An Overview of Subchondral Sclerosis

Symptoms, causes, diagnosis, and treatment

Subchondral sclerosis, which is also called marginal sclerosis, is a thickening of the bone beneath the cartilage in joints. It can be associated with painful joint symptoms and bone spurs. Subchondral sclerosis is commonly seen in joints of the knee, hip, spine, and foot. Subchondral sclerosis, like bone spurs and cartilage loss, is a feature of osteoarthritis

Film x-ray both knees show narrow joint space, osteophyte, subchondral sclerosis
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Symptom and Causes

To understand what subchondral sclerosis is, it helps to have a clear picture of how osteoarthritis affects the joints of the body. Osteoarthritis degrades the cartilage in a joint and wears away at the subchondral bone underneath the cartilage.

The body tries to repair the damaged bone. As the bone is remodeled, it comes back thicker than before, resulting in subchondral sclerosis. These changes are most commonly detected in the later stages of osteoarthritis.

Subchondral sclerosis is associated with painful bone spurs, which can reduce the range of motion of the affected joint. It can also occur when there's a deterioration of joint cartilage, which can make a person shorter—especially if the knee, hip, or spine are affected. When subchondral sclerosis occurs in the knee, the joint can also sometimes lock.

Risk factors for subchondral sclerosis include genetic predisposition, female sex, older age, obesity, previous joint injury, joint malalignment, or abnormal joint shape.

Diagnosis

When the affected joint is examined with an X-ray, subchondral sclerosis can appear as a dense area of bone just under the cartilage in your joints, and it looks abnormally white bone along the joint line.

Magnetic resonance imaging (MRI) is also a good test for visualizing soft tissue damage.

The presence of subchondral sclerosis is not predictive of the progression or severity of your osteoarthritis. You should not assume that your condition is worsening if you have subchondral sclerosis.

In fact, a study published in Osteoarthritis and Cartilage suggests that subchondral sclerosis may prevent cartilage loss in people with varus knee osteoarthritis. According to the researchers, the overgrowth of bone may sometimes help realign bowed knee joints and prevent excessive abrading.

Another study published in 2014 similarly found no significant association between baseline subchondral sclerosis and the risk of cartilage loss in the knee.

Treatment

There is no cure for subchondral sclerosis. But, there are steps you can take to slow the progression of underlying osteoarthritis and reduce painful symptoms.

Low-impact physical exercise, such as biking on a stationary bike, yoga, and swimming are good ways to keep your joints active. If you are overweight, losing weight is also recommended as a way to reduce stress on your joints.

Your doctor may recommend physical therapy, hydrotherapy, or holistic medical treatments, such as acupuncture. And anti-inflammatory medications such as ibuprofen may be recommended.

For osteoarthritis symptoms, prescription medications may help provide relief. When symptoms are severe, joint replacement surgery may be appropriate for certain joints.

As with any chronic condition, consult with your doctor to determine the best course of treatment for your condition.

A Word From Verywell

Subchondral bone and cartilage affect each other. When cartilage is thinned due to osteoarthritis, the bone often reacts. Strategies you can use to keep your joints as healthy as they can include getting regular low-impact exercise and participating in physical therapy.

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  1. Akamatsu Y, Kobayashi H, Kusayama Y, et al. Does subchondral sclerosis protect progression of joint space narrowing in patients with varus knee osteoarthritis? Osteoarthritis Cartilage. 2014;22(Supplement): S362. doi:10.1016/j.joca.2014.02.667

  2. Crema MD, Cibere J, Sayre EC, Roemer FW, Wong H, Thorne A, Singer J, Esdaile JM, Marra MD, Kopec JA, Nicolaou S, Guermazi A. The relationship between subchondral sclerosis detected with MRI and cartilage loss in a cohort of subjects with knee pain: the Knee Osteoarthritis Progression (KOAP) study. Osteoarthritis Cartilage. 2014;22(4):540-6. doi:10.1016/j.joca.2014.01.006

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