SAT0380 Silent Osteonecrosis of the Femoral Head Following High-Dose Corticosteroids in Patients

Kianmehr, Nahid; Bidari, Ali; Mofìdi, Mani; Bahar, Nasim

doi:10.1136/annrheumdis-2013-eular.2105

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…Our study showed higher prevalence of avascular necrosis in osteoporotic patients. Some studies in lupus patients treated with cytotoxic drugs and corticosteroids have been carried out, which have shown that the prevalence of asymptomatic avascular necrosis is high in these patients (8). One of the things that justifies the difference between our study and these studies, is that avascular necrosis can be caused by lupus in lupus patients.…”

Section: Discussionmentioning

confidence: 55%

“…These drugs put patients in risk of hip avascular necrosis (6,7). Some studies in patients using glucocorticoids and immunosuppressant drugs like lupus, show that risk of femoral head avascular necrosis is high (8). One of the reasons that prevalence of femoral head avascular necrosis is higher in these patients is the use of glucocorticoids (9,10).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Asymptomatic Avascular Necrosis of the Hip in Patients With Kidney Transplantation

Kazemi

Samimagham

Tamaddondar³

et al. 2016

Acta Healthmedica

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Introduction: Kidney transplant is one of the treatments in patients with ESRD (end stage renal disease) that increases the quality of life in patients. Following kidney transplant, patients need glucocorticoid and immunosuppressant drugs. These drugs put patients in risk of hip avascular necrosis. The purpose of this study was to evaluate the prevalence of asymptomatic avascular necrosis of the hip in patients with kidney transplantation. Methods: This prospective descriptive cross-sectional study was conducted on all patients referred to the Shahid Mohammedi Hospital, Bandar Abbas, Iran, who had a kidney transplant at least six month before our study. All patients' information was collected with a questionnaire consisting of demographic information including age, sex, weight, height, history of hemodialysis, history of peritoneal dialysis, history of smoking, alcohol intake, history of prednisolone and the main variable data of the disease, including the causes of ESRD such as diabetes, hypertension and diabetes combined, polycystic kidney disease, IgA nephropathy reflux disease, focal segmental glomerulonephritis and time elapsed after the transplant. Magnetic resonance imaging (MRI) was used for the detection of avascular necrosis. Diagnosis of avascular necrosis was confirmed by two separate radiologists. Data was analyzed using IBM SPSS 21.0 software. Results: In this study, 83 patients were studied. Among these patients, 45 (54.2%) were male and 38 (45.8%) were female. The average age of the subjects was 41.29 ± 13.72 years. Demographic variables were similar in two groups. There was no relation among the vertebrae and overall results densitometry with avascular necrosis (p>0.05) . Based on this chart, prevalence of avascular necrosis in patients with osteoporotic hip based on densitometry, was significantly more than other people (p = 0.008). Conclusion: According to results, prevalence of femoral head avascular necrosis is not higher in patients after transplant and it has no significant relation to age, sex, BMI, time passed after transplant, CMV infection, hospitalization, history of dialysis or type of donator. Also, there was no significant correlation between the vertebra densitometry and the overall results of densitometry with avascular necrosis on MRI. The only factor associated with avascular necrosis in this study, was osteoporosis in the hip densitometry.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Prevalence of Asymptomatic Avascular Necrosis of the Hip in Patients With Kidney Transplantation

Kazemi

Samimagham

Tamaddondar³

et al. 2016

Acta Healthmedica

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“…Monitoring of high-risk patients with periodic hip MRI would help diagnose necrosis in its early stage. [ 40 ] The radiologic features correspond to the underlying pathology. The typical change in T1 imaging is a single density line that represents the separation of the normal and necrotic bones, while that in T2 imaging with another high signal line represents the granulation tissue with an increased vascularity.…”

