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Review

Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes

Guangyi Li12, Jimin Yin1, Junjie Gao2, Tak S Cheng2, Nathan J Pavlos2, Changqing Zhang1* and Ming H Zheng2*

Author Affiliations

1 Department of Orthopaedics, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 200233, China

2 Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Perth 6009, Australia

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Arthritis Research & Therapy 2013, 15:223  doi:10.1186/ar4405

Published: 9 December 2013

Abstract

Osteoarthritis (OA) is a major cause of disability in the adult population. As a progressive degenerative joint disorder, OA is characterized by cartilage damage, changes in the subchondral bone, osteophyte formation, muscle weakness, and inflammation of the synovium tissue and tendon. Although OA has long been viewed as a primary disorder of articular cartilage, subchondral bone is attracting increasing attention. It is commonly reported to play a vital role in the pathogenesis of OA. Subchondral bone sclerosis, together with progressive cartilage degradation, is widely considered as a hallmark of OA. Despite the increase in bone volume fraction, subchondral bone is hypomineralized, due to abnormal bone remodeling. Some histopathological changes in the subchondral bone have also been detected, including microdamage, bone marrow edema-like lesions and bone cysts. This review summarizes basic features of the osteochondral junction, which comprises subchondral bone and articular cartilage. Importantly, we discuss risk factors influencing subchondral bone integrity. We also focus on the microarchitectural and histopathological changes of subchondral bone in OA, and provide an overview of their potential contribution to the progression of OA. A hypothetical model for the pathogenesis of OA is proposed.