title: Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study.
abstract: OBJECTIVE
  The purpose of this study was to clarify the incidence of (CS)-associated osteonecrosis among different underlying diseases and to evaluate the risk factors for steroid-associated osteonecrosis in a prospective MRI study.
  
  
  METHODS
  We prospectively used MRI to study 337 eligible underlying disease patients requiring CS therapy and succeeded in examining 1199 joints (hips and knees) in 302 patients with MRI for at least 1 year starting immediately after the onset of CS therapy (1-year follow-up rate of 90%). The underlying diseases included SLE in 687 joints (173 patients) and a variety of other rheumatological disorders in 512 joints (129 patients).
  
  
  RESULTS
  The incidence of osteonecrosis was significantly higher in SLE patients than in non-SLE patients (37 vs 21%, P = 0.001). Logistic regression analysis revealed that adolescent and adult patients had a significantly higher risk of osteonecrosis compared with paediatric patients [odds ratio (OR) = 13.2], that high daily CS dosage (>40 mg/day) entailed a significantly higher risk of osteonecrosis compared with the dosage of <40 mg/day (OR = 4.2), that SLE patients had a significantly higher risk of osteonecrosis compared with non-SLE patients (OR = 2.6) and that male patients had a significantly higher risk of osteonecrosis compared with female patients (OR = 1.6).
  
  
  CONCLUSIONS
  These findings suggest that the incidence of CS-associated osteonecrosis varies among different underlying diseases.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-0856, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Shigemura
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakamura
authors.forename: Shunji
authors.initials: S
authors.lastname: Kishida
authors.forename: Yoshitada
authors.initials: Y
authors.lastname: Harada
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Koya
authors.initials: K
authors.lastname: Kamikawa
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Ochiai
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006621:Hip Joint / Q000187:drug effects / Q000473:pathology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007719:Knee Joint / Q000187:drug effects / Q000473:pathology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids