Difference between an osteophyte a syndesmophyte and an enthesophyte

Difference between an osteophyte a syndesmophyte and an enthesophyte?

Osteophyte, syndesmophyte, and enthesophyte are terms used to describe different types of bony outgrowths that can develop in various musculoskeletal conditions.

Here’s a brief differences between each:

  1. Osteophyte: An osteophyte, also known as a bone spur, is a bony outgrowth that forms on the edge of a bone. It typically occurs at the site of joint degeneration or in response to stress or inflammation. Osteophytes can develop in joints affected by osteoarthritis, where the protective cartilage lining the joint breaks down. They can limit joint mobility, cause pain, and potentially impinge on adjacent structures.
  2. Syndesmophyte: A syndesmophyte is a bony outgrowth that specifically forms within a joint, typically in the spine. It is often associated with ankylosing spondylitis, a chronic inflammatory condition that primarily affects the spine and sacroiliac joints. Syndesmophytes are characterized by the gradual fusion of adjacent vertebral bodies, leading to the formation of a continuous bony bridge. This can result in reduced spinal flexibility, stiffness, and potential complications such as kyphosis (abnormal forward curvature) or ankylosis (joint fusion).
  3. Enthesophyte: An enthesophyte is a bony outgrowth that develops at the site where a tendon or ligament attaches to a bone, known as the enthesis. It is often seen in conditions such as enthesitis-related arthritis, spondyloarthritis, or repetitive stress injuries. Enthesophytes can occur due to chronic inflammation, mechanical stress, or the body’s attempt to stabilize the enthesis. They can cause pain, restrict joint movement, and potentially lead to tendon or ligament damage.


Osteophytes are thick, triangle-shaped osseous excrescences that form at the site of Sharpey fibers attachment between the annulus fibrosus and the margin of the vertebral body just above or below the endplate margin.

  • An osteophyte may eventually grow and meet an osteophyte on the other side of the disc space to form a bridging osteophyte.
  • Osteophytes can contribute both to the functional properties of affected joints and to clinical relevant symptoms.
  • Osteophyte formation is highly associated with cartilage damage but osteophytes can develop without explicit cartilage damage.
  • Osteophytes are mainly derived from precursor cells in the periosteum and growth factors of the TGFbeta superfamily appear to play a crucial role in their induction.

Osteophyte is one of the salient features of osteoarthritis

Osteophytes typically begin by growing outward.

What are the risk factors of osteophytes?

The below are the risk factors for development of osteophytes

  • Age
  • Physical activity
  • body mass index
  • Certain genetic
  • Environmental factors 


Syndesmophytes are outgrowths from the bone (osseous excrescences) from the spinal ligaments as they attach to adjacent vertebral bodies.

Syndesmophytes are typically associated with ankylosing spondylitis.

Ankylosing spondylitis (AS) is characterized by the formation of syndesmophytes and occurs more frequently in HLA-B27+ individuals, but whether these two phenomena are related has been uncertain.

According to the results of a new study, HLA-B27 misfolding is directly linked to syndesmophyte formation via tissue-nonspecific alkaline phosphatase (TNAP), in a process that can be targeted therapeutically.

Syndesmophytes are thin, gracile ossifications of the annulus fibrosus and are more vertically oriented than osteophytes, attaching right at the endplate margin.

Syndesmophytes are seen in only a limited number of conditions including: 

  • ankylosing spondylitis
  • ochronosis
  • fluorosis
  • reactive arthritis
  • psoriatic arthritis

Appearances of the Syndesmophytes in various diseases or conditions

  • In Reiter’s syndrome and psoriasis – Syndesmophytes typically appear as non-marginal syndesmophytes. They are massive and bridge adjacent vertebrae asymmetrically. Usually in these conditions they appear to arise from a broad zone on the vertebrae, and tend to spare the anterior surfaces of the vertebrae.
  • In ankylosing spondylitis – Syndesmophytes typically appear as marginal syndesmophytes. They tend to be thinner, more vertical, and symmetrical, involving anterior as well as the lateral vertebral body margins. The disc space is often narrowed, and vertebral bodies may show anterior end plate erosions and appear to lose the normal anterior concavity

In this study, mesenchymal stem cells (MSCs) were derived from the entheses of patients with AS to address if there is any abnormality in AS-derived MSCs,” explains co-corresponding author Kuo-I Lin. “No significant differences were found in the production of the cytokines or chemokines that we tested in AS-derived MSCs as compared with control MSCs, but AS-derived MSCs did show accelerated mineralization upon osteogenic induction.


