Osteonecrosis (avascular necrosis, bone infarction, aseptic necrosis, ischemic bone necrosis) is necrosis of bone due to bone infarction.
Presentation
Serum amylase was elevated in 33 patients; liver dysfunction was present in 50; hepatomegaly was found in 32; and biopsy-confirmed cirrhosis was present in 22 cases. Hyperuricemia was found in 22 patients, some of whom had received steroids. [ncbi.nlm.nih.gov]
Entire Body System
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Gaucher Disease
The osteonecrosis was idiopathic in 6 shoulders, was a result of corticotherapy in 10, occurred after radiation in 2, and occurred after Gaucher's disease in 1. A total shoulder arthroplasty was performed in 5 cases and a hemiarthroplasty in 14. [ncbi.nlm.nih.gov]
disease, and systemic lupus erythematosus. [medicinenet.com]
’s disease, alcoholism Pathophysiology: initially necrosis of epiphysis, with variable necrosis of adjacent cartilage; dead bone is resorped by “creeping substitution” over months/years; new bone is soft, may flatten and cause degenerative joint disease [pathologyoutlines.com]
The following are possible causes: Using oral or intravenous steroids Excessive alcohol use Sickle cell disease Dislocation or fractures around a joint Clotting disorders HIV or taking HIV drugs Radiation therapy Gaucher disease (disease in which harmful [nlm.nih.gov]
Gaucher’s disease. Decompression sickness, also know as divers' disease, the bends, or caisson disease. Gout. Vasculitis. Osteoarthritis. Osteoporosis. Blood disorders, such as sickle cell disease. [niams.nih.gov]
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Soft Tissue Mass
The radiographic appearance is that of a soft tissue mass associated with bone destruction at a site of previous bone infarction. [emedicine.medscape.com]
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Cushingoid
Patients with AVN, when compared with controls, had a significantly higher incidence of neurological disease (39% vs 14%; P 0.001) and Cushingoid body habitus after steroid treatment (79% vs 53%; P 0.004). [ncbi.nlm.nih.gov]
Jaw & Teeth
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Oral Ulcers
Oral ulcer, pleuritis, Raynaud's phenomenon, cutaneous vasculitis, lymphadenopathy, autoimmune thyroiditis, peripheral neuropathy and Sjögren's syndrome were higher incidence in SLE patients with AVN. [ncbi.nlm.nih.gov]
Musculoskeletal
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Osteophyte
Necrotic area in cross section is yellow, opaque, chalky with hyperemic fibrous tissue at margin Adjacent bone may be thickened Late changes are breaks in smooth contour of femoral head, destruction of articular cartilage, loose bodies and marginal osteophytes [pathologyoutlines.com]
[…] acquired deformities of limbs ( Valgus deformity, Varus deformity, Wrist drop, Foot drop, Flat feet, Club foot, Unequal leg length, Winged scapula ) patella ( Luxating patella, Chondromalacia patellae ) Protrusio acetabuli - Hemarthrosis - Arthralgia - Osteophyte [wikidoc.org]
In stage IV there is progressive loss of articular cartilage and the development of acetabular osteophytes. The radiographic picture is that of osteoarthritis superimposed on a deformed femoral head. [doi.org]
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Bone Disorder
Unlike other bone disorders, this happens most often in men between age 40 and 50. Untreated injuries and diseases can cause AVN. Other causes include: Injury, such as a major impact from an accident or during sports. [upmc.com]
Would you like to order publications on bone disorders to be mailed to you? Visit our online order form. [web.archive.org]
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Lordosis
Systemic lupus erythematosus ( Drug-induced ) - Dermatomyositis ( Juvenile dermatomyositis ) - Polymyositis - Scleroderma - Sjögren's syndrome - Behçet's disease - Polymyalgia rheumatica - Eosinophilic fasciitis - Hypermobility Dorsopathies Kyphosis - Lordosis [wikidoc.org]
Psychiatrical
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Distractibility
