The Top 10 Causes of Cartilage Loss

Top Ten Causes of Cartilage Loss and Arthritis

The Top Ten Causes of Cartilage Loss

And What YOU Can Do to Prevent It!


Our patients often ask what they can do to help their cartilage. Understanding why we lose cartilage in the first place is helpful in understanding how you can keep more cartilage as you age.


1. Obesity-Mechanical

Being heavier places more wear and tear forces on cartilage.

SOLUTION – Lose Weight. This one is simple, but often tough to accomplish and maintain.


2. Obesity-Biochemical

Metabolic syndrome – As I’ve blogged before, obesity not only breaks down cartilage by wear and tear, but also causes changes in the patient’s insulin response system, which breaks down cartilage. This is called a “Metabolic Syndrome” which is defined by obesity (apple or pear body), high blood pressure, and early diabetes. This syndrome itself dramatically destabilizes the chemical matrix (structure) of cartilage.

SOLUTION – Not only lose weight, but reduce your carbohydrate and sugar load to reduce spikes in blood sugar and insulin release. This means if you have the genes that create the risk for metabolic syndrome you need a strict low glycemic diet (you likely have the genes if you have that middle-aged paunch, muffin top, or belly). This means no sodas, no added sugar, limited whole grains, no caffeine (it will spike your blood sugar), no fruit drinks, no baked goods, etc… Some low glycemic diet sites: Zone , AtkinsSouth Beach.


3. Trauma

Injuring the cartilage surface in a sudden traumatic event can lead to a weak spot in the cartilage that can cause that area to break down easier with normal forces. Think of a strong fabric with a rent. The damage may be small, but the fabric will wear faster due to the rent.

SOLUTION – Consider cell based solutions for cartilage repair before the problem becomes bigger. This might include platelet rich plasma or stem cell injections.


4. Joint Instability

Think of ligaments as duct tape that hold a joint together. An unstable joint means that ligaments have been injured which will cause the joint move around too much. All of this extra motion can further slowly injure the cartilage in the joint. Signs of instability include soreness or swelling after activity and if the instability is severe you might notice sudden shifting, popping, or cracking. Realize that without a physician who will spend the time to look for small amounts of instability, your joint instability may be missed.

SOLUTION – Injections like prolotherapy, PRP, and stem cells in our clinical experience can help reduce instability. Click here for an example of how stem cell injections improved the symptoms and MRI appearance of one patient’s loose ACL ligament.  If the instability is more severe, you may need to have it surgically corrected.


5. Nutrition

You are what you eat. 1,500 mg of Glucosamine has been shown in MRI studies to protect cartilage. The same cartilage protection holds true for 1,200 mg of Chondroitin a day. Vitamin C also has a protective effect. Resveratrol also seems to help stabilize cartilage matrix breakdown caused by Metabolic Syndrome. Vitamin E may also be able to protect against premature cell death due to excessive wear due to obesity or chemical insults such as medication. If you are overweight with high blood pressure, you likely have a metabolic syndrome, see dietary advice above.


6. Medications

The most common medications injected into arthritic joints are also likely the most toxic to cartilage-local anesthetics and steroid medications cause cartilage cell death (called apoptosis). Local anesthetics that contain epinephrine (a common medication used to prolong the effects of anesthetics for injections) are even more toxic due to their low pH and a preservative used to prolong the shelf life of the medication. In addition, commonly used NSAID medications like Ibuprofen (Motrin, Advil), Naproxen (Aleve, Naprosyn), and Celebrex (Celecoxib) may also have adverse impacts on normal cartilage cells. In one study, Celebrex hurt the production of good protective chemicals by cartilage cells and increased the production of bad chemicals. In some drug company sponsored trials, some researchers have suggested NSAIDs might protect cartilage, however one large real world patient study found no such protective effect.

SOLUTION – Stay away from “cortisone shots” and consider using natural anti-inflammatories like fish oil.


7. Hormonal changes

The most important hormone related to cartilage breakdown is Leptin. Leptin is the hormonal switch that tells you when you’re full. In patients who chronically overeat (usually due to the right genes combined with a sugary or carbohydrate loaded diet-see Metabolic syndrome above) too much Leptin is produced. The body looses it’s sensitivity to Leptin and a Metabolic syndrome sets in. Lack of response to Leptin has been associated with more arthritis.