An enthesophyte is a bony outgrowth or spur that forms at the site where a tendon or ligament attaches to a bone. It is also known as an enthesial spur or enthesial reaction. Enthesophytes typically develop as a result of chronic stress or repetitive mechanical strain on the attachment site.

Enthesophytes can occur in various areas of the body, commonly at the points where tendons and ligaments attach to bones. Some common sites for enthesophyte formation include the heel (Achilles tendon insertion), elbow (common extensor or flexor tendon insertions), knee (patellar tendon insertion), and shoulder (rotator cuff insertions).

Enthesophytes themselves may or may not cause symptoms. In some cases, they are incidental findings on imaging studies and do not require treatment. However, if an enthesophyte becomes symptomatic and causes pain, restricted movement, or inflammation, treatment options may include:

  1. Rest and activity modification: Avoiding activities that aggravate the symptoms and allowing time for healing.
  2. Physical therapy: Specific exercises and stretching routines can help improve flexibility, strengthen surrounding muscles, and alleviate symptoms.
  3. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may be prescribed to manage pain and reduce inflammation.
  4. Surgical intervention: In rare cases where conservative measures fail to provide relief, surgery may be considered to remove the enthesophyte or address any associated issues.

Enthesophytes are often associated with certain conditions or factors, including:

  1. Age-related degeneration: As people age, the tendons and ligaments may become less flexible and more susceptible to developing enthesophytes.
  2. Overuse or repetitive strain: Engaging in activities that involve repetitive motion or placing excessive stress on certain joints and tendons can lead to enthesophyte formation over time.
  3. Inflammatory conditions: Certain inflammatory conditions, such as ankylosing spondylitis or psoriatic arthritis, can increase the risk of developing enthesophytes.
  4. Sports injuries: Athletes involved in sports that require repetitive motions, such as running, jumping, or throwing, may be at a higher risk of developing enthesophytes.

The management of enthesophytes depends on the individual’s symptoms, the location and extent of the enthesophyte, and the underlying condition, if present. It’s important to consult with a healthcare professional, such as an orthopedic specialist or rheumatologist, for an accurate diagnosis and appropriate treatment options based on the specific needs of the individual.

What research says about Osteophytes and Enthesophytes?

Study 1

A study conducted on Nine adults younger than 60 years with a diagnosis of X-Linked hypophosphatemia (XLH) and self-reported musculoskeletal disability, but who were able to independently ambulate.

The Musculoskeletal function of these participants was evaluated by validated questionnaires and in an interdisciplinary clinical space where participants underwent full-body radiologic imaging, goniometric range of motion (ROM) measurements, general performance tests, and kinematic gait analysis.

Enthesophytes, degenerative arthritis, and osteophytes were found to be consistently bilateral and diffusely present at the spine and synovial joints across these nine participants, with predominance at weight-bearing joints.

In a study, 226 radiographs from HBM cases and 437 radiographs from control subjects were included.

Enthesophytes (grade ≥1) and moderate enthesophytes (grade ≥2) were more prevalent in HBM cases compared with controls (adjusted odds ratio [OR] 3.00 [95% confidence interval (95% CI) 1.96–4.58], P < 0.001 for any enthesophyte; adjusted OR 4.33 [95% CI 2.67–7.02], P < 0.001 for moderate enthesophytes).

In the combined population of cases and controls, the enthesophyte grade was positively associated with BMD at both the total hip and lumbar spine (adjusted P for trend < 0.001).

In addition, a positive association between osteophytes and enthesophytes was observed; for each unit increase in enthesophyte grade, the odds of any osteophyte being present were increased >2-fold (P < 0.001).

In a review of literature, New syndesmophytes develop in one-third of patients over 2 years. Consistent clinical predictors are male sex, elevated serum C-reactive protein levels, and preexisting syndesmophytes. Concomitant vertebral inflammation and fat dysplasia on MRI predict future syndesmophytes at the same vertebral location, but most syndesmophytes do not have recognized antecedents. Associations with serum levels of Wingless pathway proteins are inconsistent, as are the results of observational studies of tumor necrosis factor-alpha inhibitors.

Although there is better understanding of the frequency of syndesmophyte development, the pathogenesis of syndesmophytes remains unclear.




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