Steroid induced avascular necrosis hip

Bisphosphonate therapy is a proven method of preventing femoral head collapse in patients with avascular necrosis and subchondral lucency.

Lai et al evaluated the effect of alendronate on patients with Steinberg stage-II or III osteonecrosis of the femoral head. They found that alendronate prevented early collapse of the femoral head at twenty-four months.

Agarwala et al evaluated the effect of bisphosphonate therapy on patient reported and radiographic outcomes in femoral head avascular necrosis. They found alendronate reduces pain, improves function and may prevent disease progression at 5 year followup.

Nishii et al evaluated the effect of alendronate on 20 hips with osteonecrosis of the femoral head without collapse. They found a lower frequency of collapse and less patient reported pain in patients treated with bisphosphonate therapy compared to controls at 12 month follow up.

Thanks to Dr. Chris Rice at UW Madison:
"Recent level 1 evidence seems to cast doubt on the efficacy of bisphosphonate treatment in precolapse AVN with medium to large lesions. There is also some thought that the supposed success seen in smaller lesions is due to the natural history of these lesions which often do not progress to collapse even in the absence of any treatment. "
Lee YK, Ha YC, Cho YJ, Suh KT, Kim SY, Won YY, Min BW, Yoon TR, Kim HJ, Koo KH Does Zoledronate Prevent Femoral Head Collapse from Osteonecrosis? A Prospective, Randomized, Open-Label, Multicenter Study. J Bone Joint Surg Am. 2015 Jul 15.

Incorrect Answers:
Answer 1: Cyclic parathyroid hormone therapy is used in osteoporosis treatment, and not in the treatment of femoral head avascular necrosis.
Answer 3 & 4: Neither RANK nor RANK ligand are being used in therapeutic forms currently. Denosumab, an anti-RANK ligand antibody, has shown early success in the treatment of bone lysis in oncologic applications.
Answer 5: Selective estrogen receptor modulator therapy is used in osteoporosis, and not in the treatment of femoral head avascular necrosis.

In a Cochrane review on the treatment for AVN of bone in individuals with sickle cell disease (SCD), Martí-Carvajal and colleagues (2009) found no evidence that adding hip core decompression to physical therapy achieves clinical improvement compared to physical therapy alone.  However, these investigators highlighted that their conclusion was based on 1 trial with high attrition rates.  They stated that further randomized controlled trials are needed to assess the role of hip-core depression for this clinical condition.  Endpoints should focus on participants' subjective experience (., quality of life and pain) as well as more objective "time-to-event" measures (., mortality, survival, hip longevity).

The first isolation and structure identifications of prednisone and prednisolone were done in 1950 by Arthur Nobile . [22] [23] [24] The first commercially feasible synthesis of prednisone was carried out in 1955 in the laboratories of Schering Corporation, which later became Schering-Plough Corporation , by Arthur Nobile and coworkers. [25] They discovered that cortisone could be microbiologically oxidized to prednisone by the bacterium Corynebacterium simplex. The same process was used to prepare prednisolone from hydrocortisone . [26]

Complications are frequent and include peripheral keratitis, uveitis, cataract and glaucoma. Central stromal keratitis may also occur in the absence of treatment. Sclerokeratitis in which peripheral cornea is opacified by fibrosis and lipid deposition with neighboring scleritis may occur particularly with herpes zoster scleritis. Sclerosing keratitis may present with crystalline deposits in the posterior corneal lamellae. Sclerokeratitis may move centrally gradually and thus opacify a large segment of the cornea. Vitritis (cells and debris in vitreous) and exudative detachments occur in posterior scleritis.

Steroid induced avascular necrosis hip

steroid induced avascular necrosis hip

Complications are frequent and include peripheral keratitis, uveitis, cataract and glaucoma. Central stromal keratitis may also occur in the absence of treatment. Sclerokeratitis in which peripheral cornea is opacified by fibrosis and lipid deposition with neighboring scleritis may occur particularly with herpes zoster scleritis. Sclerosing keratitis may present with crystalline deposits in the posterior corneal lamellae. Sclerokeratitis may move centrally gradually and thus opacify a large segment of the cornea. Vitritis (cells and debris in vitreous) and exudative detachments occur in posterior scleritis.

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