Journal of Bone and Mineral Metabolism

, Volume 32, Issue 2, pp 101–109 | Cite as

The relationship between osteoarthritis and osteoporosis

  • Gun-Il ImEmail author
  • Min-Kyu Kim
Review Article


The relationship between osteoarthritis (OA) and osteoporosis (OP), the two most common skeletal disorders related to aging, is controversial. Previous studies suggest that OA is inversely related to OP when studied cross-sectionally and systematically. However, there are differences in the results depending on the parameter used to define OA. The purpose of this review is to analyze and summarize the literature, and derive possible answers to three key questions along with a brief introduction on underlying mechanisms: (1) Is OA correlated to a high bone mineral density (BMD)? (2) Does OA influence the progression of OP or osteoporotic fractures? (3) Does high BMD affect the incidence and progression of OA? A review of the literature suggests that OA is inversely related to OP in general when studied cross-sectionally and systematically. However, when analyzed in individual bones, the BMD of the appendicular skeleton in OA-affected joints may decrease, particularly in the upper extremities. On whether OA influences bone loss or osteoporotic fractures, differences are observed according to the affected joints. The risk for osteoporotic fracture does not seem to decrease despite a high BMD in patients with OA, probably due to postural instability and muscle strength. Low BMD at the lumbar spine is associated with a lower incidence of knee OA although it does not arrest the progression of knee OA.


Osteoarthritis Osteoporosis Relationship Incidence Progression 



This study was supported by a grant from the National Research Foundation of Korea (2009-0092196).

Conflict of interest

No potential conflicts of interest were disclosed.


