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Review
. 2018 Jun;46(6):2141-2148.
doi: 10.1177/0300060517700299. Epub 2017 May 1.

Role of coagulopathy in glucocorticoid-induced osteonecrosis of the femoral head

Qiankun Zhang  1 , Jin L V  2 , Lie Jin  1
Affiliations
Review

Role of coagulopathy in glucocorticoid-induced osteonecrosis of the femoral head

Qiankun Zhang et al. J Int Med Res. 2018 Jun.

Abstract

The two major theories of glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH) are apoptosis and ischaemia. The traditional theory implicates ischaemia as the main aetiological factor because the final common pathway of ONFH is interruption of blood supply to the bone. The most common causes of interruption of blood supply include fat embolism and coagulation disorders. GCs can directly or indirectly lead to coagulation disorders, producing a hypercoagulable state, followed by poor blood flow, ischaemia, and eventually ONFH. This review summarizes the existing knowledge on coagulation disorders in the context of GC-induced ONFH, including hypofibrinolysis and thrombophilia, endothelial cell dysfunction and damage, endothelial cell apoptosis, lipid metabolism, platelet activation, and the effect of anticoagulant treatment.

Keywords: Glucocorticoid; coagulopathy; femoral head; ischaemia; osteonecrosis.

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Figures

Figure 1.
Figure 1.
Plausible mechanisms for steroid-induced development of ONFH
See this image and copyright information in PMC

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