**3. Bone-acting agents**

*Recent Advances in Bone Tumours and Osteoarthritis*

reactions but fewer systemic adverse effects [21].

mixed exercises were the least ranked exercise [23].

the Multicenter Osteoarthritis Study (MOST) [24].

likely to develop hand, foot, and knee OA compared to men [4].

many domains of physical impairment in people with OA [23].

different exercise forms [22].

The safety of IAHA has been evaluated in eight meta-analyses of RCTs comparing IAHA to IA placebo. However, a Cochrane review of 76 RCTs was unable to conclude a definitive report on the safety of HA due to limitations concerning sample size; however, no major safety issues were found, in addition, IAHA demonstrated similar efficacy to systemic forms of medical interventions, with more local

Evidence suggests that exercise is one of the core therapies for OA to improve function and pain. The degree of response varies according to the type of exercise (e.g. aerobic, strengthening, etc.). Little is known about the relative effeciency of

The comparisons were seen between strengthening exercises and mixed exercises versus usual care. For pain, function, and performance, all types of exercise were significantly better than usual care. The largest effect was observed for aerobic and mind-body exercises for function and pain. Strengthening and flexibility exercises had a moderate score, whereas mixed exercise gave the minimum score for all outcomes and was significantly less effective than aerobic or mind-body exercise for pain. The ranking mainly corresponded to the magnitude of the score shown by each exercise. Aerobic exercises were the best-ranked for performance and pain, whereas mind-body was also the best-ranked for self-reported pain and function. Strengthening and flexibility/skill generally received mid-level rankings while

It is confirmed that exercise is still important for people suffering from hip and knee OA for outcomes of performance function, pain. In additon, it was found that mind-body and aerobic exercise have the largest score for improvements in function and pain; strengthening and flexibility exercises improve multiple outcomes to a varying degree [23]. Older age is a well-known risk factor for OA; women are more

Varus thrust increased the odds of worsening medial bone marrow lesions (BMLs) and medial cartilage loss as well as the odds of incident medial BMLs of the knee among those with KOA and those with increased risk of Knee OA according to

It was found that aerobic exercises have similar effects to mind-body exercises for controlling pain. Mind-body exercise such as yoga and tai chi can be characterized as mild to moderate intensity exercise performed with an intentional awareness (mindfulness) on breathing and slow controlled movement [25]. Although the underlying mechanism is not clear, the effect of both mind-body and aerobic exercises may be related to the possibility that these exercises affect the altered central nervous system such as central pain sensitization, mood disorders, and sleep disturbance. Pain experience is the result of interactions between these central failure and peripheral pain mechanisms, as aerobic and mind-body exercise can influence both central and peripheral pain mechanisms. There is no satisfactory explanation for the poor effect of mixed exercise, particularly when considering that there are

So far, NSAIDs, symptomatic slow-acting drugs for OA, analgesics, bone-acting

agents, putative disease-modifying agents, and agents for intra-articular injection including HA and corticosteroids have been used as pharmacological agents for treating OA. However, it has been reported that these agents are not efficient against the main cause of OA, may cause some side effects, and are not adequate for the long-term management of OA. NSAIDs are the most commonly used drugs for the management of OA. They showed moderate improvement against OA pain; however, it is advised that NSAIDs be used intermittently and not advised for longer periods. NSAIDs can be classified as cyclooxygenase-2 selective agents and nonse-

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lective agents [26].

Bone-forming agents or antiresorptive agents like zoledronic acid, risedronate, strontium ranelate, calcitonin, and vitamin D are classified as bone-acting agents for the management of OA. They are bone-acting agents that showed some recorded effect in the turnover of subchondral bone, although these agents did not show a significant improvement in the structure of the joint [26].