  1. 1.
    Foss MV, Byers PD (1972) Bone density, osteoarthrosis of the hip, and fracture of the upper end of the femur. Ann Rheum Dis 31:259–264PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Burger H, van Daele PL, Odding E, Valkenburg HA, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1996) Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study. Arthritis Rheum 39:81–86PubMedCrossRefGoogle Scholar
  3. 3.
    Hannan MT, Anderson JJ, Zhang Y, Levy D, Felson DT (1993) Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study. Arthritis Rheum 36:1671–1680PubMedCrossRefGoogle Scholar
  4. 4.
    Hart DJ, Mootoosamy I, Doyle DV, Spector TD (1994) The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study. Ann Rheum Dis 53:158–162PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Lethbridge-Cejku M, Tobin JD, Scott WW Jr, Reichle R, Roy TA, Plato CC, Hochberg MC (1996) Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: data from the Baltimore Longitudinal Study of Aging. J Rheumatol 23:1943–1947PubMedGoogle Scholar
  6. 6.
    Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, Cummings SR (1995) Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum 38:907–916PubMedCrossRefGoogle Scholar
  7. 7.
    Sowers M, Lachance L, Jamadar D, Hochberg MC, Hollis B, Crutchfield M, Jannausch ML (1999) The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women. Arthritis Rheum 423:483–489CrossRefGoogle Scholar
  8. 8.
    Bergink AP, van der Klift M, Hofman A, Verhaar JA, van Leeuwen JP, Uitterlinden AG, Pols HA (2003) Osteoarthritis of the knee is associated with vertebral and nonvertebral fractures in the elderly: the Rotterdam Study. Arthritis Rheum 49:648–657PubMedCrossRefGoogle Scholar
  9. 9.
    Hochberg MC, Lethbridge-Cejku M, Tobin JD (2004) Bone mineral density and osteoarthritis: data from the Baltimore Longitudinal Study of Aging. Osteoarthritis Cartilage 12:S45–S48PubMedCrossRefGoogle Scholar
  10. 10.
    Hart DJ, Cronin C, Daniels M, Worthy T, Doyle DV, Spector TD (2002) The relationship of bone density and fracture to incident and progressive radiographic osteoarthritis of the knee: the Chingford Study. Arthritis Rheum 46:92–99PubMedCrossRefGoogle Scholar
  11. 11.
    Zhang Y, Hannan MT, Chaisson CE, McAlindon TE, Evans SR, Aliabadi P, Levy D, Felson DT (2000) Bone mineral density and risk of incident and progressive radiographic knee osteoarthritis in women: the Framingham Study. J Rheumatol 27:1032–1037PubMedGoogle Scholar
  12. 12.
    Arden NK, Nevitt MC, Lane NE, Gore LR, Hochberg MC, Scott JC, Pressman AR, Cummings SR (1999) Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures. Study of Osteoporotic Fractures Research Group. Arthritis Rheum 42:1378–1385PubMedCrossRefGoogle Scholar
  13. 13.
    Jones G, Nguyen T, Sambrook PN, Lord SR, Kelly PJ, Eisman JA (1995) Osteoarthritis, bone density, postural stability, and osteoporotic fractures: a population based study. J Rheumatol 22:921–925PubMedGoogle Scholar
  14. 14.
    Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, Dieppe PA (2000) Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 43:995–1000PubMedCrossRefGoogle Scholar
  15. 15.
    Felson DT, Nevitt MC (2004) Epidemiologic studies for osteoarthritis: new versus conventional study design approaches. Rheum Dis Clin North Am 30:783–797PubMedCrossRefGoogle Scholar
  16. 16.
    Ichchou L, Allali F, Rostom S, Bennani L, Hmamouchi I, Abourazzak FZ, Khazzani H, El Mansouri L, Abouqal R, Hajjaj-Hassouni N (2010) Relationship between spine osteoarthritis, bone mineral density and bone turn over markers in postmenopausal women. BMC Womens Health 10:25PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Glowacki J, Tuteja M, Hurwitz S, Thornhill TS, Leboff MS (2010) Discordance in femoral neck bone density in subjects with unilateral hip osteoarthritis. J Clin Densitom 13:24–28PubMedCrossRefGoogle Scholar
  18. 18.
    Lingard EA, Mitchell SY, Francis RM, Rawlings D, Peaston R, Birrell FN, McCaskie AW (2010) The prevalence of osteoporosis in patients with severe hip and knee osteoarthritis awaiting joint arthroplasty. Age Ageing 39:234–239PubMedCrossRefGoogle Scholar
