the severity of osteoarthritis, including preradiographic osteoarthritis. The addition of computerized tomography-derived 3D metrics has improved the prediction of hip joint replacement compared to radiographs alone. Trials of bone-targeted therapies for osteoarthritis have been disappointing, although cathepsin K inhibition may slow structural progression.