Section: Iagnosis and P Rognosismentioning

confidence: 99%

Corticosteroid-induced Osteonecrosis of the Femoral Head

Liu

Zhang

Sun

et al. 2017

Chinese Medical Journal

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Objective:This review aimed to provide a current recommendation to multidisciplinary physicians for early detection, diagnosis, and treatment of corticosteroid-induced osteonecrosis of the femoral head (ONFH) based on a comprehensive analysis of the clinical literature.Data Sources:For the purpose of collecting potentially eligible articles, we searched for articles in the PubMed, Cochrane Library, Embase, and CNKI databases up to February 2017, using the following key words: “corticosteroid”, “osteonecrosis of the femoral head”, “risk factors”, “diagnosis”, “prognosis”, and “treatment”.Study Selection:Articles on relationships between corticosteroid and ONFH were selected for this review. Articles on the diagnosis, prognosis, and intervention of earlier-stage ONFH were also reviewed.Results:The incidence of corticosteroid-induced ONFH was associated with high doses of corticosteroids, and underlying diseases in certain predisposed individuals mainly occurred in the first 3 months of corticosteroid prescription. The enhanced awareness and minimized exposure to the established risk factors and earlier definitive diagnosis are essential for the success of joint preservation. When following up patients with ONFH, treatment should be started if necessary. Surgical treatment yielded better results than conservative therapy in earlier-stage ONFH. The ideal purpose of earlier intervention and treatment is permanent preservation of the femoral head without physical restrictions in daily living.Conclusions:Clinicians should enhance their precaution awareness of corticosteroid-induced ONFH. For high-risk patients, regular follow-up is very important in the 1st year after high-dose prescription of corticosteroids. Patients with suspected ONFH should be referred to orthopedists for diagnosis and treatment in its earlier stage to preserve the joint.

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“…Meanwhile, it is estimated that 15,000-20,000 new cases of ONFH are diagnosed in the US each year [7]. The incidence of ONFH is increasing, and more patients with ONFH are now diagnosed in the clinic [8,9].…”

Section: Introductionmentioning

confidence: 99%

The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: A systematic review

Han

Gao²,

Sun³

et al. 2019

Preprint

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Background: As a pathological process, osteonecrosis of the femoral head (ONFH) is characterized by the avascularity of the femoral head, cellular necrosis, microfracture, and the collapse of the articular surface. Currently, critical treatment for early stage ONFH is limited to core decompression. However, the efficacy of core decompression remains controversial. To improve the core decompression efficacy, regenerative techniques such as the use of platelet-rich plasma (PRP) were proposed for early stage ONFH. As a type of autologous plasma containing concentrations of platelets greater than the baseline, PRP plays an important role in tissue repair, regeneration, and the differentiation of mesenchymal stem cells (MSCs). In this review, we present a comprehensive overview of the operation modes, mechanism and efficacy of PRP for early stage ONFH treatment. Methods: We searched for relevant studies in the PubMed, Web of Science, and Embase databases. By searching these electronic databases, the identification of either clinical or experimental studies evaluating PRP, MSC, core decompression and ONFH was our goal. Results: Seventeen studies of PRP and avascular necrosis of the femoral head were evaluated in our review. Ten studies related to the possible mechanism of PRP for treating ONFH were reviewed. Seven studies of the operation modes of PRP in treating ONFH were identified. We reviewed the efficacy of PRP in treating ONFH systematically and made an attempt to compare the PRP operation modes in 7 studies and other operation modes in past studies for early stage ONFH treatment. Conclusion: PRP treats ONFH mainly through three mechanisms: inducing angiogenesis and osteogenesis to accelerate bone healing; inhibiting inflammatory reactions in necrotic lesions; and preventing apoptosis induced by glucocorticoids. In addition, as an adjunctive therapy for core decompression, the use of PRP is recommended to improve the treatment of early stage ONFH patients, especially when combined with stem cells and bone grafts, by inducing osteogenic activity and stimulating the differentiation of stem cells in necrotic lesions.

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SAT0380 Silent Osteonecrosis of the Femoral Head Following High-Dose Corticosteroids in Patients

Cited by 9 publications

References 13 publications

Prevalence of Asymptomatic Avascular Necrosis of the Hip in Patients With Kidney Transplantation

Prevalence of Asymptomatic Avascular Necrosis of the Hip in Patients With Kidney Transplantation

Corticosteroid-induced Osteonecrosis of the Femoral Head

The use of platelet-rich plasma for the treatment of osteonecrosis of the femoral head: A systematic review

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