Steroid-induced osteonecrosis : THE NUMBER OF LESIONS IS RELATED TO THE DOSAGE

• Published in: Journal of bone and joint surgery. British volume Vol. 90; no. 9; pp. 1239 - 1243
• Main Authors: ZHANG, N.-F, LI, Z. R, WEI, H.-Y, LIU, Z.-H, HERNIGOU, P
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01-09-2008; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Adult; Biological and medical sciences; China; Diseases of the osteoarticular system; Dose-Response Relationship, Drug; Female; Glucocorticoids - administration & dosage; Glucocorticoids - adverse effects; Humans; Male; Medical sciences; Methylprednisolone - administration & dosage; Methylprednisolone - adverse effects; Orthopedic surgery; Osteonecrosis - chemically induced; Osteonecrosis - diagnosis; SARS coronavirus; Severe Acute Respiratory Syndrome - drug therapy; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular bone diseases; China; Steroid; Osteonecrosis; Orthopedic surgery; Treatment; Lesion; Diseases of the osteoarticular system
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.90B9.20056

Severe acute respiratory syndrome (SARS) is a newly described infectious disease caused by the SARS coronavirus which attacks the immune system and pulmonary epithelium. It is treated with regular high doses of corticosteroids. Our aim was to determine the relationship between the dosage of steroids and the number and distribution of osteonecrotic lesions in patients treated with steroids during the SARS epidemic in Beijing, China in 2003. We identified 114 patients for inclusion in the study. Of these, 43 with osteonecrosis received a significantly higher cumulative and peak methylprednisolone-equivalent dose than 71 patients with no osteonecrosis identified by MRI. We confirmed that the number of osteonecrotic lesions was directly related to the dosage of steroids and that a very high dose, a peak dose of more than 200 mg or a cumulative methylprednisolone-equivalent dose of more than 4000 mg, is a significant risk factor for multifocal osteonecrosis with both epiphyseal and diaphyseal lesions. Patients with diaphyseal osteonecrosis received a significantly higher cumulative methylprednisolone-equivalent dose than those with epiphyseal osteonecrosis. Multifocal osteonecrosis should be suspected if a patient is diagnosed with osteonecrosis in the shaft of a long bone.