The effects of corticosteroids on bone: osteonecrosis (avascular necrosis of the bone)

Objective: To provide information about risk factors for, diagnosis of, and potential treatments and prevention of avascular necrosis (AVN) in patients frequently given systemic corticosteroid therapy for the management of allergic and/or inflammatory diseases. Data Sources: Articles on AVN cited in PubMed from 1975 through 2008. Study Selection: Publications consisted of case reports, reviews of osteonecrosis, and animal and human studies (mostly open, nonrandomized, and observational). Results: Case reports of rare and infrequent use of corticosteroids and the development of osteonecrosis are of great concern to physicians, but most patients affected may also be at risk of developing osteonecrosis because of repetitive systemic corticosteroid use with underlying hyperlipidemia, alcoholism, smoking. connective tissue disorders, and/or previous trauma to the affected area. The use of statins for patients with hyperlipidemias may be useful in decreasing the risk of osteonecrosis but is considered investigational. Enhanced magnetic resonance imaging is the most sensitive tool for diagnosing AVN early. Prophylaxis with bisphosphonates may be worthwhile in certain patients for the early management of pain due to AVN. but eventually surgical intervention is warranted in the treatment of osteonecrosis. Conclusions: Recognition of risk factors and educating (enabling) the patient remain the most effective ways of preventing AVN caused by corticosteroid use. Ann Allergy Asthma Immunol. 2009; 103:91-98.