Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Shibatani, Masahiko; Fujioka, Mikihiro; Arai, Yuji; Takahashi, Kenji; Ueshima, Keiichiro; Okamoto, Masahiko; Yoshimura, Norio; Hirota, Yoshio; Fukushima, Wakaba; Kubo, Toshikazu

doi:10.1080/17453670810016641

Cited by 48 publications

(34 citation statements)

References 21 publications

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“…The incidence of osteonecrosis of the femoral head (ONFH) has been on the rise in recent years due to the widespread use of steroid medication for immunosuppression, especially in transplant patients and in the treatment of rheumatic diseases [1][2][3]. However, the pathogenesis of steroidinduced ONFH has not yet been identified.…”

Section: Introductionmentioning

confidence: 99%

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

Erken

Ofluoğlu

Aktaş

et al. 2012

International Orthopaedics (SICOT)

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Purpose Pentoxifylline (PTX) is a derivative of methylxanthine and is used in peripheral vascular and cerebrovascular diseases for its effect on the regulation of blood circulation. We investigated whether PTX could be beneficial for femoral head osteonecrosis associated with steroid through these effects. Methods Sixty mature Leghorn type chickens were chosen and divided into three groups. The 25 chickens in group A were given a weekly dose of 3 mg/kg/week methylprednisolone acetate intramuscularly. Four chickens in group B died after the first drug injection and were excluded from the study. Therefore, the remaining 21 chickens in group B were additionally given 25 mg/kg/day pentoxifylline intramuscularly, along with the steroid medication as given in group A. The ten chickens in group C were not given any injections, as they were accepted as the control group. After the sacrifice of the animals at week 14, both femoral heads were taken from each animal. The animals which died along the course of the study also underwent pathological examination but were not a part of the statistical analysis. Results In this study, steroid induced femoral head osteonecrosis has been experimentally observed in chickens after high doses of corticosteroid therapy. The chickens were given pentoxifylline in order to prevent the effects of steroid on bones and bone marrow. The results showed that chickens are suitable osteonecrosis models, and that steroid causes adipogenesis and necrosis in the bone marrow and the death of the subchondral bone. Conclusions The results of this study hint at the assumption that PTX may have a positive benefit on ONFH. PTX seems to minimise the effects of the steroid and reduce the incidence of ONFH.

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Section: Introductionmentioning

confidence: 99%

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

Erken

Ofluoğlu

Aktaş

et al. 2012

International Orthopaedics (SICOT)

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“…MRI has been reported to have high sensitivity and specificity for the diagnosis of AVN (Sugano et al 1999), and should be used for precise assessment of AVN development. Only a few reports have used MRI to determine the risk of AVN development in the early period after renal transplantation; this includes studies that have shown statistically significant relationships (1) between AVN development and total dose of steroid within 2 months postoperatively (Shibatani et al 2008), and (2) between AVN development and delayed renal function (Takao et al 2011). …”

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confidence: 99%

Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis

et al. 2014

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Background and purposeIt has been suggested that avascular osteonecrosis (AVN) of the femoral head occurs early after systemic steroid administration. The purpose of this study was to investigate the risks regarding development of AVN at a very early stage after renal transplantation.MethodsThe presence or absence of AVN was determined by MRI at 4 weeks, at 6–12 weeks, at 24 weeks, and at 12 months after renal transplantation in 286 patients (183 males) with a mean age of 39 (16–65) years. The relationship between AVN and age, sex, absence or presence of acute rejection (AR), type of transplanted kidney (living or cadaveric), type of immune suppressor, and total dose of orally administered steroids given in the 2-week period after transplantation was investigated.ResultsThere were no statistically significant correlations between the development of AVN and age, sex, absence or presence of AR, type of transplanted kidney, or type of immune suppressor. A significant dose-response relationship was found between development of AVN and the total dose of steroid administered in the first 2 weeks after surgery.InterpretationWe found a relationship between AVN development and steroid dose in the early postoperative period, and we also showed a dose-response relationship.

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“…Also is not clear whether the risk of ON is related to cumulative steroid dosage or not dose dependent. [1,[8][9][10][11][12] In the literature, some case series showed that corticosteroid associated ON could be related to individual response (e.g. changes in steroid metabolism, hypercoagulable, hypofibrinolysis and genetic factors).…”

Section: Discussionmentioning

confidence: 99%

“…[1,2] In contrast, many different investigators suggest that steroidinduced osteonecrosis is dose dependent. [1,[11][12][13] In our liver transplantation center, steroid usually tapered in three to six months. However, our patient has a history of high dose steroid usage for a long time due to immune thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Multifocal osteonecrosis and osteomyelitis in a liver transplant recipient

Ucer¹

2015

FNG & Bilim Tıp Dergisi

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Osteonecrosis is the destruction of bone as a result of temporary or permanent cessation of blood supply to the bones. Trauma, drugs, infections, hypercoagulability and solid organ transplantation are the most common causes. Osteonecrosis has been reported in many case series after renal, liver and cardiac transplantation; mainly in areas adjacent to the joints, especially on hip. Here, we are reporting multifocal osteonecrosis with osteomyelitis including diaphyseal region of the tibia in a patient with liver transplantation.

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Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Cited by 48 publications

References 21 publications

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

Effect of pentoxifylline on histopathological changes in steroid-induced osteonecrosis of femoral head: experimental study in chicken

Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis

Multifocal osteonecrosis and osteomyelitis in a liver transplant recipient

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