Arthritis Osteoarthritis Diagnosis Bone-On-Bone Osteoarthritis By Carol Eustice Carol Eustice LinkedIn Twitter Carol Eustice is a writer who covers arthritis and chronic illness. She is the author of "The Everything Health Guide to Arthritis." Learn about our editorial process Updated on March 10, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by David Ozeri, MD Medically reviewed by David Ozeri, MD LinkedIn David Ozeri, MD, is a board-certified rheumatologist from Tel Aviv, Israel specializing in arthritis, autoimmune diseases, and biologic therapies. Learn about our Medical Expert Board Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Angela Underwood Fact checked by Angela Underwood LinkedIn Angela Underwood's extensive local, state, and federal healthcare and environmental news coverage includes 911 first-responder compensation policy to the Ciba-Geigy water contamination case in Toms River, NJ. Her additional health-related coverage includes death and dying, skin care, and autism spectrum disorder. Learn about our editorial process Print If your healthcare provider suspects arthritis, he will order X-rays or other imaging studies of your painful joint. X-rays will show if there is any evidence of cartilage loss. X-rays do not detect early cartilage abnormalities, though—and there is not always a direct correlation between the severity of damage evident on X-rays and the severity of symptoms. SMC Images / Getty Images X-rays Tell the Story X-rays can show mild osteoarthritis while you may be experiencing severe symptoms. The reverse is also true — an X-ray may show changes that point to advanced osteoarthritis while you may be experiencing few if any, symptoms. Even though early cartilage abnormalities are detectable with magnetic resonance imaging (MRIs), usually X-rays are ordered initially to help diagnose osteoarthritis. How Is Osteoarthritis Diagnosed? Joint Space Narrowing: If the joint damage that appears on X-ray is severe, you may be told that you are "bone-on-bone." Bone-on-bone is a layman's term that refers to complete joint space narrowing, which is the result of cartilage loss. As cartilage deteriorates, there is less cushioning between the ends of the bone that form the joint. The space between the ends of the bone decreases and the ends of the bone become closer to each other. When there is essentially no cartilage left, the bones rub against each other. The term bone-on-bone refers to the ends of the bones rubbing against each other. A Disease of the Cartilage: Osteoarthritis is primarily considered a disease of cartilage. As cartilage wears away, the role it serves as a shock absorber and lubricant (to protect the ends of the bones and allow friction-free movement) is affected. Healthy cartilage works in harmony with bones, muscles, tendons, ligaments, and other support structures to maintain joint function and mobility. When a joint is at an advanced stage of osteoarthritis and has become bone-on-bone, the range of motion can be very limited and it is typically very painful. Common Osteoarthritis Symptoms Was this page helpful? Thanks for your feedback! Learn tips for managing arthrits pain, medications, and daily challenges. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 5 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Wang X, Oo WM, Linklater JM. What is the role of imaging in the clinical diagnosis of osteoarthritis and disease management? Rheumatology. 2018;57(suppl_4):iv51-iv60. doi: 10.1093/rheumatology/kex501 Ota, S., Sasaki, E., Sasaki, S. et al. Relationship between abnormalities detected by magnetic resonance imaging and knee symptoms in early knee osteoarthritis. Sci Rep 11 15179 (2021). doi: 10.1038/s41598-021-94382-3 Muraki S, Akune T, En-yo Y, et al. Joint space narrowing, body mass index, and knee pain: the ROAD study (Oac1839r1). Osteoarthritis and Cartilage. 2015;23(6):874-881. doi: 10.1016/j.joca.2015.01.011 U.S. National Library of Medicine MedlinePlus. Osteoarthritis. Cleveland Clinic. Osteoarthritis. Additional Reading All About Osteoarthritis. Nancy E. Lane, M.D. and Daniel J. Wallace., M.D., Oxford University Press, 2002