Osteonecrosis

Your doctor has provided this information to answer some of the questions you may have about osteonecrosis and how it may affect you. It will also help you better understand what to expect when osteonecrosis has an impact on your joints and requires medical treatment.

What is it?

You may hear osteonecrosis referred to as avascular necrosis, asceptic necrosis and ischemic necrosis. The word osteonecrosis literally means "dead bone". This “dead bone” is caused by a lack of blood supply to the bone that causes the death of bone tissue. This can lead to tiny breaks in the bone that may lead to a collapse in the bone.

What are the treatment options?

Your doctor may recommend different treatment options depending on the severity of your osteonecrosis and its impact on your joint(s) and your body as a whole. Your doctor may be especially interested in the condition of your femur and whether the head of the bone is still intact.

Manage the pain and preserve your joint

Your doctor's priorities will include alleviating your pain, improving your function, preventing further joint damage and saving as much of your natural bone as possible. To accomplish this, you may be treated with very specific medications in order to slow the progression of the disease, joint deformity and loss of function. Your doctor may prescribe any one of these medications, or a combination of several: non-steroidal anti-inflammatory medications (NSAIDs), blood thinners (to increase blood flow to the affected bone) or cholesterol-lowering medications (often called statins), especially if corticosteroid use has elevated your cholesterol level.

Get the right support

Your doctor may recommend that you reduce weight bearing on the affected joint. That may mean that you'll be asked to use a crutch or limit your activities to permit your joint to heal while you're under treatment. Your doctor may also recommend some range-of-motion exercises, or even prescribe a course of physical therapy so a trained therapist can guide you through specific movements. Some studies have shown that electrical stimulation (a painless, non-invasive therapy) may promote healthy new bone growth.

Understand your surgical options

If you are still experiencing pain and joint damage that's affecting your quality of life even after all other conservative measures have been taken, your doctor may suggest surgery to help relieve your pain and restore your mobility. Your doctor will determine the proper surgical treatment based on the severity of your condition. Today, a full range of surgical solutions exist that enable your doctor to customize surgical procedures to your particular needs and anatomy, whether you need core decompression, osteotomy (re-shaping the bone), bone grafting (which may help your body create healthy new blood vessels and bone cells) or arthroplasty (replacing the affected joint).

For people diagnosed with osteonecrosis, treatment and medical management of the disease may continue throughout their lifetime. Be sure to talk with your doctor about the best treatment option for you.

Risk Factors

If a bone is fractured or becomes dislocated this may interrupt the blood flow to the bone causing osteonecrosis. Long term use of high dose steroid medications and excessive alcohol intake will also increase one’s risk of developing osteonecrosis.

Osteonecrosis is most common during the ages of 30-60, but can develop at any age. If developed at a younger age there may be significant long term consequences.

Reduced blood supply can be caused by:

• Joint or bone trauma such as an injury or dislocation 
• Cancer treatments involving radiation which weaken bone and damage blood vessels 
• Fatty deposits in blood vessels which block blood flow 
• Medical conditions such as sickle cell anemia and Gaucher’s disease

Medical conditions associated with osteonecrosis are: pancreatitis, diabetes, Gaucher’s disease, HIV/AIDS, systemic lupus erythematosus and sickle cell anemia.