Can affecting of subchondral bone slow the progression of osteoarthritis?
Authors:
Pavelka Karel
Authors‘ workplace:
Revmatologický ústav, Praha
Published in:
Clinical Osteology 2019; 24(2): 62-67
Category:
Overview
In the introduction, the author briefly discusses the problem of the pathogenesis of osteoarthritis (OA) and the identification of potential targets for therapeutic intervention, including the affecting of subchondral bone. The next section presents the methodology for evaluating the structural progression of OA. Primarily the methodology for standardization of the classical X-ray photographs is discussed, as well as the possibilities of magnetic resonance imaging. The following section focuses on the therapy of OA and the division into the symptomatic and the structure modifying treatments. Also new therapeutic approaches are described which are divided into 3 groups: preparations affecting catabolic and anabolic functions in cartilage, a group of drugs affecting inflammation, and preparations affecting the remodelling of subchondral bone. The studies conducted with the drugs of the third group mentioned are discussed in more detail. Studies of strontium ranelate (SEKOIA) have brought positive results, in terms of both symptomatic and structural effects, however the drug has been withdrawn from research due to an increased cardiovascular risk. Further, three studies of bisphosphonates are discussed which have produced inconsistent results. In conclusion, two studies of calcitonin were discussed that did not reach the primary objective after 2 years, still one of them had a proven effect on the volume of articular cartilage. Although preclinical studies show a possible beneficial effect of drugs modifying bone metabolism on the process of slowing cartilage degeneration, no clinical study has positively demonstrated this.
Keywords:
osteoarthritis – bisphosphonates – calcitonin
Sources
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Clinical biochemistry Paediatric gynaecology Paediatric radiology Paediatric rheumatology Endocrinology Gynaecology and obstetrics Internal medicine Orthopaedics General practitioner for adults Radiodiagnostics Rehabilitation Rheumatology Traumatology OsteologyArticle was published in
Clinical Osteology
2019 Issue 2
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