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Rheumatology Advance Access published online on July 11, 2006
Rheumatology, doi:10.1093/rheumatology/kel213
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
Received March 29, 2006
Accepted May 12, 2006

Original Papers

A 2 yr longitudinal radiographic study examining the effect of a bisphosphonate (risedronate) upon subchondral bone loss in osteoarthritic knee patients

J. C. Buckland-Wright 1 *, E. A. Messent 1, C. O. Bingham III 2, R. J. Ward 1, and C. Tonkin 1

1 Department of Applied Clinical Anatomy, King's College London School of Medicine, Guy's Hospital Campus, London, UK
2 Divisions of Rheumatology and Allergy and Immunology, Johns Hopkins University, Baltimore, MD, USA

* To whom correspondence should be addressed.
J. C. Buckland-Wright, E-mail: chris.buckland-wright{at}kcl.ac.uk


  Abstract

Objectives. To determine whether risedronate (RIS) slows down trabecular bone loss in the medial compartment of the proximal tibia, a characteristic of patients with progressive knee osteoarthritis (OA).

Methods. Initially, 100 patients were randomly selected from each treatment group (each N~300) comprising placebo and RIS 5 mg/day, 15 mg/day and 50 mg/week from a double blind, multi-centre, placebo-controlled, 2 yr investigation of OA knee patients in North America. Using fluoroscopic semi-flexed standard radiography, baseline and exit knee radiographs were digitized by laser scanner. Following computerized measurement of minimum medial compartment joint space width, each group was subdivided into joint space narrowing (JSN) non-progressor or JSN-progressor (JSN ≥0.6 mm measured at any point post-baseline). Computerized method of fractal signature analysis (FSA) quantified longitudinal changes separately in horizontal and vertical trabeculae in region of interest (three-fourth width of tibial compartment x 6 mm height) in the medial compartment. Following the initial study, all JSN-progressor knees within the entire patient cohort (N = 1232) were similarly analysed.

Results. OA knees in JSN non-progressor group had a slight decrease in FSA for vertical and horizontal trabeculae and showed no drug effect. In JSN-progressor knees, bone loss was greater in both placebo and RIS 5 mg/day groups compared with those in RIS 15 mg/day group in which trabeculae were retained, and in the RIS 50 mg/week group in which the vertical trabecular number increased significantly (P < 0.05).

Conclusion. This preliminary study showed that patients with marked cartilage loss (JSN≥0.6 mm) receiving RIS 15 mg/day retained vertical trabecular structure, and those receiving RIS 50 mg/week increased vertical trabecular number, thereby preserving the structural integrity of subchondral bone in knee OA.

Keywords: Osteoarthritis; Knee; Radiography; Bisphosphonates; Bone structure; Trabeculae; Risedronate.
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