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

Bisphosphonate is initially used in the treatment of osteoporosis by decreasing osteoclastic activities while improving bone mass density. Some physicians have attempted to treat osteonecrosis using bisphosphonates and accumulated some experiences. Good results were mainly observed with lumbar spine treatment. The effects of bisphosphonates in preventing or treating corticosteroid-induced ONFH are controversial, and there is no definitive recommendation on the duration of treatment and therapeutic dose. A few clinical studies suggested low molecular weight heparin, statins, and vasodilators as the pharmaceutic therapy choice. Moreover, a comparative study showed that a combination of intravenous prostacyclin and CD seemed to be more promising in the treatment of osteonecrosis. [46] The efficacy of anti-coagulants, lipid-lowering agents, and vasodilators in the treatment and prevention of the progression of early-stage ONFH is still unproven and need further investigation.