What to Know About Subchondral Sclerosis and Sclerosis Bone Lesions

Medically Reviewed By Stella Bard, MD
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Subchondral sclerosis is an X-ray finding in people with osteoarthritis (OA). It is a bone layer thickening underneath joint cartilage. OA symptoms cause the bone layer thickening. Likewise, treatment follows OA guidelines.

This article explains subchondral sclerosis, including the causes, symptoms, and treatment.

What is subchondral sclerosis?

Man sitting and holding his sore knee with two hands
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Doctors can see subchondral sclerosis on a joint X-ray. The term “sclerosis” refers to a bone thickening that shows up denser on X-rays. In this case, it affects the subchondral bone. This is the layer below the cartilage.

Subchondral sclerosis occurs in the later stages of OA. OA is a degenerative joint disease that results from mechanical damage to the joint. OA causes joint pain, stiffness, and enlargement. Subchondral sclerosis and osteophyte formation cause the joint to enlarge. Osteophytes are bony outgrowths.

What other symptoms might occur with subchondral sclerosis?

Subchondral sclerosis is a sign of OA that shows up on an X-ray. The symptoms that might occur with it are the symptoms of OA, including:

  • crepitus, or grinding sounds or sensations in the joint
  • joint instability, pain, and stiffness
  • reduced range of motion
  • enlargement or swelling of the joint

OA commonly affects the hands, hips, knees, and spine.

What causes subchondral sclerosis?

Subchondral sclerosis is part of the pathophysiology of OA. OA starts with mechanical changes in the joint. It causes cartilage degeneration. As the cartilage erodes, the subchondral bone expands and thickens. So, subchondral sclerosis is a sign of later-stage disease. It occurs after cartilage loss starts.

What are the risk factors for subchondral sclerosis?

The risk factors for subchondral sclerosis are those of OA. While anyone can get OA, it happens more commonly as you get older. It is also more common in people assigned female at birth.

Other risk factors include:

  • genetics
  • joint structure changes, such as dysplasia
  • past joint injury

When to see a doctor for sclerosis bone symptoms?

Contact your doctor if you have joint symptoms that cause concern. The symptoms may:

  • interfere with daily activities
  • persist despite home treatment
  • recur several times a month

Your primary care doctor is a good place to start. They can often diagnose and treat OA in the early stages. As the disease progresses, it may be necessary to work with an orthopedic surgeon. These doctors use both medical and surgical treatments to manage OA.

How do doctors diagnose subchondral sclerosis?

Subchondral sclerosis is not a diagnosis. Rather, it is a radiological sign of OA. Doctors will see it on an X-ray, along with other changes characteristic of OA. The changes can include joint space narrowing and the presence of osteophytes.

How do you treat subchondral sclerosis?

Doctors do not treat X-ray changes alone. In fact, radiological changes consistent with OA are at least twice as common as symptomatic OA. This means it is likely that most people older than 65 have X-ray evidence of joint damage. However, this does not mean they have symptoms or require treatment.

Treating OA is necessary when the condition causes pain or limits daily activities. Subchondral sclerosis is a marker of late disease. So, it is likely to be present when these symptoms occur. 

The goals of OA treatment are to minimize pain and maximize function. The main ways to accomplish these goals include:

In severe cases, surgery may be helpful. It is usually a last resort when other treatments do not provide relief.

Removing stress and lowering the impact on joints are also important parts of OA treatment. Weight management can help people who have overweight. Bracing and assistive devices, such as canes, are other ways to reduce the load on a joint and stabilize it.

How do you prevent subchondral sclerosis?

Subchondral sclerosis is a late finding in the course of OA. Cartilage loss takes place when subchondral sclerosis occurs. It is generally not possible to prevent OA. However, you may be able to slow its progression with the following:

  • exercising with low impact activities, such as biking or swimming
  • managing weight if necessary
  • strengthening supporting muscles 
  • stretching and practicing range of motion exercises
  • using braces or orthotics to support the joint
  • working with an occupational therapist to learn ways to protect the joint during daily activities

What are the potential complications of subchondral sclerosis?

Subchondral sclerosis is a finding that shows the progression of OA. Its presence can indicate permanent joint changes and degeneration. 

Frequently asked questions

Here are other questions people often ask about subchondral sclerosis.

Is subchondral sclerosis serious? Can it lead to disability?

Subchondral sclerosis is a central part of the development of OA. OA is a common cause of moderate to severe disability in people worldwide.

What joints can subchondral sclerosis affect?

The joints typically involved in OA, and hence subchondral sclerosis, include the feet, hands, hips, knees, and spine. 

What does sclerosis of the bone mean?

Sclerosis of the bone means bone thickening. On imaging exams, it shows up denser than usual.

Summary

Subchondral sclerosis is a radiological finding consistent with OA. It refers to the bone layer thickening beneath the cartilage. It is a sign of OA progression and indicates later-stage disease.

Doctors do not treat X-ray changes alone. However, pain and other symptoms are often present with subchondral sclerosis. Treatment aims to address these symptoms and not necessarily subchondral sclerosis itself. 

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Medical Reviewer: Stella Bard, MD
Last Review Date: 2022 Sep 16
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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