  19. 19.
    Akamatsu Y, Mitsugi N, Taki N, Takeuchi R, Saito T (2009) Relationship between low bone mineral density and varus deformity in postmenopausal women with knee osteoarthritis. J Rheumatol 36:592–597PubMedCrossRefGoogle Scholar
  20. 20.
    Güler-Yüksel M, Bijsterbosch J, Allaart CF, Meulenbelt I, Kroon HM, Watt I, Lems WF, Kloppenburg M (2011) Accelerated metacarpal bone mineral density loss is associated with radiographic progressive hand osteoarthritis. Ann Rheum Dis 70:1625–1630PubMedCrossRefGoogle Scholar
  21. 21.
    Kim SK, Park SH, Choe JY (2010) Lower bone mineral density of forearm in postmenopausal patients with radiographic hand osteoarthritis. Rheumatol Int 30:605–612PubMedCrossRefGoogle Scholar
  22. 22.
    Ding C, Cicuttini F, Boon C, Boon P, Srikanth V, Cooley H, Jones G (2010) Knee and hip radiographic osteoarthritis predict total hip bone loss in older adults: a prospective study. J Bone Miner Res 25:858–865PubMedGoogle Scholar
  23. 23.
    Bergink AP, Uitterlinden AG, Van Leeuwen JP, Hofman A, Verhaar JA, Pols HA (2005) Bone mineral density and vertebral fracture history are associated with incident and progressive radiographic knee osteoarthritis in elderly men and women: the Rotterdam Study. Bone 37–4:446–456CrossRefGoogle Scholar
  24. 24.
    Yoshimura N, Muraki S, Oka H, Mabuchi A, Kinoshita H, Yosihda M, Kawaguchi H, Nakamura K, Akune T (2009) Epidemiology of lumbar osteoporosis and osteoarthritis and their causal relationship—is osteoarthritis a predictor for osteoporosis or vice versa?: the Miyama study. Osteoporos Int 20:999–1008PubMedCrossRefGoogle Scholar
  25. 25.
    Nevitt MC, Zhang Y, Javaid MK, Neogi T, Curtis JR, Niu J, McCulloch CE, Segal NA, Felson DT (2010) High systemic bone mineral density increases the risk of incident knee OA and joint space narrowing, but not radiographic progression of existing knee OA: the MOST study. Ann Rheum Dis 69:163–168PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Radin EL, Rose RM (1986) Role of subchondral bone in the initiation and progression of cartilage damage. Clin Orthop Relat Res 213:34–40PubMedGoogle Scholar
  27. 27.
    Dequeker J, Mohan S, Finkelman RD, Aerssens J, Baylink DJ (1993) Generalized osteoarthritis associated with increased insulin-like growth factor types I and II and transforming growth factor beta in cortical bone from the iliac crest. Possible mechanism of increased bone density and protection against osteoporosis. Arthritis Rheum 36–12:1702–1708CrossRefGoogle Scholar
  28. 28.
    Lloyd ME, Hart DJ, Nandra D, McAlindon TE, Wheeler M, Doyle DV, Spector TD (1996) Relation between insulin-like growth factor-I concentrations, osteoarthritis, bone density, and fractures in the general population: the Chingford study. Ann Rheum Dis 55–12:870–874CrossRefGoogle Scholar
  29. 29.
    Mansell JP, Bailey AJ (1998) Abnormal cancellous bone collagen metabolism in osteoarthritis. J Clin Invest 101:1596–1603PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Hilal G, Martel-Pelletier J, Pelletier JP, Ranger P, Lajeunesse D (1998) Osteoblast-like cells from human subchondral osteoarthritic bone demonstrate an altered phenotype in vitro: possible role in subchondral bone sclerosis. Arthritis Rheum 41:891–899PubMedCrossRefGoogle Scholar
  31. 31.
    McAlindon TE, Teale JD, Dieppe PA (1993) Levels of insulin related growth factor 1 in osteoarthritis of the knee. Ann Rheum Dis 52–3:229–231CrossRefGoogle Scholar
  32. 32.
    Hochberg MC, Lethbridge-Cejku M, Scott WW Jr, Reichle R, Plato CC, Tobin JD (1994) Serum levels of insulin-like growth factor in subjects with osteoarthritis of the knee. Data from the Baltimore Longitudinal Study of Aging. Arthritis Rheum 37:1177–1180PubMedCrossRefGoogle Scholar
  33. 33.
