Pathogenesis and natural history of osteonecrosis

Yehudith Assouline-Dayan, Christopher Chang, Adam Greenspan, Yehuda Shoenfeld, M. Eric Gershwin

Research output: Contribution to journalArticle

512 Citations (Scopus)

Abstract

Background and Objectives: Osteonecrosis (avascular necrosis) is a relatively common disorder seen by both rheumatologists and orthopedic surgeons. The vast majority of cases are secondary to trauma. However, for non-traumatic cases, there often remains a diagnostic challenge in defining the cause of bone death. The goal of this article is to review data extensively in the medical literature with respect to the pathogenesis of osteonecrosis, its natural history, and treatment. Methods: A review of 524 studies on osteonecrosis was performed, of which 213 were selected and cited. Results: Non-traumatic osteonecrosis has been associated with corticosteroid usage, alcoholism, infections, hyperbaric events, storage disorders, marrow infiltrating diseases, coagulation defects, and some autoimmune diseases. However, a large number of idiopathic cases of osteonecrosis have been described without an obvious etiologic factor. Although corticosteroids can produce osteonecrosis, careful history is always warranted to identify other risk factors. The pathogenesis of non-traumatic osteonecrosis appears to involve vascular compromise, bone and cell death, or defective bone repair as the primary event. Our understanding of the pathogenesis of osteonecrosis is now much better defined and skeletal scintigraphy and magnetic resonance imaging have enhanced diagnosis greatly. Early detection is important because the prognosis depends on the stage and location of the lesion, although the treatment of femoral head osteonecrosis remains primarily a surgical one. Conclusions: Osteonecrosis has been associated with a wide range of conditions. Many theories have been proposed to decipher the mechanism behind the development of osteonecrosis but none have been proven. Because osteonecrosis may affect patients with a variety of risk factors, it is important that caregivers have a heightened index of suspicion. Early detection may affect prognosis because prognosis is dependent on the stage and location of the disease. In particular, the disease should be suspected in patients with a history of steroid usage, especially in conjunction with other illnesses that predispose the patient to osteonecrosis. Relevance: A better understanding of the pathophysiology, diagnosis and treatment of osteonecrosis will help the physician determine which patients are at risk for osteonecrosis, facilitating early diagnosis and better treatment options.

Original languageEnglish (US)
Pages (from-to)94-124
Number of pages31
JournalSeminars in Arthritis and Rheumatism
Volume32
Issue number2
DOIs
StatePublished - Oct 2002

Fingerprint

Osteonecrosis
Bone and Bones
Adrenal Cortex Hormones
Therapeutics
Thigh
Natural History
Radionuclide Imaging
Caregivers
Alcoholism
Autoimmune Diseases

Keywords

  • Avascular necrosis
  • Magnetic resonance imaging
  • Osteonecrosis
  • Scintigraphy

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Orthopedics and Sports Medicine
  • Rheumatology

Cite this

Pathogenesis and natural history of osteonecrosis. / Assouline-Dayan, Yehudith; Chang, Christopher; Greenspan, Adam; Shoenfeld, Yehuda; Gershwin, M. Eric.

In: Seminars in Arthritis and Rheumatism, Vol. 32, No. 2, 10.2002, p. 94-124.

Research output: Contribution to journalArticle

Assouline-Dayan, Y, Chang, C, Greenspan, A, Shoenfeld, Y & Gershwin, ME 2002, 'Pathogenesis and natural history of osteonecrosis', Seminars in Arthritis and Rheumatism, vol. 32, no. 2, pp. 94-124. https://doi.org/10.1053/sarh.2002.33724b
Assouline-Dayan, Yehudith ; Chang, Christopher ; Greenspan, Adam ; Shoenfeld, Yehuda ; Gershwin, M. Eric. / Pathogenesis and natural history of osteonecrosis. In: Seminars in Arthritis and Rheumatism. 2002 ; Vol. 32, No. 2. pp. 94-124.
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