Osteoporosis International

, Volume 14, Issue 2, pp 160–165 | Cite as

Increased cancellous bone in the femoral neck of patients with coxarthrosis (hip osteoarthritis): a positive remodeling imbalance favoring bone formation

  • G. R. Jordan
  • N. Loveridge
  • J. Power
  • M. T. Clarke
  • J. Reeve
Original Article


Osteoporosis is caused by an imbalance between bone resorption and formation which results in an absolute reduction in bone mass. In a previous study we highlighted a condition, osteoarthritis of the hip (coxarthrosis, cOA), where an imbalance between resorption and formation provided beneficial effects in the form of an absolute increase in bone mass. We demonstrated that the femoral neck in patients with cOA had increased cancellous bone area, connectivity and trabecular thickness which might contribute to the protection against fracture associated with the condition. The aim of the present study was to analyze forming and resorbing surfaces in coxarthritic cancellous bone to assess whether increased formation or reduced resorption could be responsible for these structural changes. Whole cross-sectional femoral neck biopsies were obtained from 11 patients with cOA and histomorphometric parameters compared with 14 age- and sex-matched cadaveric controls. The ratio of osteoid surface to bone surface was 121% (p<0.001) higher in the cases but there was no significant difference in resorptive surface. The percentage osteoid volume to bone volume (%OV/BV; +270%, p<0.001) and osteoid width (O.Wi; +127%, p<0.001) were also higher in the cases. This study suggests that the increased cancellous bone mass seen in cases of cOA is due to increased bone formation rather than decreased bone resorption. Investigation of the cellular and biochemical basis for these changes might provide new insights into the pathogenesis of osteoarthritis and highlight novel biological mechanisms regulating bone multicellular unit (BMU) balance that could be relevant to developing new interventions against hip and other osteoporotic fractures.


Cancellous Coxarthrosis Histomorphometry Osteoarthritis Osteoporosis 



This work was supported by The Arthritis Research Campaign grant no. LO539. The authors thank Dr Philip Bearcroft, Department of Radiology, University of Cambridge for the radiological gradings.


