Bone marrow lesions in hip osteoarthritis are characterized by increased bone turnover and enhanced angiogenesis

M Shabestari; J Vik; J E Reseland; E F Eriksen

doi:10.1016/j.joca.2016.05.009

Bone marrow lesions in hip osteoarthritis are characterized by increased bone turnover and enhanced angiogenesis

Osteoarthritis Cartilage. 2016 Oct;24(10):1745-1752. doi: 10.1016/j.joca.2016.05.009. Epub 2016 May 24.

Authors

M Shabestari¹, J Vik², J E Reseland³, E F Eriksen⁴

Affiliations

¹ Department. of Biomaterials, University of Oslo, Oslo, Norway. Electronic address: maziarg@medisin.uio.no.
² Department. of Orthopedic Surgery, Martina Hansen Hospital, Bærum, Akershus, Norway.
³ Department. of Biomaterials, University of Oslo, Oslo, Norway.
⁴ Department. of Endocrinology, Oslo University Hospital (Aker), Oslo, Norway.

PMID: 27233775
DOI: 10.1016/j.joca.2016.05.009

Abstract

Objective: Bone marrow lesions (BML), previously denoted bone marrow edema, are detected as water signals by magnetic resonance imaging (MRI). Previous histologic studies were unable to demonstrate any edematous changes at the tissue level. Therefore, our aim was to investigate the underlying biological mechanisms of the water signal in MRI scans of bone affected by BML.

Methods: Tetracycline labeling in addition to water sensitive MRI scans of 30 patients planned for total hip replacement surgery was undertaken. Twenty-one femoral heads revealed BML on MRI, while nine were negative and used as controls (CON). Guided by the MRI images cylindrical biopsies were extracted from areas with BML in the femoral heads. Tissue sections from the biopsies were subjected to histomorphometric image analyses of the cancellous bone envelope.

Results: Patients with BML exhibited an average 40- and 18-fold increase of bone formation rate and mineralizing surface, respectively. Additionally, samples with BML demonstrated 2-fold reduction of marrow fat and 28-fold increase of woven bone. Immunohistochemical analysis showed a 4-fold increase of angiogenesis markers CD31 and von Willebrand Factor (vWF) in the BML-group compared to CON.

Conclusion: This study indicates that BML are characterized by increased bone turnover, vascularity and angiogenesis in keeping with it being a reparatory process. Thus, the water signal, which is the hallmark of BML on MRI, is most probably reflecting increased tissue vascularity accompanying increased remodeling activity.

Keywords: Angiogenesis; Bone marrow lesion; Bone turnover; Osteoarthritis.

MeSH terms

Bone Marrow
Bone Marrow Diseases
Bone Remodeling
Humans
Magnetic Resonance Imaging
Osteoarthritis, Hip*
Osteoarthritis, Knee