Steroid-induced osteonecrosis

Abstract

Severe acute respiratory syndrome (SARS) is a newly described infectious disease caused by the SARS coronavirus which attacks the immune system and pulmonary epithelium. It is treated with regular high doses of corticosteroids. Our aim was to determine the relationship between the dosage of steroids and the number and distribution of osteonecrotic lesions in patients treated with steroids during the SARS epidemic in Beijing, China in 2003. We identified 114 patients for inclusion in the study. Of these, 43 with osteonecrosis received a significantly higher cumulative and peak methylprednisolone-equivalent dose than 71 patients with no osteonecrosis identified by MRI. We confirmed that the number of osteonecrotic lesions was directly related to the dosage of steroids and that a very high dose, a peak dose of more than 200 mg or a cumulative methylprednisolone-equivalent dose of more than 4000 mg, is a significant risk factor for multifocal osteonecrosis with both epiphyseal and diaphyseal lesions. Patients with diaphyseal osteonecrosis received a significantly higher cumulative methylprednisolone-equivalent dose than those with epiphyseal osteonecrosis. Multifocal osteonecrosis should be suspected if a patient is diagnosed with osteonecrosis in the shaft of a long bone.

Inflammatory Bowel Disease, High-Dose Steroids, Osteoporosis, or an Oncological Etiology for a Pathological Femoral Neck Fracture in a Young Adult: A Case Report

“…At the time of initial treatment, the patient’s hip fracture was thought to be due to her long-standing osteoporosis from high-dose corticosteroid use for the treatment of her ulcerative colitis. Long-term use of steroids leading to osteoporosis and increased risk of fractures has been well documented in the literature [5-7]. Gasterointestinal diseases in childhood have also been implicated as a cause of osteoporosis [8].…”

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

“…In another study on 540 SLE patients, mean daily dose and intravenous pulse in addition to cumulative dose of prednisolone were related to ON ( 12 ). Zhang et al showed that the number of ON lesions was directly associated with the dosage of CS, pulse and cumulative regimen ( 13 ). In other survey on 106 SLE patients during follow up period of 13.6 years, total duration of CS and duration of treatment was not related to ON ( 14 ).…”

Bilateral Osteonecrosis of the Femoral Head During Pregnancy Following Two Corticosteroid Injections: A Case Report and Review of the Literature

“…A particularly devastating cause is steroid use, which may result in fat and/or thromboembolism and compromise the blood supply to the femoral head [ 1 ]. However, little is understood about the duration and quantity of steroids required to cause osteonecrosis [ 5 - 7 ].…”