Multifocal osteonecrosis related to corticosteroid: ten years later, risk of progression and observation of subsequent new osteonecroses

Purpose No study has reported the risk of other site osteonecroses after the diagnosis of multifocal osteonecrosis related to corticosteroids in patients who continue this corticosteroid treatment. An analysis of the time-course to other sites of osteonecrosis, as well as the effects of underlying c...

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Bibliographic Details
Published in:International orthopaedics 2016-04, Vol.40 (4), p.669-672
Main Authors: Flouzat-Lachaniette, Charles-Henri, Roubineau, François, Heyberger, Clemence, Bouthors, Charlie, Hernigou, Philippe
Format: Article
Language:English
Subjects:
Adult
Disease Progression
Female
Follow-Up Studies
Glucocorticoids - adverse effects
Humans
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Original Paper
Orthopedics
Osteonecrosis - chemically induced
Osteonecrosis - diagnosis
Prevalence
Prospective Studies
Risk Factors
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Summary:Purpose No study has reported the risk of other site osteonecroses after the diagnosis of multifocal osteonecrosis related to corticosteroids in patients who continue this corticosteroid treatment. An analysis of the time-course to other sites of osteonecrosis, as well as the effects of underlying corticosteroid risk factor on the evolution of asymptomatic lesions at the time of diagnosis, is presented. Methods Two hundred patients were followed prospectively every year during a minimum ten years with a radiograph if a joint became symptomatic. In absence of evidence of osteonecrosis on radiographs of a symptomatic or non-symptomatic joint (hips, shoulders, knees, ankles), patients had an MRI performed at the most recent follow up. The average duration of follow-up after inclusion of the patient in the study was 15 years (range 10–20). Results Of the 200 patients followed for an average of 15 years (minimum 10 years, maximum 20 years), 35 patients developed new osteonecrosis lesions during the period of study. Asymptomatic lesions became symptomatic and a high number of collapse was observed resulting in 258 arthroplasties (187 hips, 51 shoulders, 20 knees) at the most recent follow up. Conclusion The continuation of peak doses (>200 mg) of corticosteroids predicted ( p  = 0.04) occurrence of new lesions and the continuation of corticosteroids without peak dose was a risk for quicker progression to collapse.
ISSN:0341-2695
1432-5195
DOI:10.1007/s00264-015-3060-8