Cowell, Bisphosphonate rescue in distraction osteogenesis: a case series, Bone 38 (2006) 80-80; R. Marx, Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic, J. Oral Maxillofac. [ncbi.nlm.nih.gov]
Workup
The purpose of this article is to report a prototypical case with complete radiographic and histologic workup and to provide facts regarding Kummel disease that are salient to the primary care provider. [doi.org]
Besides confirming the diagnosis, another major role for the radiologist in the workup of osteonecrosis is staging the current state of the disease. The usual plain film and MR stages are listed below. [rad.washington.edu]
See Workup. Early diagnosis and appropriate intervention can delay the need for joint replacement. However, most patients present late in the disease course. [emedicine.com]
X-Ray
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Schmorl's Nodes
nodes - Degenerative disc disease - Coccydynia - Back pain ( Radiculopathy, Neck pain, Sciatica, Low back pain ) Soft tissue disorders muscle : Myositis - Myositis ossificans ( Fibrodysplasia ossificans progressiva ) synovium and tendon : Synovitis / [wikidoc.org]
Treatment
Most people with osteonecrosis need treatment. The goals of treatments are to: Improve use of the joint. Stop further damage. Protect bones and joints. Your treatment options may include surgery or nonsurgical treatments, such as medicines. [niams.nih.gov]
Although a treatment for bisphosphonate-induced bone lesions has not yet been established, we suggest careful evaluation of the patients' oral health before prescribing bisphosphonate treatment. [ncbi.nlm.nih.gov]
Prognosis
Clinical data as well as treatment and prognosis information were obtained from all 14 patients. RESULTS: Twelve patients (86%) were submitted to biphosphonate therapy. [ncbi.nlm.nih.gov]
In addition, lesion size and location can be more easily assessed on magnetic resonance images, and this has been shown to relate to prognosis and need for treatment. [doi.org]
They have been used most often in treating osteonecrosis of the hip where the prognosis without treatment is worse than that for other regions. [merck.com]
Etiology
Editions Published Year of Publication subjects Accessible book, Necrosis, Bones, Abnormalities, Bones--Necrosis, Etiology, Tibia, Adverse effects, Blood supply, Blood-vessels, Decompression sickness, Diphosphonates, Diseases, Drug Therapy, Jaw Diseases [openlibrary.org]
The etiology and management of herpes zoster infection associated with destructive oral sequelae are discussed. [ncbi.nlm.nih.gov]
Because this disease can masquerade as many other pathologies, physicians should be aware of the etiology, presentation, and treatment options for osteonecrosis in the foot. [doi.org]
Epidemiology
Introduction Clinical definition reduced vascular sup ply to the bone resulting in progressive and painful degeneration of the bone also termed osteonecrosis Epidemiology incidence typically occurs in the anterolateral femoral head demographics dependent [medbullets.com]
Epidemiology Frequency United States The frequency of AVN depends on the site involved. The most common site is the hip; other locations include the carpals, talus, femur, metatarsal, mandible, and humerus. [emedicine.com]
Epidemiology For oral bisphosphonates used to treat osteoporosis, the number of spontaneous reports of ONJ submitted to their manufacturers indicates a reporting rate of less than 1 per 100,000 patient treatment years. [iofbonehealth.org]
Pathophysiology
We will review the pathophysiologic mechanisms of AVN and the current use of MRI in the diagnosis of this condition. [doi.org]
Pathogenesis The underlying pathophysiological mechanisms behind ONJ have yet to be elucidated. [iofbonehealth.org]
Pathophysiology Although the pathophysiology of AVN is not fully understood, the final common pathway is interruption of blood flow to the bone. [emedicine.com]
Prevention
Therefore, early treatment to slow or prevent progression and save the joint is desirable. No completely effective treatment is yet available. [merck.com]
Recognition of the quite characteristic imaging findings can prevent misdiagnosis and may have implications for the prediction of the natural course of the disease. [ncbi.nlm.nih.gov]