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

A lower incidence of SAON happened in Hong Kong and Guang Zhou in China during explosion of severe acute respiratory syndrome (SARS) but was higher in Beijing e partially explained by use of the antiinflammatory herbs, but no clinical trials were performed, so our group established both quadrupedal and bipedal models for testing and supporting herbal Epimedium in the prevention of SAON, with functions in bone formation stimulation, anti-adipogenesis etc. [7, 10, 11, 16, 24, 25] . Liuwei Dihuang pills and Huogu I formula can prevent SAON by improving lipid metabolism, relieving bone lesions, and protecting against cell death [46, 54] . Genistein aglycone, an isoflavone acting on de novo protein synthesis and on amplification of the interaction between the oestrogen receptor complex and nuclear DNA in osteoblasts, could prevent complications of ON with longterm glucocorticoid treatment due to its action on trabecular bone by a mechanism involving estrogen receptor (ER)-b upregulation during the bone mineralisation phase [47] .