Bone Health

A Mark Fendrick and Bruce P Greenberg Osteopathic Medicine and Primary Care 2009, 3:1 (full text available)
This review is intended to provide physicians with an overview of the benefits and risks associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the management of their patients with mild-to-moderate osteoarthritis (OA). New information on the inflammatory component of OA and the cardiovascular (CV) risk associated with cyclooxygenase (COX)-2-specific inhibitors has prompted efforts to revise the current recommendations for the use of NSAIDs in the treatment of patients with OA. Clinical studies have shown that naproxen and ibuprofen are significantly more effective at reducing OA pain than is acetaminophen, the traditional first-line therapy, which has no apparent anti-inflammatory activity in the joints. The theoretical advantage of COX-2-specific inhibitors in reducing gastrointestinal (GI) toxicity has been demonstrated by clinical studies. GI complications can be reduced by using lower NSAID doses for the shortest duration or with a concomitant proton-pump inhibitor. All prescription NSAIDs carry a black box warning regarding CV risks; these risks vary among the NSAIDs. While ibuprofen and diclofenac are associated with an increased CV risk, naproxen was associated with a neutral CV risk relative to placebo. Ibuprofen, but not naproxen, attenuates the antiplatelet effects of aspirin. An understanding of the risks and benefits is important when choosing an NSAID.

Osteoarthritis is a common condition that is typically associated with older adults. Other causes of osteoarthritis, such as those cases resulting from childhood Perthes disease, can affect younger people and frequently have a major impact on the lives of those affected. This case report describes the experiences of one patient with osteoarthritis, using examples of her poetry to illustrate her social, psychological and emotional transformation.
Jane C Richardson, Christian D Mallen and Helen S Burrell Cases Journal 2008, 1:153

Archive Copy: 1999 Annual Meeting Scientific Program. New Approaches to the Treatment of Osteoarthritis: Oral Chondroitin Sulfate and Glucosamine, Hyalurocan Injections and Intra-Articular Polyurethane

See: Chondral and Osteochondral Injuries of the Knee
Enchondral Ossification
Articular Cartilage: Injury and Potential for Repair:
Osteoarthritis
Wheeless' Textbook of Orthopaedics

January 11, 2008 — An 8-week exercise program was associated with relief of symptoms and reduced fatigue in elderly patients with arthritis, according to a randomized controlled trial reported in the January issue of Arthritis Care & Research.

Obesity and Osteoarthritis in Knee, Hip, and/or Hand: An Epidemiological Study in the General Population With 10 Years Follow-up
Posted 11/11/2008 from BMC Musculoskelet Disord. 2008 (full text) Margreth Grotle; Kare B. Hagen; Bard Natvig; Fredrik A. Dahl; Tore K. Kvien
Obesity is one of the most important risk factors for osteoarthritis (OA) in knee(s). However, the relationship between obesity and OA in hand(s) and hip(s) remains controversial and needs further investigation. The purpose of this study was to investigate the impact of obesity on incident osteoarthritis (OA) in hip, knee, and hand in a general population followed in 10 years.
Conclusion: A high BMI was significantly associated with knee OA and hand OA, but not with hip OA.

Siddiqui & Laborde 2007
Osteoarthritis (OA) is the most common joint disease and a major cause of morbidity and disability. It is commonly seen in the elderly population; however, its appearance at an early age is possible. Thus, the disease can no longer be considered a simple consequence of aging and cartilage degeneration. Unfortunately, in young patients, arthritis is often confused with traumatic arthritis, which occurs after an injury to a joint, whether by a macroincident or by repeated microincidents.
Synonyms and related keywords: OA, degenerative joint disease, degenerative arthritis, osteoarthrosis, arthritis

Osteoarthritis (OA) is the most common articular disease worldwide, affecting over 20 million individuals in the United States alone. Its high prevalence entails significant costs to society. Direct costs include physician visits, medications, and surgical intervention. Indirect costs include such items as time lost from work. Costs can be particularly significant for the elderly, who face potential loss of independence and who may need help with daily living activities. As the populations of developed nations age over the next few decades, the need for better understanding of OA and for improved therapeutic alternatives will continue to grow.
Synonyms and related keywords: osteoarthrosis, OA, joint pain, back pain, physical therapy, wear and tear
Lozada & Steigelfest 2006

Medscape Patient Education Center on Osteoarthritis

Presentation by L.C.Jones PhD

Osteoarthritis, the most common type of joint disease, is a heterogeneous group of conditions that result in common histopathologic and radiologic changes. It is a degenerative disorder that results from the biochemical breakdown of articular cartilage in the synovial joints. Although osteoarthritis is thought to be largely due to excessive wear and tear, secondary nonspecific inflammatory changes may also affect the joints.
Historically, osteoarthritis has been divided into primary and secondary forms, although this division is somewhat artificial. Secondary osteoarthritis is conceptually easier to understand. It refers to degenerative disease of the synovial joints that results from some predisposing condition, usually trauma, that has adversely altered the articular cartilage and/or subchondral bone of the affected joints. Secondary osteoarthritis often occurs in relatively young individuals. This form of the disease is beyond the scope of this article.
The definition of primary osteoarthritis is more nebulous. In the broadest sense of the term, primary osteoarthritis is an idiopathic phenomenon, occurring in previously intact joints, with no apparent initiating factor. Primary osteoarthritis is related to the aging process and typically occurs in older individuals. Some clinicians limit primary osteoarthritis to the joints of the hands (specifically the distal interphalangeal joints, proximal interphalangeal joints, and joints at the base of the thumb), whereas others include the knees, hips, spine (apophyseal articulations), and hands as potential sites of involvement. This article primarily focuses on osteoarthritis of the hand, knee, and hip joints.
Synonyms and related keywords: idiopathic osteoarthritis, degenerative joint disease, arthritis, secondary osteoarthritis
Stacy & Basu 2007

Remodelling of Biological Tissues

David S. Hungerford, MD Professor, Orthopaedic Surgery Chief, Division of Arthritis Surgery Johns Hopkins University Baltimore, Maryland
Osteoarthritis (OA) is the most common form of joint disease in the United States. Because of its prevalence and the severe impact of its symptoms on patients’ quality of life, OA justly represents a major concern for health-care providers. 1,2 Recently, there has been a surge of interest in the use of chondroprotective agents to treat OA. To fully understand the definition and mechanism of action of these compounds, it is important to understand the biochemistry of normal articular cartilage.