Pathophysiology and risk factors for osteonecrosis

Shah, Kalpit N.; Racine, Jennifer; Jones, Lynne C.; Aaron, Roy K.

doi:10.1007/s12178-015-9277-8

Cited by 216 publications

(187 citation statements)

References 85 publications

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“…It has been hypothesized that chronic CS use promotes intraosseous adipocyte hypertrophy and fat conversion of red marrow, leading to increased bone marrow pressure, which compromises intraosseous perfusion 8 . Another postulated mechanism is that CS alter lipid metabolism, leading to fat microemboli in subchondral vessels 8 .…”

Section: Rheumatologymentioning

confidence: 99%

“…Many theories regarding the mechanisms leading to blood interruption have been proposed and include increased bone marrow pressure and intravascular occlusion of subchondral vessels by coagulation, fat emboli, thrombi, or abnormally shaped red blood cells. Moreover, direct osteotoxicity by alcohol and drugs can lead to bone cell death 8 . Although the use of corticosteroids (CS) has been recognized as a major risk factor for the development of ON, ON occurs more frequently in patients with SLE than in any other illness requiring administration of systemic CS 9 .…”

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confidence: 99%

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Monitoring of Osteonecrosis in Systemic Lupus Erythematosus: A Systematic Review and Metaanalysis

et al. 2018

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Objective.Nontraumatic osteonecrosis (ON) is a well-recognized complication causing disability and affecting quality of life in patients with systemic lupus erythematosus (SLE). The aim of this study was to identify the risk factors for ON, and to identify the minimal investigation(s) needed to optimally monitor the risk of ON in patients with SLE.Methods.A systematic review was conducted using MEDLINE and EMBASE. These databases were searched up to January 2016 using the Medical Subject Heading (MeSH) terms “Osteonecrosis,” “Systemic lupus erythematosus,” and synonymous text words. Randomized controlled trials, case control, cohort, and cross-sectional studies were included. Risk factors for ON in patients with SLE were compiled. The quality of each study was assessed using the Newcastle-Ottawa scale for nonrandomized studies. The quality of evidence of each risk factor was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation method.Results.Of the 545 references yielded, 50 met inclusion criteria. Corticosteroid (CS) use may be strongly associated with ON in patients with SLE. Other clinical variables were moderately associated, including hypertension, serositis, renal disease, vasculitis, arthritis, and central nervous system disease. However, the evidence was low to very low in quality.Conclusion.Based on the best evidence available, CS use may be strongly associated with ON in patients with SLE. Results of this review were considered in the development of recommendations for the diagnosis and monitoring of patients with SLE in Canada and will guide clinicians in their assessment of these patients.

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Section: Rheumatologymentioning

confidence: 99%

mentioning

confidence: 99%

Monitoring of Osteonecrosis in Systemic Lupus Erythematosus: A Systematic Review and Metaanalysis

et al. 2018

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“…The femoral head is more prone to developing osteonecrosis due to the lack of a collateral circulation and due to the fact that it has relatively avascular sinusoids and bone marrow. The etiological factors are long term alcohol or steroid intake, collagen vascular disease, sickle cell disorders and coagulopathies [4][5][6][7] . Certain cases occur without any associated etiologic factor and are deemed to be idiopathic.…”

Section: Introductionmentioning

confidence: 99%

The role of core decompression in the management of early osteonecrosis of the femoral head

Subash¹,

Ramanusan²,

Karunakaran³

2018

Int. J. Orthop. Sci.

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Background: Osteonecrosis represents the death of cellular elements in the marrow which progresses in stages resulting in collapse of the femoral head and its treatment is stage specific. The aim of this study was to evaluate the role of Core decompression in the management of early osteonecrosis of the femoral head. Methods: 15 patients with Stage 1 and 2 osteonecrosis of the femoral head were studied between January 2010 to January 2013 and were followed up for a period of 3 years. Results: Mean age of the patients was 36.3 years ranging from 29 to 41 years. There was a male preponderance seen in our study. Chronic alcoholism was the most common etiological factor followed by idiopathic and steroid induced. The average pre-operative Harris hip score was 52 which significantly increased to 79.8 in the post-operative period. All patients reported excellent relief of pain in the immediate post-operative period due to resolution of bone marrow edema. Follow up MRI revealed resolution of necrosis in 10 hips with progression seen in 1 hip. Conclusion: Core decompression is a safe, inexpensive procedure which gives good functional results in terms of pain relief and improvement in the quality of life for the patient if done in the early stages of Osteonecrosis before the onset of mechanical collapse of the femoral head.

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“…AVN, a pathological condition defined as death of all cellular elements and progressive destruction of the bone, occurs because of bone vasculature disruption, death of osteocytes and fat cells, and bone architecture alterations (5,6). Generally, various factors such as corticosteroid administration, alcohol use, smoking, radiation, hyperlipidemia, thrombophlebitis, and intravascular coagulation have been proposed as risk factors for AVN throughout the population (7)(8)(9). Joint pain radiating to buttocks, thighs, or knees while the patient bears their weight on the affected joint is the first and typical symptom of AVN (10).…”

Section: Introductionmentioning

confidence: 99%