title: Glucocorticoid-induced osteonecrosis.
abstract: Awareness of the need for prevention of glucocorticoid-induced fractures is growing, but glucocorticoid administration is often overlooked as the most common cause of nontraumatic osteonecrosis. Glucocorticoid-induced osteonecrosis develops in 9-40% of patients receiving long-term therapy although it may also occur with short-term exposure to high doses, after intra-articular injection, and without glucocorticoid-induced osteoporosis. The name, osteonecrosis, is misleading because the primary histopathological lesion is osteocyte apoptosis. Apoptotic osteocytes persist because they are anatomically unavailable for phagocytosis and, with glucocorticoid excess, decreased bone remodeling retards their replacement. Glucocorticoid-induced osteocyte apoptosis, a cumulative and unrepairable defect, uniquely disrupts the mechanosensory function of the osteocyte-lacunar-canalicular system and thus starts the inexorable sequence of events leading to collapse of the femoral head. Current evidence indicates that bisphosphonates may rapidly reduce pain, increase ambulation, and delay joint collapse in patients with osteonecrosis.
authors.affiliation: Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA. weinsteinroberts@uams.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D019386:Alendronate / Q000627:therapeutic use; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D017209:Apoptosis / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000009:adverse effects; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D010011:Osteocytes / Q000187:drug effects; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D019386:Alendronate