title: Osteonecrosis 15 years after femoral neck fracture and long-term low-dose inhaled corticosteroid therapy.
abstract: Posttraumatic avascular necrosis of the femoral head typically occurs immediately or within a few years after a femoral neck injury, and non-traumatic avascular necrosis is often related to systemic glucocorticoid therapy. We report an unusual case in which avascular necrosis of the femoral head occurred 15 years after a transcervical femoral fracture in a woman with a 20-year history of daily inhaled glucocorticoid therapy for chronic bronchitis. She had not taken glucocorticoids by any other route and had no other risk factors for osteonecrosis. To our knowledge, this is the first report of osteonecrosis associated with inhaled glucocorticoid therapy in a patient with a local cause of diminished vascular reserve. Inhaled glucocorticoid therapy should be added to the list of risk factors for osteonecrosis.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital, Pauwelsstrasse 30, 52057 Aachen, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Kisielinski
authors.forename: Christopher
authors.initials: C
authors.lastname: Niedhart
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schneider
authors.forename: Fritz-Uwe
authors.initials: FU
authors.lastname: Niethard
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D001507:Beclomethasone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications*; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging / Q000209:etiology*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D011859:Radiography; D012307:Risk Factors; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D001507:Beclomethasone