Abstract
Osteoarthritis (OA) refers to a group of mechanically-induced joint disorders to which both genetic and acquired factors contribute. Current pathophysiological concepts focus on OA as a disease of the whole joint. Within these models, the functional unit formed by the articular cartilage and the subchondral bone seems to be of particular interest. Cartilage and bone receive and dissipate the stress associated with movement and loading, and are therefore continuously challenged biomechanically. Recent data support the view that cartilage and bone can communicate over the calcified tissue barrier; vessels reach out from bone into the cartilage zone, patches of uncalcified cartilage are in contact with bone, and microcracks and fissures further facilitate transfer of molecules. Several molecular signaling pathways such as bone morphogenetic proteins and Wnts are hypothesized to have a role in OA and can activate cellular and molecular processes in both cartilage and bone cells. In addition, intracellular activation of different kinase cascades seems to be involved in the molecular crosstalk between cartilage and bone cells. Further research is required to integrate these different elements into a comprehensive approach that will increase our understanding of the disease processes in OA, and that could lead to the development of specific therapeutics or treatment strategies.
Key Points
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Osteoarthritis (OA) is a disease of the whole joint, to which changes in cartilage, bone, bone marrow, synovium, menisci, ligaments and neural tissue contribute
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Subchondral bone changes, with increased metabolism and sclerosis, are often the first detectable alterations in the OA process
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Increased subchondral remodeling might lead to decreased local mineralization
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Molecular crosstalk between the cartilage and bone is possible, and it increases with progression of OA
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Identifying risk factors for disease and halting disease progression are the main clinical challenges in OA
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Acknowledgements
R. J. Lories is the recipient of a post-doctoral fellowship from the Flanders Research Foundation (FWO Vlaanderen). Research on osteoarthritis in the authors' laboratory is supported by FWO Vlaanderen, a GOA grant from KU Leuven, and Translational Research in Europe—Applied Technologies for Osteoarthritis (TREAT-OA), a large collaborative FP7 project supported by the European Union.
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R. J. Lories and F. P. Luyten contributed equally to all aspects of preparation of this manuscript.
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Lories, R., Luyten, F. The bone–cartilage unit in osteoarthritis. Nat Rev Rheumatol 7, 43–49 (2011). https://doi.org/10.1038/nrrheum.2010.197
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DOI: https://doi.org/10.1038/nrrheum.2010.197
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