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

As stated before, not all patients who received steroid administration would develop SAON, because about 11.2e40% of patients with a history of high-dose corticosteroid develop ON [32e34]. This indicated the presence of individual differences in steroid sensitivity. So, genetic traits may play an important role on predisposing the development of SAON. It was reported that inherited thrombophilia and hypofibrinolysis (high factor VIII, factor V Leiden heterozygosity, and resistance to activated protein C) were risk factors for SAON. Genetic susceptibility factors in SAON include single nucleotide polymorphism (SNP) and gene mutation. Most SNP was related with the angiogenesis, drug delivery, steroid metabolism, lipid metabolism, and drug resistance, which may influence the development of SAON. It seems that the genetic analysis showed a potential relationship between SAON and SNP, which is suggested to be useful for predicting the development of ON and of benefit to the clinician in preventing ON as early as possible.