Abnormal Lipid Profiles in Nontraumatic Osteonecrosis of the Femoral Head

Abstract

Background:Abnormal lipid metabolism may play an important role in the development of nontraumatic osteonecrosis of the femoral head (ON). By comparing lipid biomarkers in patients with ON and osteoarthritis (OA) after propensity score matching, we sought to reveal (1) common lipid biomarkers that are abnormal in ON regardless of the etiology and (2) specific lipid biomarkers associated with ON according to the etiology.Methods:Among 2,268 patients who underwent primary THA, 1,021 patients were eligible for this study. According to the Association Research Circulation Osseous criteria, ON was classified as either idiopathic (n = 230), alcohol-associated (n = 293), or glucocorticoid-associated ON (n = 132). Most common cause of OA was hip dysplasia in 106 patients (47%). We investigated patient lipid profiles by assessing total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), apolipoprotein (Apo) A1 and B, lipoprotein (a) levels and ApoB/A1 ratio. Since age and body mass index affect the lipid profile, we performed propensity score matching to select 304 patients for final analysis and compared lipid profiles between the ON and OA groups. We also compared biomarkers between the ON subgroups and the OA group.Results:Overall, the ON group showed lower HDL-C (p < 0.001), higher TGs (p = 0.001) levels and higher ApoB/A1 ratio (p = 0.003). Idiopathic ON patients demonstrated lower HDL-C (p = 0.032), higher TGs (p = 0.016), ApoB (p = 0.024) levels and ApoB/A1 ratio (p = 0.008). The alcohol-associated ON subgroup showed lower HDL-C (p < 0.001), higher TGs (p = 0.010) levels and ApoB/A1 ratio (p = 0.030). Finally, the steroid-associated ON subgroup demonstrated lower HDL-C (p = 0.003), higher TGs (p = 0.039), lower TC (p = 0.022), LDL-C (p = 0.021), and ApoA1 (p = 0.004) levels.Conclusions:Higher TGs and lower HDL-C levels were associated with nontraumatic ON regardless of the etiology. Additionally, idiopathic ON was associated with higher ApoB levels and ApoB/A1 ratio. Alcohol-associated ON was related to higher ApoB/A1 ratio, and steroid-associated ON paired with decreased TC, LDL-C, and ApoA1 levels. Our findings may support future efforts for prevention and management of nontraumatic ON.Level of Evidence:Diagnostic Level III.

Unraveling the Role of Endothelial Dysfunction in Osteonecrosis of the Femoral Head: A Pathway to New Therapies

“…By augmenting PAI-1 levels and diminishing tPA levels, GCs provoke an increase in coagulation and reduce fibrinolytic activity [ 63 , 64 ]. In patients and animal models of GIONFH, a great deal of fibrinogen and lipoprotein imply a hypercoagulable environment at the site of bone lesions [ 65 , 66 ]. A great deal of fibrinogen and lipoprotein results in activated platelets and retarded thrombolysis, further supporting the notion that thrombophilia and low fibrinolysis are closely associated with disease progression in osteonecrosis [ 67 ].…”

Advances in the Pathogenesis of Steroid-Associated Osteonecrosis of the Femoral Head

“…The occurrence of femoral head necrosis is associated with an increase in interleukin-6 (IL-6) secretion in macrophages [ 38 ]. Bai pointed out that high triglyceride (TG) and low high-density lipoprotein (HDL-C) levels were both associated with SANFH [ 39 ].…”

Complex causal association between genetically predicted 731 immunocyte phenotype and osteonecrosis: a bidirectional two-sample Mendelian randomization analysis

“…Osteonecrosis is currently considered to be a multifactorial disease 12 , such as genetic susceptibility 13 , apoptosis of bone cells 14 , abnormal lipid metabolism 15 , osteoporosis 16 , oxidative stress 17 , intraosseous hypertension 18 , thrombosis 19 , and coagulation disorders 20 . In recent years, the influence of the interaction between innate and adaptive immune cells and osteoblasts on the balance of bone metabolism has attracted more and more attention in a variety of bone tissue diseases, which has developed into a new discipline, osteoimmunology 21 , 22 .…”