Metabolic syndrome and subchondral bone alterations: The rise of osteoarthritis - A review

Gabriel Ohana Marques Azzini; Gabriel Silva Santos; Silvia Beatriz Coutinho Visoni; Vitor Ohana Marques Azzini; Rafael Gonzales Dos Santos; Stephany Cares Huber; José Fábio Lana

doi:10.1016/j.jcot.2020.06.021

Metabolic syndrome and subchondral bone alterations: The rise of osteoarthritis - A review

J Clin Orthop Trauma. 2020 Oct;11(Suppl 5):S849-S855. doi: 10.1016/j.jcot.2020.06.021. Epub 2020 Jun 17.

Authors

Gabriel Ohana Marques Azzini¹, Gabriel Silva Santos², Silvia Beatriz Coutinho Visoni³, Vitor Ohana Marques Azzini¹, Rafael Gonzales Dos Santos¹, Stephany Cares Huber⁴, José Fábio Lana¹

Affiliations

¹ Orthopedics, Sports Medicine, Pain Physician, IOC, Instituto do Osso e da Cartilagem, The Bone and Cartilage Institute, Presidente Kennedy Avenue, 1386, 2nd Floor, Room #29, Cidade Nova I, Indaiatuba, SP, Brazil.
² Biomedical Scientist, IOC, Instituto do Osso e da Cartilagem, The Bone and Cartilage Institute, Presidente Kennedy Avenue, 1386, 2nd Floor, Room #29, Cidade Nova I, Indaiatuba, SP, Brazil.
³ Biologist, IOC, Instituto do Osso e da Cartilagem, The Bone and Cartilage Institute, Presidente Kennedy Avenue, 1386, 2nd Floor, Room #29, Cidade Nova I, Indaiatuba, SP, Brazil.
⁴ Biomedical Scientist, Universidade Estadual de Campinas (UNICAMP), The University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, SP, Brazil.

Abstract

Metabolic syndrome (MS) has become one of the top major health burdens for over three decades not only due to its effects on cardiovascular health but also its implications in orthopedics. Extensive research has shown that MS is tightly linked to osteoarthritis and inflammation, a process which appears to primarily occur in the subchondral bone via the incidence of bone-marrow lesions (BMLs). Numerous studies identify obesity, dyslipidemia, insulin resistance and hypertension as the top metabolic risk factors, the so-called "deadly quartet". These factors are responsible for the disruptive physiological processes that culminate in detrimental alterations within the subchondral bone, cartilage damage and, overall, the predominant pro-inflammatory joint microenvironment. Although it has long been thought that osteoarthritis was limited to the cartilage component of the joint, other studies indicate that the disease may originate from the harmful alterations that occur primarily in the subchondral bone, especially via means of vascular pathology. Since metabolic risk factors are manageable to a certain extent, it is therefore possible to decelerate the progression of OA and mitigate its devastating effects on the subchondral bone and subsequent articular cartilage damage.

Methods: Literature was reviewed using PubMed and Google Scholar in order to find a correlation between metabolic syndrome and osteoarthritic progression. The investigation included a combination of nomenclature such as: "metabolic syndrome", "obesity", "insulin resistance", "hypertension", "dyslipidemia", "low-grade systemic inflammation", "osteoarthritis", "subchondral bone", "cartilage" and "inflammatory biomarkers".

Conclusion: Based on several studies, there seems to be a significant association between The Deadly Quartet (metabolic syndrome), dysregulation of both pro- and anti-inflammatory biomarkers, and osteoarthritic progression arising from unbridled systemic inflammation.

Keywords: Cartilage; Inflammation; Metabolic syndrome; Osteoarthritis; Subchondral bone.