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

Birla, Vikas; Vaish, Abhishek; Vaishya, Raju

doi:10.1016/j.jcot.2021.101643

Cited by 9 publications

(3 citation statements)

References 57 publications

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“…Furthermore, the time interval between corticosteroid administration to FHAVN development ranged between 6 to 12 months [ 46 , 47 ]. However, some authors reported "very early" steroid-induced FHAVN, which could develop after one to three months [ 48 , 49 ].…”

Section: A-theories Behind Fhavn Development In Patients Post-covid-1...mentioning

confidence: 99%

Femoral head avascular necrosis in COVID-19 survivors: a systematic review

Hassan

Khalifa

2023

Rheumatol Int

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The current systematic review aimed to document published cases of femoral head avascular necrosis (FHAVN) post-COVID-19, to report the COVID-19 disease characteristics and management patients received, and to evaluate how the FHAVN were diagnosed and treated among various reports. A systematic literature review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a comprehensive English literature search on January 2023 through four databases (Embase, PubMed, Cochrane Library, and Scopus), including studies reporting on FHAVN post-COVID-19. Fourteen articles were included, ten (71.4%) were case reports, and four (28.6%) case series reported on 104 patients having a mean age of 42.2 ± 11.7 (14:74) years, in which 182 hip joints were affected. In 13 reports, corticosteroids were used during the COVID-19 management plan for a mean of 24.8 ± 11 (7:42) days, with a mean prednisolone equivalent dose of 1238.5 ± 492.8 (100:3520) mg. A mean of 142.1 ± 107.6 (7:459) days passed between COVID-19 diagnosis and FHAVN detection, and most of the hips were stage II (70.1%), and concomitant septic arthritis was present in eight (4.4%) hips. Most hips (147, 80.8%) were treated non-surgically, of which 143 (78.6%) hips received medical treatment, while 35 (19.2%) hips were surgically managed, 16 (8.8%) core decompression, 13 (7.1%) primary THA, five (2.7%) staged THA and three (1.6%) had first stage THA (debridement and application of antibiotic-loaded cement spacer). The outcomes were acceptable as regards hip function and pain relief. Femoral head avascular necrosis post-COVID-19 infection is a real concern, primarily attributed to corticosteroid usage, besides other factors. Early suspicion and detection are mandatory, as conservative management lines are effective during early stages with acceptable outcomes. However, surgical intervention was required for progressive collapse or patients presented in the late stage.

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Section: A-theories Behind Fhavn Development In Patients Post-covid-1...mentioning

confidence: 99%

Femoral head avascular necrosis in COVID-19 survivors: a systematic review

Hassan

Khalifa

2023

Rheumatol Int

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“…One of the most common and serious complications caused by steroid therapy is steroid-induced osteonecrosis of the femoral head (SONFH) [ 2 ]. Its incidence in patients receiving long-term steroid therapy ranges from 9 to 40%, mainly in young adults aged 30–50 [ 3 ]. SONFH seriously affects the function of the hip joint, causes hip disability, and severely affects the quality of patient life.…”

Section: Introductionmentioning

confidence: 99%

Astragalus polysaccharide ameliorates steroid-induced osteonecrosis of the femoral head by regulating miR-200b-3p-mediated Wnt/β-catenin signaling pathway via inhibiting SP1 expression

