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Review
. 2024 Dec;56(1):2416070.
doi: 10.1080/07853890.2024.2416070. Epub 2024 Nov 12.

Pathological mechanisms and related markers of steroid-induced osteonecrosis of the femoral head

Longyu Li  1 , Shangkun Zhao  1 , Zikuan Leng  1 , Songfeng Chen  1 , Yifang Shi  1 , Lijun Shi  1 , Jinfeng Li  1 , Keya Mao  2 , Hai Tang  3 , Bin Meng  4 , Yisheng Wang  1 , Guowei Shang  1 , Hongjian Liu  1
Affiliations
Review

Pathological mechanisms and related markers of steroid-induced osteonecrosis of the femoral head

Longyu Li et al. Ann Med. 2024 Dec.

Abstract

Background: Osteonecrosis of the femoral head (ONFH) is a refractory orthopedic disease with a high disability rate. Long-term administration of steroids is the most common pathogenic factor for non-traumatic ONFH. Early diagnosis of steroid-induced osteonecrosis of the femoral head (SONFH) is difficult and mainly depends on imaging.

Objectives: The objectives of this review were to examine the pathological mechanisms of SONFH, summarize related markers of SONFH, and identify areas for future studies.

Methods: We reviewed studies on pathological mechanisms and related markers of SONFH and discussed the relationship between them, as well as clinical applications and the outlook of potential markers.

Results: The pathological mechanisms of SONFH included decreased osteogenesis, lipid accumulation, increased intraosseous pressure, and microcirculation disruption. Differential proteomics and genomics play crucial roles in the occurrence, progression, and outcome of SONFH, providing novel insights into SONFH. Additionally, the biological functions of mesenchymal stem cells (MSCs) and exosomes (Exos) in SONFH have attracted increasing attention.

Conclusions: The pathological mechanisms of SONFH are complex. The related markers mentioned in the current review can predict the occurrence and progression of SONFH, which will help provide effective early clinical prevention and treatment strategies for SONFH.

Keywords: Steroid-induced osteonecrosis of the femoral head; genomics; lipid metabolism; markers; pathological mechanisms; proteomics.

Plain language summary

This paper reviews the pathological mechanisms of SONFH from several perspectives, including lipid accumulation, lipotoxicity, microvascular injury, and increased intraosseous pressure.We summarize related markers connected with SONFH in the previous studies, including potential biomarkers, related molecules and so on, which can predict the occurrence and progression of SONFH.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
The pathological mechanism of lipid metabolism in SONFH.
See this image and copyright information in PMC

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