Zeng Zi-Jun, Huang Cai-Lian, Yao Fang-Ming, Wu Jia-Wei, Gu Bang-Ning, Han Long-Fei, Yang Xu-Hui, Yang Jia-Qi, He Min-Cong, Wei Qiu-Shi, He Wei
Guangzhou University of Chinese Medicine, Guangzhou, China.
Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China.
Osteoporos Int. 2025 Aug 27. doi: 10.1007/s00198-025-07652-5.
Previous studies show osteoporosis causes tibial varus in knee osteoarthritis patients. Our analysis of tibial plateau specimens from osteoarthritic patients reveals that osteoporosis accelerates the deterioration of the subchondral microstructure of the tibial plateau, exacerbating tibial varus.
The relationship between osteoporosis (OP) and knee osteoarthritis (OA) has garnered significant clinical interest, particularly regarding the prevalence of tibial varus in patients suffering from both conditions. This study aimed to elucidate the association between OP and knee OA by examining bone remodeling and microstructural parameters of cartilage and subchondral bone.
We analyzed tibial plateau specimens from 50 patients, with 25 in the OA group and 25 in the OP-OA group. These specimens were further categorized into four subgroups: OA medial plateau, OA lateral plateau, OP-OA medial plateau, and OP-OA lateral plateau. Comprehensive analyses, including cartilage histology, micro-CT, immunohistochemical techniques, basic fuchsin histological analysis, and micro-finite elements, revealed significant microstructural differences and aberrant bone remodeling processes between the groups.
The OARSI cartilage score of the medial tibial plateau was 13.71% higher in the OP-OA group compared to the OA group (P < 0.05), indicating more severe cartilage degeneration. Micro-CT analysis revealed a lower BV/TV in the subchondral bone of the medial tibial plateau in the OP-OA group (0.58 ± 0.02) compared to the OA group (0.68 ± 0.02) (P < 0.05). Additionally, significant decreases were observed in Tb.N and Tb.Th, while Tb.Sp and SMI increased. The number of osteoblasts in the subchondral bone of the medial tibial plateau was lower in the OP-OA group than in the OA group, while the number of osteoclasts was 55.90% higher (P < 0.05). Result of basic fuchsin staining showed that the CrDn in the subchondral bone of the medial tibial plateau was 69.01% higher in the OP-OA group (P < 0.05), with greater microdamage severity. Micro-finite element analysis showed that subchondral bone stresses in the OP-OA group were higher and more localized to the medial side compared to the OA group.
Our findings indicate that osteoporosis significantly intensifies cartilage degeneration in the medial tibial plateau of patients with knee osteoarthritis. It aggravates aberrant subchondral bone remodeling, increases microdamage, impairs mechanical structure, and accelerates tibial varus.
先前的研究表明，骨质疏松症会导致膝关节骨关节炎患者出现胫骨内翻。我们对骨关节炎患者的胫骨平台标本进行分析后发现，骨质疏松症会加速胫骨平台软骨下微结构的恶化，加剧胫骨内翻。
骨质疏松症（OP）与膝关节骨关节炎（OA）之间的关系已引起了临床的广泛关注，尤其是两种疾病患者中胫骨内翻的患病率。本研究旨在通过检查软骨和软骨下骨的骨重塑及微观结构参数，阐明OP与膝关节OA之间的关联。
我们分析了50例患者的胫骨平台标本，其中OA组25例，OP - OA组25例。这些标本进一步分为四个亚组：OA内侧平台、OA外侧平台、OP - OA内侧平台和OP - OA外侧平台。综合分析，包括软骨组织学、显微CT、免疫组织化学技术、碱性品红组织学分析和微观有限元分析，揭示了各组之间显著的微观结构差异和异常的骨重塑过程。
与OA组相比，OP - OA组胫骨内侧平台的OARSI软骨评分高13.71%（P < 0.05），表明软骨退变更严重。显微CT分析显示，与OA组（0.68±0.02）相比，OP - OA组胫骨内侧平台软骨下骨的骨体积分数（BV/TV）更低（0.58±0.02）（P < 0.05）。此外，骨小梁数量（Tb.N）和骨小梁厚度（Tb.Th）显著降低，而骨小梁间距（Tb.Sp）和结构模型指数（SMI）增加。OP - OA组胫骨内侧平台软骨下骨中成骨细胞数量低于OA组，而破骨细胞数量高55.90%（P < 0.05）。碱性品红染色结果显示，OP - OA组胫骨内侧平台软骨下骨的软骨下骨退变（CrDn）高69.01%（P < 0.05），微损伤严重程度更大。微观有限元分析显示，与OA组相比，OP - OA组软骨下骨应力更高，且更集中在内侧。
我们的研究结果表明，骨质疏松症会显著加剧膝关节骨关节炎患者胫骨内侧平台的软骨退变。它会加剧软骨下骨的异常重塑，增加微损伤，损害机械结构，并加速胫骨内翻。
