title: Prevalence of Nontraumatic Osteonecrosis of the Femoral Head and its Associated Risk Factors in the Chinese Population: Results from a Nationally Representative Survey.
abstract: BACKGROUND
  Nontraumatic osteonecrosis of the femoral head (NONFH) is a debilitating disease that represents a significant financial burden for both individuals and healthcare systems. Despite its significance, however, its prevalence in the Chinese general population remains unknown. This study aimed to investigate the prevalence of NONFH and its associated risk factors in the Chinese population.
  
  
  METHODS
  A nationally representative survey of 30,030 respondents was undertaken from June 2012 to August 2013. All participants underwent a questionnaire investigation, physical examination of hip, and bilateral hip joint X-ray and/or magnetic resonance imaging examination. Blood samples were taken after overnight fasting to test serum total cholesterol, triglyceride, and high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels. We then used multivariate logistic regression analysis to investigate the associations between various metabolic, demographic, and lifestyle-related variables and NONFH.
  
  
  RESULTS
  NONFH was diagnosed in 218 subjects (0.725%) and the estimated NONFH cases were 8.12 million among Chinese people aged 15 years and over. The prevalence of NONFH was significantly higher in males than in females (1.02% vs. 0.51%, χ2 = 24.997, P < 0.001). Among NONFH patients, North residents were subjected to higher prevalence of NONFH than that of South residents (0.85% vs. 0.61%, χ 2 = 5.847, P = 0.016). Our multivariate regression analysis showed that high blood levels of triglycerides, total cholesterol, LDL-cholesterol, and non-HDL-cholesterol, male, urban residence, family history of osteonecrosis of the femoral head, heavy smoking, alcohol abuse and glucocorticoid intake, overweight, and obesity were all significantly associated with an increased risk of NONFH.
  
  
  CONCLUSIONS
  Our findings highlight that NONFH is a significant public health challenge in China and underscore the need for policy measures on the national level. Furthermore, NONFH shares a number of risk factors with atherosclerosis.
authors.affiliation: Orthopedic Medical Research Center, Dalian University; Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, China.
authors.forename: De-Wei
authors.initials: DW
authors.lastname: Zhao
authors.forename: Mang
authors.initials: M
authors.lastname: Yu
authors.forename: Kai
authors.initials: K
authors.lastname: Hu
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Lei
authors.initials: L
authors.lastname: Yang
authors.forename: Ben-Jie
authors.initials: BJ
authors.lastname: Wang
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Gao
authors.forename: Yong-Ming
authors.initials: YM
authors.lastname: Guo
authors.forename: Yong-Qing
authors.initials: YQ
authors.lastname: Xu
authors.forename: Yu-Shan
authors.initials: YS
authors.lastname: Wei
authors.forename: Si-Miao
authors.initials: SM
authors.lastname: Tian
authors.forename: Fan
authors.initials: F
authors.lastname: Yang
authors.forename: Nan
authors.initials: N
authors.lastname: Wang
authors.forename: Shi-Bo
authors.initials: SB
authors.lastname: Huang
authors.forename: Hui
authors.initials: H
authors.lastname: Xie
authors.forename: Xiao-Wei
authors.initials: XW
authors.lastname: Wei
authors.forename: Hai-Shen
authors.initials: HS
authors.lastname: Jiang
authors.forename: Yu-Qiang
authors.initials: YQ
authors.lastname: Zang
authors.forename: Jun
authors.initials: J
authors.lastname: Ai
authors.forename: Yuan-Liang
authors.initials: YL
authors.lastname: Chen
authors.forename: Guang-Hua
authors.initials: GH
authors.lastname: Lei
authors.forename: Yu-Jin
authors.initials: YJ
authors.lastname: Li
authors.forename: Geng
authors.initials: G
authors.lastname: Tian
authors.forename: Zong-Sheng
authors.initials: ZS
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Cao
authors.forename: Li
authors.initials: L
authors.lastname: Ma
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D044466:Asian People; D002681:China / Q000453:epidemiology; D005260:Female; D005271:Femur Head Necrosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult