Biomarkers and pharmaceutical strategies in steroid-induced osteonecrosis of the femoral head: A literature review

Qi, Xinyu; Zeng, Yirong

doi:10.1177/0300060514554724

Cited by 20 publications

(13 citation statements)

References 41 publications

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“…Although the pathophysiology of NONFH has yet to be fully elucidated, previous studies hypothesize that NONFH is induced by vascular impairment, altered bone cell physiology, oxidative stress, and insufficient blood supply among other factors. [ 1 2 22 23 ] Meanwhile, alcohol intake[ 24 25 26 ] and steroid use[ 10 27 28 29 30 ] have been identified as the major risk factors for NONFH. While this is consistent with our findings, glucocorticoid intake was found to have a stronger association with NONFH than alcohol use.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population

Zhao

et al. 2015

Chinese Medical Journal

229

191

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Background:Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population.Methods:A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH.Results:NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ2 = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ2 = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH.Conclusions:Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population

Zhao

et al. 2015

Chinese Medical Journal

229

191

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“…While stem cell factor (SCF)19 and grape seed proanthocyanidin proved protective by reducing oxidative stress20. Based on the studies mentioned above, it is widely suspected that oxidative stress leads to osteonecrosis of ONFH21. Effective, selective, multifunctional drugs suppressing oxidative stress have tremendous potential in ONFH treatment, which can be realized by nanocomposites.…”

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confidence: 99%

Treatment of steroid-induced osteonecrosis of the femoral head using porous Se@SiO2 nanocomposites to suppress reactive oxygen species

Deng

Niu

Zhou

et al. 2017

Sci Rep

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Reducing oxidative stress (ROS) have been demonstrated effective for steroid-induced osteonecrosis of the femoral head (steroid-induced ONFH). Selenium (Se) plays an important role in suppressing oxidative stress and has huge potential in ONFH treatments. However the Se has a narrow margin between beneficial and toxic effects which make it hard for therapy use in vivo. In order to make the deficiency up, a control release of Se (Se@SiO2) were realized by nanotechnology modification. Porous Se@SiO2 nanocomposites have favorable biocompatibility and can reduced the ROS damage effectively. In vitro, the cck-8 analysis, terminal dexynucleotidyl transferase (TdT)-mediated dUTP nick end labeling (TUNEL) stain and flow cytometry analysis showed rare negative influence by porous Se@SiO2 nanocomposites but significantly protective effect against H2O2 by reducing ROS level (detected by DCFH-DA). In vivo, the biosafety of porous Se@SiO2 nanocomposites were confirmed by the serum biochemistry, the ROS level in serum were significantly reduced and the curative effect were confirmed by Micro CT scan, serum Elisa assay (inflammatory factors), Western blotting (quantitative measurement of ONFH) and HE staining. It is expected that the porous Se@SiO2 nanocomposites may prevent steroid-induced ONFH by reducing oxidative stress.

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“…A consensus etiopathogenesis of steroid-associated ON has been recently unified on both intravascular thrombosis-induced occlusion and extravascular lipid deposition–induced pressure, leading to impairment of intraosseous blood supply [28] . Therefore, an ideal agent for preventing CS-induced ONFH should simultaneously target both intravascular thrombosis and extravascular lipid deposition [22] . Motomura et al combined anticoagulant and lipid-lowering treatments in animal models and showed that the combined drug group had a significantly lower incidence of osteonecrosis than both the anticoagulant and the lipid-lowering groups (5%, 33% and 38%, respectively) [13] .…”

Section: Discussionmentioning

confidence: 99%

“…As CS impairs osteogenesis of osteoblasts and increases apoptosis of osteoblasts and osteocytes and the adipogenic potential of bone marrow mesenchymal cells, Fufang herbs may share the common pathways or the similar underlying mechanisms for the prevention of both osteoporosis and osteonecrosis [21] . Moreover, around 90% of the patients with CS-induced osteonecrosis coexisted with or accompanied by osteoporosis [22] .…”

Section: Introductionmentioning

confidence: 99%

Herbal Fufang Xian Ling Gu Bao prevents corticosteroid-induced osteonecrosis of the femoral head—A first multicentre, randomised, double-blind, placebo-controlled clinical trial

Cheng

Wang

et al. 2018

Journal of Orthopaedic Translation

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Background/ObjectiveThis is a multicentre, randomised, double-blind, placebo-controlled clinical trial to investigate the safety and efficacy of Chinese herbal Fufang Xian Ling Gu Bao (XLGB) with antiadipogenic compounds for the prevention of corticosteroid (CS)-induced osteonecrosis of femoral head (ONFH).MethodsPatients of both genders, aged between 18 and 65 years, with diseases such as systemic lupus erythematosus, nephrosis, dermatosis and rheumatoid arthritis indicated for CS treatment and who did not show magnetic resonance imaging of ONFH at baseline were recruited into the study and then randomised into either XLGB group (n = 129) with daily oral administration of XLGB or placebo group (n = 146).ResultsMagnetic resonance imaging revealed a total of 30 ONFH cases at 6 months after CS treatment, with 6.98% (9 of 129 cases) and 14.4% (21 of 146 cases) in the XLGB group and placebo group, respectively, (p < 0.05), i.e., a 2-fold significantly less ONFH identified in the XLGB treatment group. Blood tests suggested that XLGB significantly inhibited the elevation of activated protein C resistance induced by CS treatment.ConclusionThis is the first multicentre clinical study to demonstrate that the antiadipogenic compounds–rich herbal Fufang (formula) XLGB is effective in preventing CS-associated ONFH in patients with immune-inflammatory diseases under CS treatment.The translational potential of this articleThe translation potential of this clinical trial is that the initially officially approved clinical indication for XLGB for treatment of osteoporosis has been now also proven to be effective for a new clinical application.

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Biomarkers and pharmaceutical strategies in steroid-induced osteonecrosis of the femoral head: A literature review

Cited by 20 publications

References 41 publications

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population

Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population

Treatment of steroid-induced osteonecrosis of the femoral head using porous Se@SiO2 nanocomposites to suppress reactive oxygen species

Herbal Fufang Xian Ling Gu Bao prevents corticosteroid-induced osteonecrosis of the femoral head—A first multicentre, randomised, double-blind, placebo-controlled clinical trial

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