Steroid induced osteonecrosis: An analysis of steroid dosing risk

Christian Powell, Christopher Chang, Stanley M Naguwa, Gurtej S. Cheema, M. Eric Gershwin

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.

Original languageEnglish (US)
Pages (from-to)721-743
Number of pages23
JournalAutoimmunity Reviews
Volume9
Issue number11
DOIs
StatePublished - Sep 2010

Fingerprint

Osteonecrosis
Steroids
Adrenal Cortex Hormones
Connective Tissue Diseases
Hyperlipidemias
Comorbidity
Therapeutics
Retrospective Studies
Joints
Prospective Studies
Guidelines
Morbidity
Bone and Bones
Wounds and Injuries

Keywords

  • Autoimmune disease
  • Avascular necrosis
  • Bone death
  • Corticosteroids
  • Transplantation

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

Cite this

Steroid induced osteonecrosis : An analysis of steroid dosing risk. / Powell, Christian; Chang, Christopher; Naguwa, Stanley M; Cheema, Gurtej S.; Gershwin, M. Eric.

In: Autoimmunity Reviews, Vol. 9, No. 11, 09.2010, p. 721-743.

Research output: Contribution to journalArticle

@article{c840bad4f961440c86867eab5794d871,
title = "Steroid induced osteonecrosis: An analysis of steroid dosing risk",
abstract = "Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.",
keywords = "Autoimmune disease, Avascular necrosis, Bone death, Corticosteroids, Transplantation",
author = "Christian Powell and Christopher Chang and Naguwa, {Stanley M} and Cheema, {Gurtej S.} and Gershwin, {M. Eric}",
year = "2010",
month = "9",
doi = "10.1016/j.autrev.2010.06.007",
language = "English (US)",
volume = "9",
pages = "721--743",
journal = "Autoimmunity Reviews",
issn = "1568-9972",
publisher = "Elsevier",
number = "11",

}

TY - JOUR

T1 - Steroid induced osteonecrosis

T2 - An analysis of steroid dosing risk

AU - Powell, Christian

AU - Chang, Christopher

AU - Naguwa, Stanley M

AU - Cheema, Gurtej S.

AU - Gershwin, M. Eric

PY - 2010/9

Y1 - 2010/9

N2 - Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.

AB - Osteonecrosis is a serious condition involving bone destruction that frequently requires surgical treatment to rebuild the joint. While there is an abundance of literature documenting corticosteroid related osteonecrosis, there is no consensus as to the relative risk of osteonecrosis after administration of steroids via parenteral, oral, topical, inhaled and other routes. This risk is an important prognostic indicator because identification and conservative intervention can potentially reduce morbidity associated with aggressive surgical treatment of osteonecrosis. This paper provides insight into establishing guidelines related to the risk of developing osteonecrosis as a result of corticosteroid use. Case studies, retrospective studies and prospective studies in humans on different corticosteroids and varied dosages were assessed. Most cases of osteonecrosis are secondary to systemically administered corticosteroids and/or high dose daily therapy, particularly in patients with underlying comorbidities including connective tissue diseases, hyperlipidemia, or previous trauma. Previous case reports of osteonecrosis related to inhaled or topical use of steroids are complicated by the fact that in the great majority of cases, the patients are also treated with systemic steroids prior to the development of osteonecrosis. Based on the literature, a set of recommendations regarding the risk of osteonecrosis in patients on steroids was formulated.

KW - Autoimmune disease

KW - Avascular necrosis

KW - Bone death

KW - Corticosteroids

KW - Transplantation

UR - http://www.scopus.com/inward/record.url?scp=77956190013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956190013&partnerID=8YFLogxK

U2 - 10.1016/j.autrev.2010.06.007

DO - 10.1016/j.autrev.2010.06.007

M3 - Article

C2 - 20621176

AN - SCOPUS:77956190013

VL - 9

SP - 721

EP - 743

JO - Autoimmunity Reviews

JF - Autoimmunity Reviews

SN - 1568-9972

IS - 11

ER -