Bone-On-Bone Osteoarthritis

If your healthcare provider suspects arthritis, they 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.

X-rays Tell the Story

X-rays may show mild osteoarthritis even though you have severe symptoms, or an X-ray may show changes that point to advanced osteoarthritis even though you have only mild symptoms—or even no symptoms. Even though early cartilage abnormalities are detectable with magnetic resonance imaging (MRIs), usually X-rays are ordered initially to help diagnose osteoarthritis.

Joint Space Narrowing: As you lose cartilage in a joint, the space between the ends of the bone decreases. When there is little or no cartilage left, the bones rub against each other. If the joint damage that appears on an X-ray is severe, you may be told that you are “bone-on-bone.” This is a layperson’s term for complete joint space narrowing due to cartilage loss.

A Disease of the Cartilage: Osteoarthritis is primarily considered a disease of cartilage. As the cartilage wears away, the role it serves as a shock absorber (protecting the ends of the bones) and lubricant (allowing 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. Crepitus (a grating sound or sensation) is another common symptom.