Zhang

Ke-fang

Zeng

et al. 2023

BMC Musculoskelet Disord

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Background Steroid-induced osteonecrosis of the femoral head (SONFH) is the necrosis of the femur bone caused by prolonged and massive use of corticosteroids. The present study probed into the significance of Astragalus polysaccharide (APS) in SONFH progression. Methods SONFH cell model was constructed using murine long bone osteocyte Y4 (MLO-Y4) cells and then treated with APS. mRNA microarray analysis selected differentially expressed genes between control group and SONFH group. RT-qPCR determined SP1 and miR-200b-3p expression. Levels of SP1, β-catenin, autophagy-related proteins (LC3II/LC3I, Beclin1, p62) and apoptosis-related proteins (Bax, C-caspase3, C-caspase9, Bcl-2) were tested by Western blot. ChIP and luciferase reporter assays confirmed relationship between SP1 and miR-200b-3p. Fluorescence intensity of LC3 in cells was detected by immunofluorescence. Flow cytometry assessed cell apoptosis. Osteonecrosis tissues from SONFH mice were examined by HE and TRAP staining. Results APS induced autophagy and suppressed apoptosis in SONFH cell model. APS inhibited SP1 expression and SP1 overexpression reversed effects of APS on SONFH cell model. Mechanistically, SP1 targeted miR-200b-3p to inhibit Wnt/β-catenin pathway. MiR-200b-3p depletion rescued the promoting effect of SP1 on SONFH cell model by activating Wnt/β-catenin pathway. HE staining showed that APS treatment reduced the empty lacunae and alleviated inflammation in trabecular bone of SONFH mice. TRAP staining revealed decreased osteoclasts number in SONFH mice after APS treatment. Conclusion APS regulated osteocyte autophagy and apoptosis via SP1/miR-200b-3p axis and activated Wnt/β-catenin signaling, thereby alleviating SONFH, shedding new insights for therapy of SONFH.

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“…Long-term high-dose use of glucocorticoids is the key risk factor for nontraumatic femoral head necrosis ( 4 , 5 ), which was known as steroid-induced osteonecrosis of the femoral head (SONFH). With the widespread use of glucocorticoids in the treatment of rheumatic immune diseases ( 6 , 7 ), SONFH was commonly seen in clinical, with the incidence up to 40% ( 8 , 9 ). SONFH is bilateral and symmetrical, with a wide range of necrosis and a high disability rate, which brings a catastrophic burden to patients and their families.…”

Section: Introductionmentioning

confidence: 99%

Global research trends of steroid-induced osteonecrosis of the femoral head: A 30-year bibliometric analysis

Lü¹,

Qi²,

Xu³

et al. 2022

Front. Endocrinol.

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ObjectiveTo explore the global research trends and hotspots of steroid-induced osteonecrosis of the femoral head (SONFH) through qualitative and quantitative analysis of bibliometrics.MethodsAll publications on SONFH published from 1992 to 2021 were extracted from the Web of Science Core Collection database. CiteSpace was used for the visualization analysis of major countries, active institutions, productive authors, and the burst of keywords. VOSviewer was used for coupling analysis of countries/regions, institutions, and authors. Microsoft Excel 2017 was used for statistical analysis, drawing bar charts, pie charts, and cumulative area charts. The software of MapInfo was used to draw the distribution map of the publications.ResultsA total of 780 publications were included for analyses. The most productive year was 2020 with 98 records. China was the most influential country with 494 publications, an H-index of 59, and total citations of 16820. The most prolific institution was Shanghai Jiaotong University in China with 53 publications and 998 citations. Clinical Orthopaedics and Related Research (IF = 4.755, 2021) was the most active journal with 26 articles. The hot keywords were “osteonecrosis”, “avascular necrosis”, “osteogenic differentiation”, “proliferation”, “PPAR gamma”, “apoptosis”, “oxidative stress”, “genetic polymorphism” and “mesenchymal stem cells”. The keywords like “proliferation”, “PPAR gamma” and “genome-wide” have emerged in recent years.ConclusionThe number of publications in SONFH has increased significantly in the last three decades. The pathologic mechanism of SONFH gathered most research interests. Genomics and cell molecular biology of SONFH are the research frontiers.

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

Cited by 9 publications

References 57 publications

Femoral head avascular necrosis in COVID-19 survivors: a systematic review

Femoral head avascular necrosis in COVID-19 survivors: a systematic review

Astragalus polysaccharide ameliorates steroid-induced osteonecrosis of the femoral head by regulating miR-200b-3p-mediated Wnt/β-catenin signaling pathway via inhibiting SP1 expression

Global research trends of steroid-induced osteonecrosis of the femoral head: A 30-year bibliometric analysis

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