Osteonecrosis of the hip after short courses of oral and inhaled steroids in a child with an increased number of glucocorticoid receptors

Drigo, Ilenia; Saccari, Alessia; Barbi, Egidio; Bartoli, Fiora; Decorti, Giuliana; Ventura, Alessandro

doi:10.1007/s00431-006-0197-x

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…In theory, the cumulative dose of inhaled steroid over a lifetime could add up to sizeable amounts. However, conclusions regarding steroid risk are again difficult to draw from the 4 reported cases related to inhaled steroids [14][15][16][17] because all cases were concurrently or subsequently treated with oral steroids prior to the diagnosis of osteonecrosis. Though no studies have been performed, the recent unapproved but commonplace use of swallowed ultra high dose inhaled steroids (specifically fluticasone dipropionate) to treat eosinophilic esophagitis will increase the risk of osteonecrosis in these patients.…”

Section: Case Reportsmentioning

confidence: 99%

Steroid induced osteonecrosis: An analysis of steroid dosing risk

Powell

Chang²,

Naguwa

et al. 2010

Autoimmunity Reviews

148

149

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Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.

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Section: Case Reportsmentioning

confidence: 99%

Steroid induced osteonecrosis: An analysis of steroid dosing risk

Powell

Chang²,

Naguwa

et al. 2010

Autoimmunity Reviews

148

149

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“…However, the concurrence of them is rarely reported possibly due to overlook of either condition. Drigo I et al (7) described a child with increased number of GC receptors developed osteonecrosis and recurrent myopathy with steroid therapy. Here we reported concurrence of GC-induced osteonecrosis and pathologically confirmed myopathy in a patient with ABCB1 polymorphisms.…”

Section: Discussionmentioning

confidence: 99%

Concurrence of osteonecrosis and steroid myopathy secondary to oral steroid therapy in a patient with ABCB1 gene polymorphisms: A case report

Lin

2022

Front. Endocrinol.

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Glucocorticoids (GCs) are widely used in various autoimmune diseases. Side effects may occur in patients with long-term or high-dose GC usage. Among them, steroid myopathy and osteonecrosis are two severe forms. We report a patient with pemphigus vulgaris on GC-treatment who developed muscle weakness when a cumulative dose of methylprednisolone reached about 20g (14-80mg/d for 2.5 years). Laboratory tests showed slightly elevated lactate dehydrogenase and hydroxybutyrate dehydrogenase. MRI revealed osteonecrosis in the femoral head, distal femur, and proximal tibia of both legs. The biopsy of the right quadriceps revealed atrophy of type II myofiber without leukocyte infiltration, which was suggestive of steroid myopathy. Genotyping of the patient showed 5G/5G genotype of the PAI-1 gene and CC genotype of the ABCB1 gene (C3435T), suggesting she was sensitive to GCs. The patient’s lesions were considered to be GC-induced adverse events, which were improved with tapering GC. Therefore, it is important to recognize steroid-induced musculoskeletal side effects and genotyping favors personalized medication.

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“…Other than the corticosteroid use, she had no known risk factors for the development of osteonecrosis. However, upon further testing she was found to have an increased number of glucocorticoid receptor sites per cell and thus an increased sensitivity to the medication [9]. …”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the Femoral Head in an Adolescent on Long-Term Inhalational Corticosteroids

Egger

Ballock

2017

Case Reports in Pediatrics

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A relationship between the development of osteonecrosis of the femoral head and systemic corticosteroids has been well established in the literature, particularly in adults. However, the link between osteonecrosis and inhaled corticosteroids is less researched and understood. We report an usual case report of a 10-year-old male who developed ipsilateral femoral head osteonecrosis after long-term inhalational corticosteroid and intermittent short courses of oral steroid usage with a unique presentation and delayed diagnosis.

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Osteonecrosis of the hip after short courses of oral and inhaled steroids in a child with an increased number of glucocorticoid receptors

Cited by 5 publications

References 10 publications

Steroid induced osteonecrosis: An analysis of steroid dosing risk

Steroid induced osteonecrosis: An analysis of steroid dosing risk

Concurrence of osteonecrosis and steroid myopathy secondary to oral steroid therapy in a patient with ABCB1 gene polymorphisms: A case report

Osteonecrosis of the Femoral Head in an Adolescent on Long-Term Inhalational Corticosteroids

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