Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic

Zhang, Shenqi; Wang, Chengbin; Shi, Lei; Xue, Qingyun

doi:10.2147/dddt.s298691

Cited by 63 publications

(51 citation statements)

References 100 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At last, Corticosteroid therapy in COVID-19 is known as a risk factor for osteonecrosis [10]. Zhang et al [11], reported that the complications of steroids on bones and cartilages after COVID-19 infection. They concluded that steroids administration for treatment of SARS-CoV-2 infection could develop adverse effects on bones and cause steroid-induced avascular necrosis of the femur.…”

Section: Discussionmentioning

confidence: 99%

Osteodiscitis Post- COVID-19 Infection: A Case Series

Rezvani

Zohrevand

Namazee

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Coronavirus disease (COVID-19) is an infectious disease. It affects almost all organs of the human body. Lumbar osteodiscitis is an infection of the vertebral body and disc. The association of COVID-19 with osteodiscitis has not been reported in the literature so far. The purpose of this study was to describe a series of four cases manifested as post-COVID-19 osteodiscitis.Case presentation: We performed a retrospective assessment of the clinical, radiological, and microbiological features of adult post-COVID-19 patients who underwent surgery for unstable lumbar osteodiscitis at our hospital. The mean age of patients was 45.8±7.8 years. All the patients were treated according to their clinical conditions through a combined surgical approach as laminectomy, facetectomy, pedicular screw insertion, and fusion. The clear causes of infection were not recognized by routine methods, and COVID-19 was the only common factor in patients in the last 6 to 8 weeks.Conclusions: This case series suggest that osteodiscitis could be one of the possible side effects after COVID-19 infection.

show abstract

Section: Discussionmentioning

confidence: 99%

Osteodiscitis Post- COVID-19 Infection: A Case Series

Rezvani

Zohrevand

Namazee

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…A textbook example being the reduced and worsened glycaemic control in diabetic patients whom are treated using corticosteroids [8,9]. As in the case of mucormycotic infections and their relationship with the immunosuppressive nature of corticosteroid therapy used in the treatment of COVID-19; a rise in cases of avascular necrosis of the femoral head is being reported and is being attributed to the sustained and aggressive corticosteroid therapy being implemented [10,11].…”

Section: Complications Of Corticosteroid Therapymentioning

confidence: 99%

“…This is in contrast to the current literature which states that AVN takes 6 months to 1 year to develop post corticosteroid therapy [15,17]. It has been long established that steroids induced AVN, however reports of AVN developing rapidly in COVID-19 patients post treatment where specific treatment guidelines to avoid steroid induced AVN have been adhered to suggest that the COVID-19 infection itself may also be instrumental in the development of AVN and that steroid use is not the sole benefactor to inducing AVN post steroid therapy [15,16]. Prevention Current guidelines suggest that a cumulative ceiling dose of 2000mg of prednisolone or its equivalent should not be breached in order to prevent the development of AVN, however as seen in the research conducted by Agarwal et al it is evident that AVN is being induced in patients treated far below the 2000mg ceiling.…”

Section: Steroid Induced Avascular Necrosis Of the Femoral Head (Sanfh)mentioning

confidence: 99%

Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma

Banerjee¹,

Robinson²,

Sathian

2021

Nepal J Epidemiology

View full text Add to dashboard Cite

The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head. It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing. Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whilst increasing the activity of osteoclasts, thus increasing bone resorption and decreasing calcium uptake and deposition; ultimately leading to an insufficiency in the trabecular and cortical bone. This insufficiency thus equates to an increased intraosseous pressure which impedes intramedullary circulation and results in avascular necrosis. It is evident that avascular necrosis is directly caused by high dose steroid therapy, however the case reports have very clearly indicated that the rapid onset of AVN post recovery from the COVID-19 infection cannot be solely attributed to steroid therapy and that another benefactor induced by the COVID-19 infection is at play. It is thus vital for treating physicians to take cognisance of this adverse effect post recovery and therefore should ensure that prophylactic bisphosphonate therapy is initiated timeously and congruently.

show abstract

“…8e11 It is reported that 23.1% cases developed SONFH after the use of high doses of steroids to treat SARS. 12,13 It was noted that the incidence of SONFH exist in a substantial number of cases who have taken steroids and it is further increased if they are taken for a systemic inflammatory disease.…”

Section: Incidence Of Sonfhmentioning

confidence: 99%

“…21 During COVID-19 pandemic, an increased and early onset ONFH was reported and was correlated with the use of high doses of steroids and to the coagulopathy associated with this disease. 12,22 Osteonecrosis in a steroid-treated case does not mean that mere steroids might have caused it. All the possible risk factors should be considered as in most cases it's a cumulative effect leading to ON.…”

Section: Underlying Diseasementioning

confidence: 99%

Risk factors and pathogenesis of steroid-induced osteonecrosis of femoral head - A scoping review

Birla

Vaish

Vaishya

2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Steroid induced osteonecrosis of the femoral head is commonly seen in clinical practice, but yet not fully understood. It is intriguing why only some cases develop and others escape from it. We did an extensive and up to date literature review on it, with the aim to identify its incidence, associated risk factor and pathogenesis. We found that the incidence ranged from 03 to 40%, and was more with associated risk factors. Several risk factors were identified, which included higher dose and prolonged duration of steroid consumption, and underlying disease for which the steroids were given. Pathogenesis of this disease is complex and not yet fully understood. Awareness about this condition and associated risk factors should help the clinicians in identifying the cases who are prone to develop osteonecrosis with the use of steroids.

show abstract

Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic

Cited by 63 publications

References 100 publications

Osteodiscitis Post- COVID-19 Infection: A Case Series

Osteodiscitis Post- COVID-19 Infection: A Case Series

Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma

Risk factors and pathogenesis of steroid-induced osteonecrosis of femoral head - A scoping review

Contact Info

Product

Resources

About