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Mother has just been put on prednisone for her rheumatoid arthritis. It's a trial basis to see how she does. The pharmacist gave her a sheet of possible "adverse effects" of this medication. One of the items on the list is osteonecrosis of the hip or shoulder. My uncle had this (her brother) and ended up with a hip replacement because of it. That's the last thing Mother needs right now. What are her real chances of developing osteonecrosis from taking this drug?Understanding the problem may help you evaluate your mother's situation more realistically in order to determine risk of developing osteonecrosis from taking a corticosteroid like prednisone. First, osteonecrosis of the femoral head
refers to death of the round ball of bone at the top of the femur that fits into the hip socket. Another term used for osteonecrosis is avascular or ischemic necrosis
. Avascular and ischemic both mean a loss of blood supply to the area is the cause of the problem.
What turns off the flow of blood to that area? That's the real cause or etiology
. The is more than a dozen potential causes or etiological factors
. From a broad perspective, the etiology of femoral osteonecrosis is the result of genetics, risk factors, and specific events. This is considered a multifactorial etiology.
Let's take a closer look at some of the more common causes and risk factors first. Number one is trauma: a hip fracture or hip dislocation with damage to the blood vessels supplying the femoral head is the most commonly reported cause. Most of the time, older adults are the prime group at risk.
Number two is the use of corticosteroids
-- medications such as prednisone used to reduce inflammation and the immune system. Adults with arthritis, anyone who has had an organ transplantation, and cancer patients in treatment are just a few of the types of people taking corticosteroids. Usually long-term use of corticosteroids is the trigger but there have been reports of patients developing osteonecrosis within a month of starting these drugs.
Number three: lifestyle factors. Smoking and alcohol abuse compound the problem and increase the risk of femoral head osteonecrosis. Even occasional drinking (once a week) increases the risk of developing avascular femoral necrosis. But the odds are much higher for those who drink daily and especially if they drink more than one alcoholic beverage in a 24-hour period.
The more risk factors there are, the greater the chances for developing an adverse effect from taking prednisone such as osteonecrosis. Could this happen with just a month's trial of the medication? Yes, studies show that osteonecrosis can develop within that first month of taking the medication. Most cases develop during the first year of drug use.
The best thing to do may be to sit down with your mother and her prescribing physician and review her risk factors and weigh the benefits versus drawbacks of the present plan-of-care. There may be nothing to worry about but taking a closer look can't hurt either.George C. Babis, MD, PhD, et al. Osteonecrosis of the Femoral Head. In Orthopedics
. January 2011. Vol. 34. No. 1. Pp. 39-48.
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