Avascular necrosis of the bone in HIV-infected patients: incidence and associated factors

Gutiérrez, Félix; Padilla, Sergio; Ortega, Enrique; Garcia, Jairo A.; Flores, Juan; Galera, Carlos; Merino, Esperanza; Masía, Mar; Roig, P; Boix, Vicente; Portilla, Joaquín; Cuadrado, J.M.; Gregori, Joan; López, José I.

doi:10.1097/00002030-200202150-00021

Cited by 33 publications

(13 citation statements)

References 8 publications

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“…The increase in osteonecrosis in the HIV-infected patients may simply reflect the increase in other risk factors in this population, as is demonstrated in this case [178,179].…”

Section: Discussionmentioning

confidence: 70%

SAS Weekly Rounds: Avascular Necrosis

Hamilton¹,

Goodman

Figgie

2009

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Osteonecrosis of the femoral head is a condition that affects upwards of 10,000 individuals in the USA each year. The peak incidence is in the fourth decade of life, and overall, there is a male preponderance. The condition accounts for up to 12% of total hip arthroplasties performed in developed countries. The etiology can be traumatic or non-traumatic, with 90% of atraumatic cases attributed to corticosteroid therapy or excess alcohol consumption. Osteonecrosis of the femoral head reflects the final common pathway of a range of insults to the blood supply and ultimately results in femoral head collapse, acetabular involvement, and secondary osteoarthritis. Currently, conservative treatment options, which aim to correct pathophysiologic features allowing revascularization and new bone formation, appear to be able to delay but not halt the progression of this condition. As a consequence of femoral head osteonecrosis, many individuals undergo surgical treatments including: core decompression, osteotomy, non-vascularized bone matrix grafting, free vascularized fibular grafts, limited femoral resurfacing, total hip resurfacing, and total hip arthroplasty.

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“…The increase in osteonecrosis in the HIV-infected patients may simply reflect the increase in other risk factors in this population, as is demonstrated in this case [178,179].…”

Section: Discussionmentioning

confidence: 70%

SAS Weekly Rounds: Avascular Necrosis

Hamilton¹,

Goodman

Figgie

2009

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

show abstract

“…The incidence of osteonecrosis among HIV-infected patients increased after the introduction of HAART that included protease inhibitors ∼10 years ago [20,32], raising the possibility that this class of drugs or these combination regimens played an etiologic role. However, on the basis of current data, it is difficult to conclude that protease inhibitors or antiretroviral combinations are independently associated with the development of osteonecrosis [5,6,9,12,19,33].…”

Section: Discussionmentioning

confidence: 99%

The Incidence and Natural History of Osteonecrosis in HIV-Infected Adults

Morse¹,

Mican

Jones

et al. 2007

Clinical Infectious Diseases

112

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“…These two bone disorders should in fact be differentiated because their pathophysiologies appear to be different. Several studies have attempted to identify risk factors related to these bone disorders [15]. Hyperlipidaemia, lipodystrophy, diabetes and vasculitis have been described as conditions associated with, or related to, bone disorders [16][17][18] and some risk factors have been suggested, such as alcohol abuse, smoking, hyperlactataemia and corticosteroid use [16,[19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

et al. 2004

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Background Since the inception of highly active antiretroviral therapy (HAART), mortality among HIV‐infected patients has decreased, but this has been accompanied by the appearance of several complications. Objectives To estimate the incidence of symptomatic bone disorders in HIV‐infected patients of the Aquitaine cohort (from south‐west France) for the period 1999–2002, and to describe cases. Methods We retrospectively studied the records of 2700 patients of the Aquitaine cohort, which was derived from a hospital‐based surveillance system of HIV infection in France. All cases of symptomatic bone disorders diagnosed from 1 January 1999 to 30 June 2002 were reviewed. Results Fourteen cases of bone disorders were diagnosed, eight cases of aseptic osteonecrosis and six cases of severe osteoporosis, representing incidences of 0.3/1000 patient‐years [95% confidence interval (CI): 0.14–0.62] and 0.22/1000 patient‐years (95% CI: 0.09–0.52), respectively. All patients with aseptic osteonecrosis were male, while all but one with osteoporosis were female. The ages of patients ranged from 36 to 54 years for osteonecrosis and from 39 to 50 for severe osteoporosis. At the time of clinical diagnosis, all patients were treated with nucleoside reverse transcriptase inhibitors (duration of treatment ranging from 19 to 123 months for osteonecrosis and from 46 to 132 months for severe osteoporosis). Ten patients were treated with nonnucleoside reverse transcriptase inhibitors [duration of treatment ranging from 6 to 31 months for osteonecrosis (n=6) and from 4 to 29 months for severe osteoporosis (n=4)]. Thirteen patients were treated with protease inhibitors [duration of treatment ranging from 12 to 62 months for osteonecrosis (n=8) and from 3 to 44 months for severe osteoporosis (n=5)]. All osteonecrosis and five osteoporosis patients had at least one known risk factor or comorbidity associated with the bone disorder occurrence. Conclusions In our study, the aetiology of clinical bone disorders seemed to be multifactorial, as almost all the patients had at least one possible risk factor in addition to HAART exposure.

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Avascular necrosis of the bone in HIV-infected patients: incidence and associated factors

Cited by 33 publications

References 8 publications

SAS Weekly Rounds: Avascular Necrosis

SAS Weekly Rounds: Avascular Necrosis

The Incidence and Natural History of Osteonecrosis in HIV-Infected Adults

Symptomatic bone disorders in HIV‐infected patients: incidence in the Aquitaine cohort (1999–2002)

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