Steroid-associated osteonecrosis: Epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview)

Xie, Xin-Hui; Wang, Xin-Luan; Yang, Hui-Lin; Zhao, De-Wei; Qin, Ling

It was reported that statins usage can partly lower the risk of ON. A retrospective report from Pritchett [59] showed that the ON incidence was only 1% in 284 patients who had received high-dose corticosteroids while under concurrent statins administration, which was significantly lower than the historical value of 3e20% without adjunct therapy [55] . Ajmal et al [45] analysed the renal transplant database to prove that statins usage could reduce the incidence of SAON and identified 2881 renal transplantation patients who met the entry criteria of ON. Among patients who used statins, 4.4% developed ON, versus 7% in patients who were not on statins. The prevention of SAON in animal experiments showed that statins could prevent SAON development due to their inhibition of adipogenesis and lipid deposition, reduction of blood viscosity by suppressing PPAR(sup) expression and activating the Wnt signalling pathway [42, 56, 57] . Enoxaparin, one of the anticoagulants, has less ability to inactivate thrombin and can reduce the incidence of steroid-induced ON in rabbits when combined with lovastatin [48] .