High-Dose Corticosteroid Use and Risk of Hip Osteonecrosis: Meta-Analysis and Systematic Literature Review

Abstract

The effect of varying corticosteroid regimens on hip osteonecrosis incidence remains unclear. We performed a meta-analysis and systematic literature review to determine osteonecrosis occurrences in patients taking corticosteroids at varying mean and cumulative doses and treatment durations, and whether medical diagnoses affected osteonecrosis incidence. Fifty-seven studies (23,561 patients) were reviewed. Regression analysis determined significance between corticosteroid usage and osteonecrosis incidence. Osteonecrosis incidence was 6.7% with corticosteroid treatment of >2 g (prednisone-equivalent). Systemic lupus erythematosus patients had positive correlations between dose and osteonecrosis incidence. Each 10 mg/d increase was associated with a 3.6% increase in osteonecrosis rate, and >20 mg/d resulted in a higher osteonecrosis incidence. Clinicians must be wary of osteonecrosis in patients on high corticosteroid regimens, particularly in systematic lupus erythematosus.

Microarray analysis of long‐noncoding RNAs and mRNA expression profiles in human steroid‐induced avascular necrosis of the femoral head

“…Steroid administration and diseases treated with steroids are the main etiologies of nontraumatic AVNFH . Steroid‐induced AVNFH (SAVNFH) is dose‐dependent; a 10 mg/day increase in steroid dosage is correlated with a 3.6% increase in the incidence of AVNFH, and a dosage of >20 mg/day leads to an even higher incidence of AVNFH . There are several hypotheses regarding the mechanism of SAVNFH .…”

Salter innominate osteotomy for the treatment of developmental dysplasia of the hip: 37 years of follow-up

“…[6] Hastada kortizon kullanımına bağlı osteonekroz ve daha sonra sekonder osteoartrit geliş-meseydi, muhtemelen, sağ kalça ekleminde de ağrı ve hareket kısıtlanması olmayacaktı.…”

“…Atravmatik femur başı avasküler nekrozunun kesinleşmiş risk faktörleri arasında kortikosteroid kullanımı yer almaktadır. [6] Bu makalede 37 yıl önce iki taraflı GKD nedeniyle (kıdemli yazar OŞA tarafından) iki taraflı Salter innominat osteotomisi yapılan bir hastanın ameliyattan 37 yıl sonraki radyolojik ve klinik durumu bildirildi.…”

The Treatment of Osteonecrosis in the Hip

“…Vasoconstriction of femoral head epiphyseal arteries may also be enhanced by corticosteroids. In fact, Mont et al (3) showed that there is a direct correlation, which is dose dependent, with corticosteroid use and osteonecrosis with an occurrence rate of 6.7% in patients taking over 2 g per day of steroid. Intravascular occlusion can be caused by thrombosis, fat or gas embolization, and sickle cell aggregation (4).…”