A Pubmed/Medline search was conducted (between January 1st 1980 and June 30th, 2014) to identify all randomized control trial, meta-analysis, systematic reviews, prospective and retrospective studies published on the treatment of ONFH.
BisphosphonatesBisphosphonate inhibits the osteclastic activity in the osteonecrotic lesion site and thus promotes bone healing. It prevents the onset of subchondral fracture or collapse in early ON hip, and in advanced conditions when already collapse has occurred it delays the need of total hip replacement (THR) surgery.
Clin Orthop Relat Res. 2001 May;(386):173-8.
Statin therapy decreases the risk of osteonecrosis in patients receiving steroids.
Pritchett JW1.
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Abstract
Osteonecrosis is a devastating complication of systemic steroid use. Prolonged steroid use produces a hyperlipidemic state in most patients and puts them at risk for osteoporosis and osteonecrosis. The fat content within the femoral head increases, resulting in increased intracortical pressure that may lead to sinusoidal collapse and osteonecrosis.
Statins are lipid-clearing agents that dramatically reduce lipid levels in blood and tissues. Statins are widely used to prevent cardiovascular disease and have been shown to reduce the adverse effects of steroids on lipid metabolism. The purpose of this study was to determine whether the use of statin drugs affects later development of osteonecrosis in patients receiving steroids.
The records of 284 patients who were taking statin drugs at the time they were started on high dose steroids were examined to determine whether osteonecrosis had developed. The patients remained on statin drugs during the entire time of steroid exposure. Magnetic resonance imaging scans were used to verify the osteonecrosis unless it was visible by radiograph. After an average of 7.5 years (minimum followup, 5 years), only three patients (1%) from the group had osteonecrosis develop. This 1% incidence is much less than the 3% to 20% incidence usually reported for patients receiving high-dose steroids. Statins may offer some protection against having osteonecrosis develop when steroid treatment is necessary.
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