Enhanced angiogenesis and increased bone turnover characterize bone marrow lesions in osteoarthritis at the base of the thumb

M Shabestari; N J Kise; M A Landin; S Sesseng; J C Hellund; J E Reseland; E F Eriksen; I K Haugen

doi:10.1302/2046-3758.76.BJR-2017-0083.R3

Enhanced angiogenesis and increased bone turnover characterize bone marrow lesions in osteoarthritis at the base of the thumb

Bone Joint Res. 2018 Jul 7;7(6):406-413. doi: 10.1302/2046-3758.76.BJR-2017-0083.R3. eCollection 2018 Jun.

Authors

M Shabestari¹, N J Kise², M A Landin³, S Sesseng⁴, J C Hellund⁵, J E Reseland⁶, E F Eriksen⁷, I K Haugen⁸

Affiliations

¹ Department of Biomaterials, Faculty of Dentistry, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
² Department of Orthopaedic Surgery, Martina Hansens Hospital, Akershus, Norway.
³ Department of Oral Biology, Faculty of Dentistry University of Oslo, Oslo, Norway.
⁴ Department of Radiology,Diakonhjemmet Hospital, Oslo, Norway.
⁵ Department of Radiology and Nuclear Medicine, Oslo University Hospital, Ullevål, Oslo, Norway.
⁶ Department of Biomaterials, Faculty of Dentistry University of Oslo, Oslo, Norway.
⁷ Department of Endocrinology, Oslo University Hospital, Ullevål, Oslo, Norway and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁸ Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.

PMID: 30034794
PMCID: PMC6035357
DOI: 10.1302/2046-3758.76.BJR-2017-0083.R3

Abstract

Objectives: Little is known about tissue changes underlying bone marrow lesions (BMLs) in non-weight-bearing joints with osteoarthritis (OA). Our aim was to characterize BMLs in OA of the hand using dynamic histomorphometry. We therefore quantified bone turnover and angiogenesis in subchondral bone at the base of the thumb, and compared the findings with control bone from hip OA.

Methods: Patients with OA at the base of the thumb, or the hip, underwent preoperative MRI to assess BMLs, and tetracycline labelling to determine bone turnover. Three groups were compared: trapezium bones removed by trapeziectomy from patients with thumb base OA (n = 20); femoral heads with (n = 24); and those without (n = 9) BMLs obtained from patients with hip OA who underwent total hip arthroplasty.

Results: All trapezium bones demonstrated MRI-defined BMLs. Compared with femoral heads without BMLs, the trapezia demonstrated significantly higher bone turnover (mean sd 0.2 (0.1) versus 0.01 (0.01) µm³/µm²/day), mineralizing surface (18.5% (13.1) versus 1.4% (1.3)) and vascularity (5.2% (1.1) versus 1.2% (0.6)). Femoral heads with BMLs exhibited higher bone turnover (0.3 (0.2) versus 0.2 (0.1) µm³/µm²/day), a higher mineralization rate (26.6% (10.6) versus 18.6% (11.9)) and greater trabecular thickness (301.3 µm (108) versus 163.6 µm (24.8)) than the trapezia.

Conclusion: Bone turnover and angiogenesis were enhanced in BMLs of both the thumb base and hip OA, of which the latter exhibited the highest bone turnover. Thus, the increase in bone turnover in weight-bearing joints like the hip may be more pronounced than less mechanically loaded osteoarthritic joints demonstrating BMLs. The histological changes observed may explain the water signal from BMLs on MRI.Cite this article: M. Shabestari, N. J. Kise, M. A. Landin, S. Sesseng, J. C. Hellund, J. E. Reseland, E. F. Eriksen, I. K. Haugen. Enhanced angiogenesis and increased bone turnover characterize bone marrow lesions in osteoarthritis at the base of the thumb. Bone Joint Res 2018;7:406-413. DOI: 10.1302/2046-3758.76.BJR-2017-0083.R3.

Keywords: Biomechanical stress; Bone histomorphometry; Bone marrow lesions; Bone turnover and angiogenesis.