Anti-Osteoporosis Treatment Alleviates Osteoarthritis Symptoms and Partially Reverses Disease Progression

Abstract

Objective: Osteoarthritis (OA) and osteoporosis (OP) are highly prevalent in postmenopausal women; however, their relationship remains complex and controversial. This study aimed to investigate whether anti-OP treatment alleviates osteoarthritis symptoms and reverses disease progression. Methods: This prospective clinical study enrolled 30 postmenopausal women diagnosed with OP and concomitant knee OA who visited our outpatient clinic between January and June 2023. Patients received anti-osteoporotic treatment comprising calcium carbonate, vitamin D3, and alendronate (ALN). BMD, WOMAC, and VAS scores were assessed at 6 and 12 months. In animal studies, OP was induced in rats by ovariectomy, followed by OA induction via anterior cruciate ligament sectioning and meniscectomy. ALN treatment was administered for 8 weeks, and evaluations of behavior, macroscopic appearance, pathology, and subchondral bone microstructure were performed 8 weeks after OA induction. One-way ANOVA was used for multiple group comparisons, and Spearman's rank correlation was used to assess associations. Results: Clinical outcomes demonstrated that one-year anti-OP therapy achieved dual therapeutic benefits: a 9.3% increase in bone mineral density (BMD) was accompanied by a 36.54% reduction in knee OA symptoms. Statistical analysis revealed a strong positive correlation between BMD improvement and symptomatic relief (r = 0.76, p < 0.05). In the animal model, OP markedly accelerated OA progression, leading to more severe cartilage damage, as confirmed by symptoms, macroscopic cartilage appearance, and histological evaluations. Micro-CT analysis revealed abnormal subchondral bone microarchitecture in OP animals. Notably, ALN treatment partially reversed OA progression, as evidenced by reduced cartilage degeneration, improved subchondral bone microstructure, and enhanced bone remodeling. Conclusion: Anti-OP treatment alleviates knee OA symptoms in OP patients. Postmenopausal OP accelerates OA progression, while anti-OP therapy can partially reverse this effect. These findings highlights the importance of anti-OP treatment in managing both conditions.