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

To induce SAON in rabbits, the administration of single MPSL [37] was proven to be an efficient method, but the incidence of ON was about 33.3e43%. Two injections of high-dose lipopolysaccharide (LPS) combined with a subsequent three injections of high-dose MPSL (H-LPS Â 2 þ H-MPSL Â 3) could improve the incidence of ON but result in high mortality [37] . In our group, we have developed a protocol by modifying the reported protocol with a single low-dose LPS, followed by three times injections of MPS which had a higher incidence of ON of up to 93%, with lower or no mortality [7, 10, 11, 43, 44] . We also established a bipedal emu model for testing and supporting Chinese herbal Epimedium in prevention of SAON with functions in bone formation stimulation and antiadipogenesis etc. [22] .