Bisphosphonates as a treatment modality in osteoarthritis.

Osteoarthritis (OA) is affecting large proportions of the population worldwide. So far, no effective disease modifying drug has been developed for this disease, limiting the therapeutic options to pain medications, physiotherapy and ultimately surgical approaches, mainly joint implant surgery. In vitro and animal studies have demonstrated that bisphosphonates have the potential to become effective modalities for the treatment of OA. This group of pharmacological agents modulates crucial aspects of OA pathogenesis (subchondral bone turnover and loss, bone marrow edema formation, cartilage degeneration and synovitis), and have shown clear efficacy in animal models of OA. Human studies have, however, so far been disappointing with only one of six clinical studies showing clear short-term efficacy. Possible reasons for these discrepancies will be discussed. • Preclinical studies suggest significant effects of bisphosphonates on a wide variety of factors involved in OA pathogenesis • Bisphosphonates reduce bone turnover and reduction of subchondral bone turnover seems to reduce articular cartilage deterioration • Bone marrow lesions, which play an integral role in OA pathogenesis, are areas of high bone turnover and increased vascularization, - two characteristics amenable to modulation by bisphosphonate treatment • Bisphosphonate treatment has shown disease modifying effects in a wide variety of animal models • Future studies of bisphosphoantes in OA should focus on appropriate dosing and improved selection of suitable patients with this heterogenous disease [ABSTRACT FROM AUTHOR]