SOLUTION – See above for Metabolic syndrome, also eat smaller portions. You can reset your Leptin switch to better turn off your impulse to eat with a fast or steep reduction in food intake for day or two.


8. Repetitive trauma

If your joints are normal, then running should help your cartilage. If you’ve already had joint surgery, then activities such as running or other impact sports combined with cartilage damage can worsen cartilage loss. Moderate loading activities like walking tend to protect cartilage, whereas higher levels of loading like running may break down cartilage in some patients.

SOLUTION – If you have cartilage loss, switching from high impact to mid or low impact activities may help protect your existing cartilage. If you have normal joints, keep running, it seems to help protect joints from damage.


9. Poor alignment and biomechanics

We all accept the idea that if our car alignment is off, our car’s tires will wear unevenly. The same laws of physics apply to the human body. If you have asymmetrical cartilage loss (i.e. one knee and not the other), you may have a body alignment problem that’s wearing down certain joints faster.

SOLUTION – Best to see the alignment section in our book: Orthopedics 2.0 where there are many different types of care systems recommended to fix alignment issues.


10. Age and Genes

Older patients seem to have less cartilage and certain people have genes for weaker cartilage. There may not be anything you can do about this one, so that’s why it is last on the list!


Read 24 Comments
  1. This is very informative information. Very helpful, I have controling my weight and the correct diet down. I dont run because I can’t. I do high intensity training at the highest level with no plyometric mechanics. I’m 5′ 8″ and 160 pounds, when I’m at this weight I start to have some pain, swelling and stiffness after training. Ofcourse if I’m 155 lbs or lighter this decreases 90%. My question is can regenexx help some one with no cartilage in one knee and very little in the other? I will also add I’m 60 years old. I’m sure that has something to do with it.

    1. Gunter,
      You fit right in with the majority of our patients. Given that you able to function at that level with just some pain, stiffness and swelling means that this would be the time to do something to prevent further deterioration. Without intervention that can sort out the damaging chemical environment and promote healing, the end result is the bones become affected to the point that the extra bone they attempt to compensate with will impede function drastically. This is the way we treat knees like yours: Please let us know if we can be of further assistance.

  2. I have been told by my orthopedic MD that I have bone on bone in my knee. I have received the 5 injections of Supartz back in late August – early September of this year. I have swelling in my knee but little pain. Will the stem cell treatment work for me now or do I need to let the Supartz run its course in my knee over the next few months.

    Thank you

  3. I’m a 51 year old female diagnosed with severe osteoarthritis in both hips. I have seen two orthopedic surgeons who have told me that a total hip replacement would have to be done a second time in about 15 years. I have read that a second hip replacement lasts 10 years or less. I am putting off surgery as I don’t want to be wheelchair bound in my mid 70’s. I’m very (desperately) interested in stem cell regeneration therapy. I’m aware this procedure is not as successful for hips as it is for other joints, but would welcome any improvement compared to the pain and limited ability I currently live with. If you could please guide me in the direction I need to go, I would be most grateful. I live in NH.

    Thank you in advance for your reply!

    1. Lynn,
      It looks like you’ve really done your homework and an educated patient is an empowered patient! Another important little known fact is the second hip replacement, or “revision” is actually a more traumatic surgery than the original. Here is some information on how we treat OA of the hip: On that page is a Regenexx Candidate form which will allow you to set up a phone consultation with one of our doctors who will review your MRI’s, take a medical history, answer any questions you have, give you their opinion about which type of procedure is best suited to your unique case and the chances they feel this will help. From that point if you decide to proceed, our Regenexx scheduler would help you decide which location would work best for you based on what needs to be done. This link shows what Providers are closest to you when you put in your location: for you to get an idea. Please let us know if we can be of any further assistance.

  4. I’ve had cartilage removed from both knees, both wrists right elbow, repair to left shoulder all from exposure to (TCE). what can I do to help my cartilage now ?

    1. James,
      There are things that we can all do to protect our cartilage as mentioned in the blog, however your situation is very specific and I’ve passed your question along to one of our Doctors. I will get back to you with their suggestions.

