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

Compared with sporadic case reports, some studies attempted to reduce the side effects of short-term and higher dose application of corticosteroids. A study involving 284 patients taking statins and high doses of steroids at the same time reported a 1% incidence rate of ONFH, which was lower than the usually reported incidence in patients receiving high doses of steroids only. [15] Sakamoto et al. [16] also confirmed the suppressive effects of simvastatin on plasminogen activator inhibitor-I (PAI-1) expression and secretion induced by dexamethasone from bone marrow adipocytes, which indicated preventive effects against steroid-induced ONFH. Mattano et al. [17] simply adopted the dose modification method with alternate-week dexamethasone to reduce the risk of osteonecrosis in intensified treatment children and adolescents with high-risk acute lymphoblastic leukemia (ALL). Intravenous immunoglobulin as a steroid-sparing agent in the treatment of some relevant autoimmune diseases may be a good alternative. [18] These attempts require further support from clinical and basic research studies.