Title:Role of the Osteochondral Unit in the Pathogenesis of Osteoarthritis: Focus on the Potential Use of Clodronate
Volume: 18
Issue: 1
Author(s): Luigi Molfetta, Andrea Casabella, Sergio Rosini, Gianantonio Saviola*Augusto Palermo
Affiliation:
- Istituti Clinici Scientifici Maugeri IRCCS, Rheumatology and Rehabilitation Unit of the Institute of Castel Goffredo, Mantua, Italy
Keywords:
Osteoarthritis, osteochondral unit, bone marrow edema, joint prosthesis, bisphosphonates, clodronate, rehabilitation.
Abstract: Osteoarthritis (OA) is a chronic disease characterized by inflammation and progressive
deterioration of the joint. The etiology of OA includes genetic, phlogistic, dismetabolic and mechanical
factors. Historically, cartilage was considered the target of the disease and therapy was
aimed at protecting and lubricating the articular cartilage. The osteochondral unit is composed of articular
cartilage, calcified cartilage, and subchondral and trabecular bone, which work synergistically
to support the functional loading of the joint. Numerous studies today show that OA involves the
osteochondral unit, with the participation therefore of the bone in the starting and progression of
the disease, which is associated with chondropathy. Cytokines involved in the process leading to
cartilage damage are also mediators of subchondral bone edema. Therefore, OA therapy must be
based on the use of painkillers and bisphosphonates for both the control of osteometabolic damage
and its analgesic activity. Monitoring of the disease of the osteochondral unit must be extensive,
since bone marrow edema can be considered as a marker of the evolution of OA. In the present review,
we discuss some of the pathogenetic mechanisms associated with osteoarthritis, with a particular
focus on the osteochondral unit and the use of clodronate.