title: An OA phenotype may obtain major benefit from bone-acting agents.
abstract: BACKGROUND
  Osteoarthritis (OA) joints display relevant microstructure alterations associated to an increase in remodeling at subchondral bone, which supports its crucial role in OA pathogenesis. Despite this, the treatment of knee OA patients with antiresorptive drugs has given discordant results, suggesting the existence of a particular patient subset with good response to halting high subchondral remodeling.
  
  
  OBJECTIVE
  To identify an OA phenotype that may obtain major benefit from therapy with bone-acting agents.
  
  
  METHODS
  A systematic review of the literature was performed by searching the Medline and PubMed databases from 1990 to April 2013 using the following keywords: subchondral bone, articular cartilage, and osteoarthritis in various combinations with bone agents, bone mineral density, and scintigraphy.
  
  
  RESULTS
  Early animal and human studies provided the rationale for the beneficial use of bone agents on OA cartilage damage. Several bone-acting agents have reduced low back pain and likely spondylosis progression. Recently, strontium ranelate has been reported to exert both structural and clinical benefits in knee OA patients with radiological progression. However, other antiresorptives have shown divergent results. Human studies suggest that these contradictory results may be due to the lack of well-defined OA phenotypes and an accurate methodology to recruit and follow up these patients.
  
  
  CONCLUSIONS
  A particular subset of postmenopausal patients with high remodeling and/or low subchondral bone density may benefit from the treatment with bone-acting agents hindering OA progression. This OA population could be identified with the simultaneous use of subchondral bone dual-energy X-ray absorptiometry and scintigraphy.
authors.affiliation: Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Roman-Blas
authors.affiliation: Department of Rheumatology, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma, Madrid, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: Castañeda
authors.affiliation: Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Largo
authors.affiliation: Department of Rheumatology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.affiliation: Bone and Joint Research Unit, IIS Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain. Electronic address: gherrero@fjd.es.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Herrero-Beaumont
mesh_terms: D000818:Animals; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging; D006801:Humans; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011859:Radiography
chemical_list: D050071:Bone Density Conservation Agents
keywords: articular cartilage; bone agents; osteoarthritis; osteoporosis; subchondral bone