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

In addition to intravenous administration, other applications of corticosteroid may induce femoral head necrosis. Corticosteroid is an effective choice for various inflammatory diseases. However, it may be abused to a certain extent without patients being informed, especially the long-acting dexamethasone with longer incubation periods. Children who received dexamethasone had a higher incidence of skeletal morbidity than those who were treated with prednisolone (P = 0.027, odds ratio: 2.6, 95% confidence interval: 1.1-5.9). [11] Long-acting corticosteroid use yielded a higher risk of ONFH. There were sporadic case reports on topical steroid application-induced ONFH. Egger and Ballock [12] reported a case of a 10-year-old boy who developed ipsilateral ONFH after long-term inhalational corticosteroid and intermittent short courses of oral steroid use. Moreover, a 34-year-old woman developed bilateral ONFH during the peripartum period after two large intramuscular injections of steroids for fetal lung maturity. [13] Dharmshaktu et al. [14] reported an occurrence of bilateral ONFH with a physiological replacement dose of glucocorticoids in a 38-year-old man with nonsecreting pituitary adenoma.