Idiopathic and secondary osteonecrosis of the femoral head show different thrombophilic changes and normal or higher levels of platelet growth factors

Abstract

Background and purpose Thrombophilia represents a risk factor both for idiopathic and secondary osteonecrosis (ON). We evaluated whether clotting changes in idiopathic ON were different from corticosteroid-associated ON. As platelet-rich plasma has been proposed as an adjuvant in surgery, we also assessed whether platelet and serum growth factors were similar to those in healthy subjects.Methods 18 patients with idiopathic ON and 18 with corticosteroid-associated ON were compared with 44 controls for acquired and inherited thrombophilia. Platelet factor 4 (PF4), transforming growth factor-β1, platelet-derived growth factor-BB (PDGF-BB), and vascular endothelial growth factor were assayed in the supernatants of thrombin-activated platelets, in platelet lysates, and in serum from 14 ON patients and 10 controls.Results Idiopathic ON patients had higher plasminogen levels (median 118%) than controls (101%) (p = 0.02). Those with corticosteroid-associated ON had significantly higher D-dimer (333 ng/mL) and lower protein C levels (129%) than controls (164 ng/mL, p = 0.004; 160%, p = 0.02). The frequency of inherited thrombophilia was not different from the controls. No statistically significant differences were found between idiopathic and corticosteroid-associated ON. 20 of the 36 ON patients were smokers. (The controls were selected from smokers because nicotine favors hypercoagulability). ON patients had significantly higher serum PF4 levels (7,383 IU/mL) and PDGF-BB levels (3.1 ng/mL) than controls (4,697 IU/mL, p = 0.005; 2.2 ng/mL, p = 0.02).Interpretation Acquired hypercoagulability was common in both ON types, but the specific changes varied. The release of GF from platelets was not affected, providing a biological basis for platelet-rich plasma being used as an adjuvant in surgical treatment.

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?

“…Cenni et al 50 noted higher plasminogen and D-dimer in idiopathic osteonecrosis and lower protein-C in steroid-induced osteonecrosis. Wu et al 314 observed lower antithrombin III in patients with osteonecrosis.…”

“…Dysfunction of endothelial progenitor cells, which participate in vasculogenesis, has been demonstrated 25,[46][47][48] . Other research has focused on inherited thrombophilia and hypofibrinolysis as risk factors for blood flow impediment [49][50][51][52][53][54] .…”

Tardive hip disease diagnosis in a young adult with sickle cell disease

“…Some aetiopathogenetic mechanisms have been suggested for osteonecrosis in sickle cell disease. Some studies have implicated increased intraosseous pressure due a disorder in circulation supplying the proximal femur with occlusion in to femoral head sinusoid by sickle red cells 5 . This phenomenon has been implicated in the cause of pain and evolution of osteonecrosis.…”

Avascular osteonecrosis of the hip in patient after adjuvant radiotherapy for rectal cancer

“…Its development is related to the influence of different adverse factors on bone structure such as corticosteroids, alcohol abuse, chemotherapy or, as recently postulated, thrombophilia. Bones such as the femoral or arm head as well as small bones of the hands and feet receive their blood supply from single, terminal blood vessels only, and thus are more vulnerable to AVN, compared with the areas supplied by wide blood vessel networks derived from various overlapping sources [1][2][3][4][5].…”