title: Corticosteroid-associated avascular necrosis: dose relationships and early diagnosis.
abstract: Corticosteroids are the most common etiological factor in nontraumatic avascular necrosis (AVN) of bone, accounting for about 10% of arthroplasties performed annually in the United States. Evidence is conflicting on the relative importance of peak dose, daily dose, or cumulative dose, and most likely all three represent "high dose" corticosteroid administration and play a role in AVN. The etiology may be multifactorial with corticosteroids superimposed on genetic or pathological predispositions. Joint preservation depends upon early diagnosis and treatment before fracture of the subchondral trabeculae and joint incongruity. Early intervention depends upon identifying at-risk patients and quantifying their risk by understanding clinical and pathophysiological contributions to that risk. Our data and that of others suggest that a screening MRI of at-risk populations will permit detection of AVN at a prefracture stage when preservation of the joint is possible.
authors.affiliation: Department of Orthopaedics, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. Roy_Aaron@Brown.edu
authors.forename: Roy K
authors.initials: RK
authors.lastname: Aaron
authors.forename: Anne
authors.initials: A
authors.lastname: Voisinet
authors.forename: Jennifer
authors.initials: J
authors.lastname: Racine
authors.forename: Yousaf
authors.initials: Y
authors.lastname: Ali
authors.forename: Edward R
authors.initials: ER
authors.lastname: Feller
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use; D001175:Arthrography; D001178:Arthroplasty; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D007596:Joints; D008279:Magnetic Resonance Imaging; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000235:genetics / Q000601:surgery*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones