Corticosteroid-induced Osteonecrosis of the Femoral Head: Detection, Diagnosis, and Treatment in Earlier Stages

Liu, Li-Hua; Zhang, Qing-Yu; Sun, Wei; Li, Zi-Rong; Gao, Fu-Qiang

Many studies have shown the relevance between ONFH and dose and treatment duration of corticosteroids, although it is disputable. The systemic use of corticosteroids as the gold standard treatment for many diseases is an independent factor for corticosteroid-induced ONFH, and the number of osteonecrosis is also directly associated with the dose of steroids. [1] [2] [3] [4] [5] Concepts, such as daily corticosteroid dose, daily corticosteroid dose per weight, cumulative corticosteroid dose, and pulse dose, were used as possible measuring indices. The comparative study of Kameda et al. [6] showed that the development of ONFH depended on the response to a high dose of corticosteroid therapy and a decrease in the bone mineral density value in the 1 st year. The prospective study of Shigemura et al. [7] showed that a high corticosteroid dosage (>40 mg/d) had a significantly higher risk of osteonecrosis. The study also indicated that adolescent and adult patients had a significantly higher risk of osteonecrosis than pediatric patients. Mont et al. [2] supported that patients treated with daily doses of >40 mg were at a higher risk, with a 3.6% increase in incidence for every 10 mg increase in dose. Saito et al. [8] pointed out a significant dose-response relationship between the development of ONFH and the total dose of steroid administered in the first 2 weeks after renal transplantation. Further, a study showed that their pulse steroid treatment group had a higher rate of avascular osteonecrosis than their control group. [9] The long-term results of multifocal osteonecrosis related to continuous treatment of corticosteroids showed that continuation of peak doses predicted the occurrence of new lesions, and the continuation of corticosteroids without peak doses was a risk factor for a quicker progression to collapse. [10] The available literatures demonstrated that high-dose corticosteroid treatments might increase the risk of developing osteonecrosis, especially in the first 3 months.