PATIENT FACT SHEET Osteonecrosis

Osteonecrosis is a painful condition that involves the Osteonecrosis usually occurs between the ages of 20 death of bone cells due to decreased blood flow. It is and 50 years. Bones and bone marrow need steady also called avascular necrosis (AVN) or aseptic necrosis. blood supply to stay healthy. Decreased blood flow It is a painful condition most commonly occurring in causes bone cells to die. Corticosteroid use, heavy the hips or knees, and is often more symptomatic with drinking, lupus and severe trauma or injury may cause CONDITION any weight-bearing activities, such as walking. In some osteonecrosis. cases, the bone at the hip (femoral head) may collapse. Rarer causes of osteonecrosis include HIV, DESCRIPTION Shoulders, hands and feet are less often affected. Rarely, decompression disease (“the bends”), blood disorders osteonecrosis affects the jaw (see separate chapter for such as sickle cell anemia, radiation therapy, and details on osteonecrosis of the jaw). organ transplant.

An early sign of osteonecrosis is local pain in the Diagnosis of osteonecrosis begins with an x-ray of the affected bone or joint. Hip osteonecrosis may cause painful area. Other imaging tests such as bone scans or pain in the groin. Pain from hip or knee osteonecrosis magnetic resonance imaging (MRI) may be needed. MRI may be worse during weight-bearing or walking. Nearby is effective for early osteonecrosis detection, particularly joints may develop osteoarthritis. when the x-rays do not reveal change. SIGNS/ SYMPTOMS

Treatment of early osteonecrosis includes pain collapse may need total joint replacement of the hip or medications and modifying activity to reduce weight- knee. Another option is bone grafting surgery, where bearing on affected joints.Patients with worsening dead bone is removed and replaced with healthy bone osteonecrosis may have core decompression surgery to from another part of the body to restore blood flow. remove bone from the affected area and restore blood flow. Some studies show short-term bisphosphonate COMMON In more advanced cases of osteonecrosis, osteotomy treatment may slow, improve or prevent bone collapse in surgery may remove dead bone and reposition bone the hip or knee. TREATMENTS to support the weight-bearing joint. Patients with bone

Steps to prevent osteonecrosis include reducing Smoking and alcohol consumption raise the risk corticosteroid doses, and avoiding heavy drinking and of osteonecrosis, and are adjustable risk factors the use of tobacco. If patients must take corticosteroids, to lower risk. they should take the smallest possible dose for the CARE/ shortest time necessary. MANAGEMENT TIPS

Updated March 2019 by Marcy Bolster, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing. This information is provided for general education only. © 2019 American College of Rheumatology Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.