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Review
. 2015 Jan 13;3(2):58-70.
doi: 10.1016/j.jot.2014.12.002. eCollection 2015 Apr.

Steroid-associated osteonecrosis: Epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview)

Xin-Hui Xie  1   2   3 , Xin-Luan Wang  2   4 , Hui-Lin Yang  3 , De-Wei Zhao  5 , Ling Qin  2   4
Affiliations
Review

Steroid-associated osteonecrosis: Epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview)

Xin-Hui Xie et al. J Orthop Translat. .

Abstract

Steroid-associated osteonecrosis (SAON) is a common orthopaedic problem caused by administration of corticosteroids prescribed for many nonorthopaedic medical conditions. We summarised different pathophysiologies of SAON which have adverse effects on multiple systems such as bone marrow stem cells (BMSCs) pool, bone matrix, cell apoptosis, lipid metabolism, and angiogenesis. Different animal models were introduced to mimic the pathophysiology of SAON and for testing the efficacy of both prevention and treatment effects of various chemical drugs, biological, and physical therapies. According to the classification of SAON, several prevention and treatment methods are applied at the different stages of SAON. For the current period, Chinese herbs may also have the potential to prevent the occurrence of SAON. In the future, genetic analysis might also be helpful to effectively predict the development of ON and provide information for personalised prevention and treatment of patients with SAON.

Keywords: osteonecrosis; pathophysiology; prevention; steroid; treatment.

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Figures

Figure 1
Figure 1
Five stages of osteonecrosis (ON) from X-ray and magnetic resonance imaging (MRI) according to the Association Research Circulation Osseus (ARCO) staging system on the femoral head. At Stage I, there are no visible changes on X-ray but demonstrable on MRI. At Stage II, there are some radiographic changes in the femoral head, but the joint surface maintains its integrity. As the disease progresses, the surface of the femoral head begins to collapse and finally the integrity of the joint is destroyed (Stage III and Stage IV).
Figure 2
Figure 2
Pathophysiology of steroid-associated osteonecrosis (SAON) with different pathways (summarised from published work by authors of this review paper and others). BMSC = bone marrow stem cell; VEGF = vascular endothelial growth factor.
Figure 3
Figure 3
Core decompression procedure (arrow) of femoral head with steroid-associated osteonecrosis (SAON).
Figure 4
Figure 4
Femoral head with osteonecrosis (ON) treated with allogenous bone graft (arrow).
Figure 5
Figure 5
Femoral head with osteonecrosis (ON) treated with tantalum rod implantation (arrow).
Figure 6
Figure 6
Femoral head with osteonecrosis (ON) treated with total hip arthroplasty.
See this image and copyright information in PMC

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