  1. 1.
    Cooper C (1993) Epidemiology and public health impact of osteoporosis. In: Reid D (ed) Bailliere's clinical rheumatology: osteoporosis. Bailliere Tindall, Paris, pp 459–477Google Scholar
  2. 2.
    Kushida K, et al (1995) Comparison of markers for bone formation and resorption in premenopausal and postmenopausal subjects, and osteoporosis patients. J Clin Endocrinol Metab 80: 2447–2450Google Scholar
  3. 3.
    Jowsey J, et al (1965) Quantitative microradiographic studies of normal and osteoporotic bone. J Bone Joint Surg Br 47: 785–807Google Scholar
  4. 4.
    Wu K, Jett S, Frost HM (1967) Bone resorption rates in rib in physiological, senile, and postmenopausal osteoporoses. J Lab Clin Med 69: 810–818Google Scholar
  5. 5.
    Nordin BE, et al (1981) Bone formation and resorption as the determinants of trabecular bone volume in postmenopausal osteoporosis. Lancet II: 277–279Google Scholar
  6. 6.
    Eriksen EF, et al (1990) Cancellous bone remodeling in type I (postmenopausal) osteoporosis: quantitative assessment of rates of formation, resorption, and bone loss at tissue and cellular levels. J Bone Miner Res 5: 311–319Google Scholar
  7. 7.
    Darby AJ, Meunier PJ (1981) Mean wall thickness and formation periods of trabecular bone packets in idiopathic osteoporosis. Calcif Tissue Int 33: 199–204Google Scholar
  8. 8.
    Parfitt AM (1982) The coupling of bone formation to bone resorption: a critical analysis of the concept and of its relevance to the pathogenesis of osteoporosis. Metab Bone Dis Rel Res 4: 1–6Google Scholar
  9. 9.
    Reeve J, et al (1987) The assessment of bone formation and bone resorption in osteoporosis: a comparison between tetracycline-based iliac histomorphometry and whole body85Sr kinetics. J Bone Miner Res 2: 479–489Google Scholar
  10. 10.
    Parfitt AM, et al (1995) Relations between histologic indices of bone formation: implications for the pathogenesis of spinal osteoporosis. J Bone Miner Res 10: 466–473Google Scholar
  11. 11.
    Baudoin C, Fardellone P, Sebert JL (1993) Effect of sex and age on the ratio of cervical to trochanteric hip fracture: a meta-analysis of 16 reports on 36,451 cases. Acta Orthop Scand 64: 647–653Google Scholar
  12. 12.
    Foss MVL, Byers PD (1972) Bone density, osteoarthrosis of the hip and fracture of the upper end of the femur. Ann Rheum Dis 31: 259–264Google Scholar
  13. 13.
    Cooper C, et al (1991) Osteoarthritis of the hip and osteoporosis of the proximal femur. Ann Rheum Dis 50: 540–542Google Scholar
  14. 14.
    Pogrund H, et al (1982) Osteoarthritis of the hip joint and osteoporosis: a radiological study in a random population sample in Jerusalem. Clin Orthop 164: 130–135Google Scholar
  15. 15.
    Weintroub S, et al (1982) Osteoarthritis of the hip and fractures of the proximal end of the femur. Acta Orthop Scand 53: 261–264Google Scholar
  16. 16.
    World Health Organization (1994) Assessment of fracture risk and its application to screening for osteoporosis. WHO technical report series 843. WHO, GenevaGoogle Scholar
  17. 17.
    Bell K, et al (1999) Intracapsular hip fracture: increased cortical remodelling in the thinned and porous anterior region of the femoral neck. Osteoporos Int 10: 248–257Google Scholar
  18. 18.
    Bell K, et al (1999) Regional differences in cortical porosity in the fractured femoral neck. Bone 24: 57–64Google Scholar
  19. 19.
    Bell K, et al (1999) Structure of the femoral neck in hip fracture: cortical bone loss in the infero-anterior to supero-posterior axis. J Bone Miner Res 14: 111–119Google Scholar
  20. 20.
    Crabtree N, et al (2001) Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res 16: 1318–1328Google Scholar
  21. 21.
    Kellgren J, Lawrence J (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16: 454–501Google Scholar
  22. 22.
    Kuiper J, Van Kuijk C, Grashuis J (1997) Distribution of trabecular and cortical bone related to geometry. A quantitative computed tomography study of the femoral neck. Invest Radiol 32: 83–89Google Scholar
  23. 23.
    Zanelli JM, et al (1993) Methods for the histological study of femoral neck bone remodelling in patients with fractured neck of femur. Bone 14: 249–255Google Scholar
  24. 24.
    Matrajt H, Hioco D (1966) Solochrome Cyanine R as an indicator dye of bone morphology. Stain Tech 41: 97–100Google Scholar
  25. 25.
    Parfitt AM (1983) Stereologic basis of bone histomorphometry: theory of quantitative microscopy and reconstruction of the third dimension. In: Recker RR (ed) Bone histomorphometry: techniques and interpretation. CRC Press, Boca Raton, pp 53–88Google Scholar
  26. 26.
    Fazzalari N, et al (2001) The ratio of messenger RNA levels of receptor activator of nuclear factor κB ligand to osteoprotegerin correlates with bone remodelling indices in normal human cancellous bone but not in osteoarthritis. J Bone Miner Res 16: 1015–1027Google Scholar
  27. 27.
    Hilal G, et al (1998) Osteoblast-like cells from human subchondral osteoarthritic bone demonstrate an altered phenotype in vitro: possible role in subchondral bone sclerosis. Arthritis Rheum 41: 891–899Google Scholar
  28. 28.
    Jordan G, et al (2003) The ratio of osteocytic incorporation to bone matrix formation in femoral neck cancellous bone: an enhanced osteoblast workrate in the vicinity of hip osteoarthritis. Calcif Tissue Int, in press Google Scholar
  29. 29.
    Nefussi J, et al (1991) How osteoblasts become osteocytes: a decreasing matrix forming process. J Biol Buccale 19: 75–82Google Scholar
  30. 30.
    Mullender MG, et al (1996) Osteocyte density changes in aging and osteoporosis. Bone 18: 109–113Google Scholar
  31. 31.
    Kimmel DB, et al (1990) A comparison of iliac bone histomorphometric data in post-menopausal osteoporotic and normal subjects. Bone Miner 11: 217–235Google Scholar
  32. 32.
    Bradbeer JN, et al (1992) Treatment of osteoporosis with parathyroid peptide (hPTH 1–34) and oestrogen: increase in volumetric density of iliac cancellous bone may depend on reduced trabecular spacing as well as increased thickness of packets of newly formed bone. Clin Endocrinol (Oxf) 37: 282–289Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2003

Authors and Affiliations

  • G. R. Jordan
    • 1
    • 3
  • N. Loveridge
    • 1
  • J. Power
    • 1
  • M. T. Clarke
    • 2
  • J. Reeve
    • 1
  1. 1.Bone Research Group (MRC), Department of MedicineUniversity of Cambridge Clinical SchoolCambridgeUK
  2. 2.Orthopaedic Research Unit, Department of SurgeryUniversity of Cambridge Clinical SchoolCambridgeUK
  3. 3.Trauma Research GroupMusgrave Park Hospital, Queens UniversityBelfastUK

Personalised recommendations