    Geusens P, Dequeker J, Verstraeten A (1983) Age-related blood changes in hip osteoarthritis patients: a possible indicator of bone quality. Ann Rheum Dis 42:112–113PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Jin WJ, Jiang SD, Jiang LS, Dai LY (2008) Differential bone metabolism between postmenopausal women with osteoarthritis and osteoporosis. J Bone Miner Res 23:2469–2478Google Scholar
  35. 35.
    Logar DB, Komadina R, Prezelj J, Ostanek B, Trost Z, Marc J (2007) Expression of bone resorption genes in osteoarthritis and in osteoporosis. J Bone Miner Metab 25:219–225PubMedCrossRefGoogle Scholar
  36. 36.
    Giner M, Rios MA, Montoya MA, Vázquez MA, Naji L, Pérez-Cano R (2009) RANKL/OPG in primary cultures of osteoblasts from post-menopausal women. Differences between osteoporotic hip fractures and osteoarthritis. J Steroid Biochem Mol Biol 113:46–51PubMedCrossRefGoogle Scholar
  37. 37.
    Zhang ZM, Jiang LS, Jiang SD, Dai LY (2009) Osteogenic potential and responsiveness to leptin of mesenchymal stem cells between postmenopausal women with osteoarthritis and osteoporosis. J Orthop Res 27:1067–1073PubMedCrossRefGoogle Scholar
  38. 38.
    Velasco J, Zarrabeitia MT, Prieto JR, Perez-Castrillon JL, Perez-Aguilar MD, Perez-Nuñez MI, Sañudo C, Hernandez-Elena J, Calvo I, Ortiz F et al (2010) Wnt pathway genes in osteoporosis and osteoarthritis: differential expression and genetic association study. Osteoporos Int 21:109–118PubMedCrossRefGoogle Scholar
  39. 39.
    Dragojevič J, Logar DB, Komadina R, Marc J (2011) Osteoblastogenesis and adipogenesis are higher in osteoarthritic than in osteoporotic bone tissue. Arch Med Res 42:392–397PubMedCrossRefGoogle Scholar
  40. 40.
    Tanaka S, Narusawa K, Onishi H, Miura M, Hijioka A, Kanazawa Y, Nishida S, Ikeda S, Nakamura T (2011) Lower osteocalcin and osteopontin contents of the femoral head in hip fracture patients than osteoarthritis patients. Osteoporos Int 22:587–597PubMedCrossRefGoogle Scholar
  41. 41.
    Perinpanayagam H, Zaharias R, Stanford C, Brand R, Keller J, Schneider G (2001) Early cell adhesion events differ between osteoporotic and non-osteoporotic osteoblasts. J Orthop Res 19:993–1000PubMedCrossRefGoogle Scholar
  42. 42.
    Giner M, Montoya MJ, Vázquez MA, Miranda C, Pérez-Cano R (2013) Differences in osteogenic and apoptotic genes between osteoporotic and osteoarthritic patients. BMC Musculoskelet Disord 25:41CrossRefGoogle Scholar
  43. 43.
    Astrom J, Beertema J (1992) Reduced risk of hip fracture in the mothers of patients with osteoarthritis of the hip. J Bone Joint Surg Br 74:270–271PubMedGoogle Scholar
  44. 44.
    Naganathan V, Zochling J, March L, Sambrook PN (2002) Peak bone mass is increased in the hip in daughters of women with osteoarthritis. Bone 30:287–292PubMedCrossRefGoogle Scholar
  45. 45.
    Antoniades L, MacGregor AJ, Matson M, Spector TD (2000) A cotwin control study of the relationship between hip osteoarthritis and bone mineral density. Arthritis Rheum 43–7:1450–1455CrossRefGoogle Scholar
  46. 46.
    Morrison NA, Qi JC, Tokita A, Kelly PJ, Crofts L, Nguyen TV, Sambrook PN, Eisman JA (1994) Prediction of bone density from vitamin D receptor alleles. Nature 367:284–287PubMedCrossRefGoogle Scholar
  47. 47.
    Brandi ML, Gennari L, Cerinic MM, Becherini L, Falchetti A, Masi L, Gennari C, Reginster JY (2001) Genetic markers of osteoarticular disorders: facts and hopes. Arthritis Res 3:270–280PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Dequeker J, Aerssens J, Luyten FP (2003) Osteoarthritis and osteoporosis: clinical and research evidence of inverse relationship. Aging Clin Exp Res 15:426–439PubMedCrossRefGoogle Scholar
  49. 49.
    Aerssens J, Dequeker J, Peeters J, Breemans S, Boonen S (1998) Lack of association between osteoarthritis of the hip and gene polymorphisms of VDR, COL1A1, and COL2A1 in postmenopausal women. Arthritis Rheum 41:1946–1950PubMedCrossRefGoogle Scholar
  50. 50.
    Aerssens J, Dequeker J, Peeters J, Breemans S, Broos P, Boonen S (2000) Polymorphisms of the VDR, ER and COLIA1 genes and osteoporotic hip fracture in elderly postmenopausal women. Osteoporos Int 11:583–591PubMedCrossRefGoogle Scholar
  51. 51.
