Bilateral Osteonecrosis of the Femoral and Humeral Heads after Short Term Corticosteroid Therapy. A Case Study.
Steroid induced osteonecrosis is a devastating injury that usually requires rebuild of the joint, with the femoral and the humeral head being most commonly affected. Steroid therapy is the most common reported cause of atraumatic osteonecrosis. The Collaborative Osteonecrosis Group Study confirmed that steroids are the primary cause of multi-focal osteonecrosis in 91% of the cases. Osteonecrosis is considered multifocal when three or more joints are involved. We report a rare case of bilateral steroid-induced osteonecrosis of the proximal femora and humeri nine months after a short course of intravenous methylprednisolone for treatment of multiple myeloma. The relationship between development of osteonecrosis and corticosteroid treatment has been extensively investigated. Steroid therapy is the most common reported cause of atraumatic osteonecrosis. Multi-focal osteonecrosis should be highly suspected and thoroughly investigated in patients with persistent pain at typical sites after commencement of steroids.
Brighton and Sussex University Hospital, Eastern Road, Brighton, East Sussex, United Kingdom.
Tarek Ahmed
TA
El Gamal
Derriford Hospital, Derriford Road, Plymouth, United Kingdom 3 University of Alexandria, Egypt.
Ahmed
A
El-Bakoury
Dumfries & Galloway Royal Infirmary, Dumfries, United Kingdom.
Amanda
A
Hawkins
University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
Moham
M
Ed AlTayeb Mussa
Sandwell and City Hospitals, Lyndon, West Bromwich, United Kingdom.
Tam
T
Er Ahmed Sweed
Dumfries & Galloway Royal Infirmary, Dumfries, United Kingdom.
Sam
S
Eh Samir Ansara
D005271:Femur Head Necrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects*
D011241:Prednisone; D008775:Methylprednisolone