Steroid-induced Ischemic Bone Necrosis of Femoral Head: Treatment Strategies

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2015 Jun 24

PMID 26101514

Citations 7

Authors

Bin Wu

Zhong Dong

Shuyuan Li

Hongmei Song

Affiliations

Soon will be listed here.

Abstract

Unlabelled: Fat hypertrophy, intravascular coagulation, and fat emboli are important risk factors of steroid-induced ischemic bone necrosis (SI-IBN) which may develop during the initial one year after commencing the use of steroids. This pathology is best studied by MRI, particularly for its staging. The cautious strategies such as low dose, oral route, short duration of steroid usage, use of steroid sparing agent, and alcohol avoidance should be followed as a traditional therapy. The objective of this review article was to recognize and evaluate various Treatment strategies for steroid-induced ischemic bone necrosis of femoral head.

Literature Search: Various electronic databases including PubMed, Google and Cochrane library were comprehensively searched for articles on steroid-induced ischemic bone necrosis of femoral head and its treatment strategies. Ninety four articles were reviewed, examined and importantly appraised and the most appropriate 32 papers were used to write this review article.

Conclusion: Bisphosphonates, alendronate, and hyperbaric oxygen (HBO) treatments have been reported to be effective against IBN. To recommend the regular use of bisphosphonate in IBN patients, more evidences with a larger number of patients are required to verify its therapeutic effectiveness. Core decompression, osteotomy, bone graft and tantalum rod are the surgical approaches for the management of IBN. Advance form of IBN (bone tissue collapse) is advised to be treated with arthroplasty which should be durable, particularly in young patients.

Citing Articles

Shengxue Busui Decoction activates the PI3K/Akt and VEGF pathways, enhancing vascular function and inhibiting osteocyte apoptosis to combat steroid-induced femoral head necrosis.

Liu M, Ye J, Wu R, Luo D, Huang T, Dai D Front Pharmacol. 2025; 15:1506594.

PMID: 39926257 PMC: 11803408. DOI: 10.3389/fphar.2024.1506594.

Suppression of lncRNA-MALAT1 activity ameliorates femoral head necrosis by modulating mTOR signaling.

Ma L, Gao J Arch Med Sci. 2024; 20(2):612-617.

PMID: 38757012 PMC: 11094837. DOI: 10.5114/aoms.2020.92829.

Identification of hub genes and therapeutic drugs in osteonecrosis of the femoral head through integrated bioinformatics analysis and literature mining.

Tang L, Li B, Su Q, Chen X, He R Sci Rep. 2023; 13(1):11972.

PMID: 37488209 PMC: 10366127. DOI: 10.1038/s41598-023-39258-4.

Early detection of steroid-induced femoral head necrosis using Tc-Cys-Annexin V-based apoptosis imaging in a rabbit model.

Wang X, Li J, Man D, Liu R, Zhao J Mol Med. 2020; 26(1):120.

PMID: 33272196 PMC: 7711260. DOI: 10.1186/s10020-020-00248-1.

Plasminogen Activator Inhibitor-1 4G/5G Polymorphism Contributes to Osteonecrosis of the Femoral Head Susceptibility: Evidence from a Systematic Review and Meta-analysis.

Sobhan M, Mahdinezhad-Yazdi M, Moghimi M, Aghili K, Jafari M, Zare-Shehneh M Arch Bone Jt Surg. 2019; 6(6):468-477.

PMID: 30637301 PMC: 6310193.

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