    1. CT,
      Filling in the deficit left in the disc by the microdiscectomy is not possible by any means. However, Regenexx can improve pain and function by treating the lax ligaments and muscles that likely were causative, and the facet joints and nerves that suffered because of it.

  5. hello my name is rosa and i had surgery to both knees and my orthopedic surgeon told me i have no cartilage in either knee i also have a pothole on my left one, i feel like a old woman when i get up either from bed or if i am sitting down i have to hold on the armrest of the sofa because it hurts, i live on the second floor and the pain is terrible when i go up or down the stairs sometimes when i walk i have to hold on to the rails or walk very slow, i am 63 what can i do to relieve the pain, thank you

    1. Rosa,
      Living on the second floor with bad knees can be very difficult. These are the types of situations that can be best addressed with regenerative medicine like your own stem cells and platelets, to avoid the “breakdown” in your knees to progress to the point where knee replacements are the only option. If you would like to set up a chat with one of our doctors to go over your medical history and take a look at your most recent MRI, please fill out the Candidate Form which you will find on this page which describes how we treat situations like yours. Without that we can give general advice like avoid steroid shots as they kill stem cells, avoid NSAIDS like Motrin, Advil, Aleeve, Celebrex, and control pain and inflammation with supplements like fish oil, curcumin, glucosamine and chondroitin, but please discuss these things with your doctor. This gives more info on these supplements and other suggestions: In the meantime, hang in there, and let us know if we can be of further assistance.

  6. Ok I went to 2 orthopedic 2 surgen and my family doctor both have done xray buy no MRI because they say is not necessary because they can see I am bone to bone. I limp because one leg is shorter than the other due to loss of cartilage. I did knee arthroscopic 8 months ago at beginning they though was knee they did knee arthroscopic but limping continue and they took xray and saw the lost. Now is hip replacement my only choice? I am 51 . This problem stared 3 years ago and I have been getting worst

    1. Alba,
      We would need a lot more information. It’s alarming that they thought the problem was your knee, but after doing surgery on it decided it was your hip. Alarming, but sadly not as unusual as one might think. We have seen patients who have had their joints replaced only to find out afterwards that the joint was not the problem. It would be important to be examined by someone who can actually figure out what’s going on. If you would like to set up a phone chat with one of our doctors so they can discuss your situation and see if they feel we can help, fill out the candidate form on either of these two pages: knees

  7. My daughter is 40 and told she had to have a total knee replacement. Bone on bone on one side and almost on the other side. She is over weight. Is there anything that she can do to prevent surgery?

    1. Wanda,
      That diagnosis is not unusual as a good percentage of our knee patients are bone on bone knee replacement candidates. At 40, though, it would definitely be important to exhaust every other possibility first, as knee replacements in reality don’t last nearly as long as they are marketed to and the revision surgery is more involved and has more risk and complications than the original. Beginning in middle age, the number of revisions would obviously be greater:

  8. Hii I am from India (Mumbai) 21 year old and I loss left shoulder cartilage… Doctor’s opinion is replacement shoulder joint…. But I don’t to be replaced it… pleas reply

  9. Great article! I have been diagnosed with left hip arthritis. I had left hip dysplasia as a baby and had to wear a brace the first year of my life. That did the trick because I had no problems and became a runner. Now, I’m 44 years old and healthy at 5’3″ 120 lbs and I still run only 1 to 2x per week 5 miles and under. The ortho MD told me there is nothing he can do for me and I should modify my activities. Well, I have hip pain no matter what my activity is. Even if I do some circuit workouts. Pain is always there and I am beginning to hike my hip to advance the leg from push off. I’m also a Physicsl Therapist so I stretch and strengthen my hip regularly with core workouts and Pilates. I take fish oil and Glucosamine Condroitin daily. What else can I do? I don’t want to live like this and loose my current fitness level!

  10. “In addition, commonly used NSAID medications like Ibuprofen (Motrin, Alleve), Naproxen (Naprosyn), and Celebrex (Celecoxib) may also have adverse impacts on normal cartilage cells.”

    I know it’s late, lol, but ALLEVE is Naproxen, and ADVIL is ibuprofen.
    That was bugging me

    1. Harrison,
      Thanks so much for catching that! Yes, Advil is Ibuprofen and now where it belongs, Naprosyn and Aleve with Naproxen.

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