Statin Therapy Decreases the Risk of Osteonecrosis in Patients Receiving Steroids

Pritchett, James W.

doi:10.1097/00003086-200105000-00022

Cited by 233 publications

(145 citation statements)

References 18 publications

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“…Several researchers have shown steroid-induced ON can be prevented by medications [6,17,18], and a study that used the same rabbit model as ours reported a reduction in ON frequency to 30% to 40% [16]. Our study showed similar suppressive effects, and no rabbits developed tissue damage due to electromagnetism.…”

Section: Groupsupporting

confidence: 81%

Electromagnetic Fields

Ishida

Fujioka

Takahashi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Establishing a means to prevent osteonecrosis after corticosteroid administration is an important theme. We asked whether pulsed electromagnetic field stimulation, a noninvasive treatment, could prevent osteonecrosis. Ninety rabbits were divided into four treatment groups: (1) exposure of 10 hours per day to electromagnetic stimulation for 1 week, followed by injection of methylprednisolone (20 mg/kg), and exposure of 10 hours per day to electromagnetism for a further 4 weeks (n = 40); (2) methylprednisolone injection only (n = 40); (3) no treatment (n = 5); and (4) exposure of 10 hours per day to electromagnetism for 5 weeks (n = 5). After 5 weeks, we harvested and histologically examined femurs bilaterally. The frequency of osteonecrosis was lower in the steroidelectromagnetism group (15/40) than in the steroid-only group (26/40). No necrotic lesions were found in the two control groups. We observed no clear effects of electromagnetism on the number, location, extent, and repair of necrotic lesions and intramedullary fat cell size in affected rabbits. Pulsed electromagnetic field stimulation reportedly augments angiogenesis factors and dilates blood vessels; these effects may lower the frequency of osteonecrosis. Exposure to pulsed electromagnetic field stimulation before corticosteroid administration could be an effective means to reduce the risk of osteonecrosis.

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Section: Groupsupporting

confidence: 81%

Electromagnetic Fields

Ishida

Fujioka

Takahashi

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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“…In the rabbit ON model, hyperlipidemia with associated abnormal thrombophilic coagulopathy has been linked to the development of ON [32,33]. Based on these findings, several recent clinical and experimental studies have explored the effects of lipid-lowering agents on preventing ON [20,23,30]. Wang et al [30] reported lovastatin prevented steroid-induced osteonecrosis in a chicken model.…”

Section: Introductionmentioning

confidence: 99%

Pitavastatin may Reduce Risk of Steroid-induced Osteonecrosis in Rabbits: A Preliminary Histological Study

Nishida

Yamamoto

Motomura

et al. 2008

Clinical Orthopaedics &Amp; Related Research

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Several animal and human studies suggest pharmacological approaches may prevent steroid-induced osteonecrosis (ON). We asked whether the newly developed 3-hydroxymethyl-3-glutaryl-CoA (HMG-CoA) reductase inhibitor, pitavastatin, could prevent steroidinduced ON in rabbits. We injected 65 adult male Japanese white rabbits once with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle. The rabbits were divided into two groups; one group of 35 rabbits received pitavastatins (PS), and the other group of 30 rabbits received no prophylaxis (CTR). Hematological examinations were performed just before the steroid injection (0 weeks) and at 1 and 2 weeks after steroid injection; both the femora and the humeri were histologically examined 2 weeks postinjection. The incidence of histologic changes consistent with early ON in the PS group (13 of 35; 37%) was lower in comparison to the CTR group (21 of 30; 70%). The size of the bone marrow fat cells in the PS group (56.6 ± 10 lm) was smaller than those in the CTR group (60 ± 4 lm). The data suggest pitavastatin has the potential to lower the incidence of steroid-induced ON in rabbits.

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“…According to a chicken model, Wang et al suggested that lovastatin prevented steroid-induced ION [47], and a study by Nishida et al using a rabbit model also revealed that pitavastatin had a similar efect [48]. In humans, it has been reported that the incidence of osteonecrosis was decreased by 1% by administration of statins in a study of 284 patients with various disorders (excluding SLE) who received glucocorticoid treatment [49]. We used pravastatin, pitavastatin, lovastatin, and atorvastatin for prevention of ION, but no such preventive efect was observed [32].…”

Section: Lipid Levels Statins and Ionmentioning

confidence: 99%

“…One database review found that only 1% of 284 patients developed ION after treatment with statins before glucocorticoid use. In renal transplant recipients, among 338 patients who were treated with statins, 15 (4.4%) developed ION and among 2543 patients who were not treated with statins, 180 (7%) patients developed ION [49]. Antioxidant agents have been shown to inhibit osteonecrosis in animal models [51].…”

Section: Prevention Of Osteonecrosismentioning

confidence: 99%

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Kuroda¹,

Sato²

2017

Lupus

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Osteonecrosis and osteoporosis are frequent adverse efects of glucocorticoid therapy of systemic lupus erythematosus (SLE). Idiopathic osteonecrosis (ION) of the femoral head occurs in 3-40% of patients receiving glucocorticoid, and can also develop in other bones. Higher doses of glucocorticoid and steroid pulse therapy are considered to be risk factors for ION of the femoral head. To analyze these risk factors, it seems important to detect early changes in the femoral head by magnetic resonance imaging and to monitor early clinical events atributable to steroid therapy. Prophylaxis with statins and warfarin remains debatable. The use of glucocorticoid is increase the risk of bone fractures. Bisphosphonate (BP) is used for its prevention and treatment of osteoporosis. Atypical femoral fracture (AFF) has been recently recognized as a complication associated with BP use. AFF is considered to be a form of stress fracture; localized periosteal thickening of the lateral cortex is often present at the fracture site. The thickening has been recently recognized as a complication associated with the use of antiresorptive agents such as BP and denosumab. As long-term BP/glucocorticoid use is a risk factor for beaking in patients with SLE , temporary withdrawal of BP administration should be considered.

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Statin Therapy Decreases the Risk of Osteonecrosis in Patients Receiving Steroids

Cited by 233 publications

References 18 publications

Electromagnetic Fields

Electromagnetic Fields

Pitavastatin may Reduce Risk of Steroid-induced Osteonecrosis in Rabbits: A Preliminary Histological Study

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

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