Bisphosphonates and osteoarthritis

Osteoarthritis (OA) is the most common degenerative joint disease; it represents a major public health problem and is ranked among the top 10 causes of disability worldwide, especially in elderly subjects. Although the main characteristic of OA is the progressive degeneration and loss of joint cartilage, it is now commonly accepted that all the articular components are involved, as the structural alterations observed in OA include sub-chondral bone changes, osteophyte formation, variable degrees of synovial inflammation, degeneration of ligaments and hypertrophy of the joint capsule. There are currently no treatments that delay or halt OA progression; in general, therapeutic agents that modulate the cellular activities in individual joint tissues such as bone, cartilage or synovium have proven to be effective in arresting or slowing the progression of joint pathology in animal models of OA. Particularly, bisphosphonates may determine some positive structural and symptomatic effects in the treatment of OA through different mechanisms, including their ability to modify osteoclast and osteoblast metabolism in the sub-chondral bone and to inhibit the synovial inflammatory changes.