    Yamada Y, Okuizumi H, Miyauchi A, Takagi Y, Ikeda K, Harada A (2000) Association of transforming growth factor beta1 genotype with spinal osteophytosis in Japanese women. Arthritis Rheum 43:452–460PubMedCrossRefGoogle Scholar
  52. 52.
    Ogata N, Matsumura Y, Shiraki M, Kawano K, Koshizuka Y, Hosoi T, Nakamura K, Kuro-O M, Kawaguchi H (2002) Association of klotho gene polymorphism with bone density and spondylosis of the lumbar spine in postmenopausal women. Bone 31:37–42PubMedCrossRefGoogle Scholar
  53. 53.
    Bailey AJ, Mansell JP (1997) Do subchondral bone changes exacerbate or precede articular cartilage destruction in osteoarthritis of the elderly? Gerontology 43:296–304PubMedCrossRefGoogle Scholar
  54. 54.
    Evans RG, Collins C, Miller P, Ponsford FM, Elson CJ (1994) Radiological scoring of osteoarthritis progression in STR/ORT mice. Osteoarthr Cartil 2:103–109PubMedCrossRefGoogle Scholar
  55. 55.
    Meacock SC, Bodmer JL, Billingham ME (1990) Experimental osteoarthritis in guinea-pigs. J Exp Pathol (Oxford) 71:279–293Google Scholar
  56. 56.
    Milgram JW, Jasty M (1982) Osteopetrosis. A morphological study of twenty-one cases. J Bone Joint Surg Am 64:912–929PubMedGoogle Scholar
  57. 57.
    Benichou OD, Laredo JD, de Vernejoul MC (2000) Type II autosomal dominant osteopetrosis (Albers-Schonberg disease): clinical and radiological manifestations in 42 patients. Bone 26:87–93PubMedCrossRefGoogle Scholar
  58. 58.
    Li B, Aspden RM (1997) Composition and mechanical properties of cancellous bone from the femoral head of patients with osteoporosis or osteoarthritis. J Bone Miner Res 12:641–651PubMedCrossRefGoogle Scholar
  59. 59.
    Li B, Aspden RM (1997) Mechanical and material properties of the subchondral bone plate from the femoral head of patients with osteoarthritis or osteoporosis. Ann Rheum Dis 56:247–254PubMedCentralPubMedCrossRefGoogle Scholar
  60. 60.
    Brandt KD, Schauwecker DS, Dansereau S, Meyer J, O’Connor B, Myers SL (1997) Bone scintigraphy in the canine cruciate deficiency model of osteoarthritis. Comparison of the unstable and contralateral knee. J Rheumatol 24:140–145PubMedGoogle Scholar
  61. 61.
    Seibel MJ, Duncan A, Robins SP (1989) Urinary hydroxy-pyridinium crosslinks provide indices of cartilage and bone involvement in arthritic diseases. J Rheumatol 16:964–970PubMedGoogle Scholar
  62. 62.
    Fazzalari NL, Parkinson IH (1997) Fractal properties of subchondral cancellous bone in severe osteoarthritis of the hip. J Bone Miner Res 12:632–640PubMedCrossRefGoogle Scholar
  63. 63.
    Zhang ZM, Li ZC, Jiang LS, Jiang SD, Dai LY (2010) Micro-CT and mechanical evaluation of subchondral trabecular bone structure between postmenopausal women with osteoarthritis and osteoporosis. Osteoporos Int 21:1383–1390PubMedCrossRefGoogle Scholar
  64. 64.
    Marinović M, Bazdulj E, Celić T, Cicvarić T, Bobinac D (2012) Histomorphometric analysis of subchondral bone of the femoral head in osteoarthritis and osteoporosis. Coll Antropol 35:19–23Google Scholar
  65. 65.
    Zupan J, van’t Hof RJ, Vindišar F, Haring G, Trebše R, Komadina R, Marc J (2013) Osteoarthritic versus osteoporotic bone and intra-skeletal variations in normal bone: evaluation with μCT and bone histomorphometry. J Orthop Res 31:1059–1066PubMedCrossRefGoogle Scholar
  66. 66.
    Shen Y, Zhang YH, Shen L (2013) Postmenopausal women with osteoporosis and osteoarthritis show different microstructural characteristics of trabecular bone in proximal tibia using high-resolution magnetic resonance imaging at 3 tesla. BMC Musculoskelet Disord 15–14:136CrossRefGoogle Scholar
  67. 67.
    Li ZC, Dai LY, Jiang LS, Qiu S (2012) Difference in subchondral cancellous bone between postmenopausal women with hip osteoarthritis and osteoporotic fracture: implication for fatigue microdamage, bone microarchitecture, and biomechanical properties. Arthritis Rheum 64:3955–3962PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan 2013

Authors and Affiliations

  1. 1.Department of OrthopaedicsDongguk University Ilsan HospitalGoyangRepublic of Korea

Personalised recommendations