Hip Bone Issues: Steroid Use and Osteonecrosis Risks - Internal Medicine

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Hip bone issues?


Hello, doctor.
I would like to ask if long-term use of corticosteroids will definitely lead to avascular necrosis of the hip, or does it depend on individual constitution? Is it only possible to prevent avascular necrosis of the hip by discontinuing corticosteroid use?

Xiao Qiao, 20~29 year old female. Ask Date: 2017/07/18

Dr. Gao Jiankai reply Internal Medicine


Hello, Xiao Qiao, thank you for your question.
Long-term use of corticosteroids does indeed increase the risk of complications such as avascular necrosis of the femoral head compared to individuals who do not use corticosteroids.
We will strive to minimize the dosage of corticosteroids while controlling the condition at the lowest effective dose.
If necessary, we prioritize tapering off the medication, which can effectively reduce the likelihood of avascular necrosis.
However, it is important to note that all medications have dual effects; while they can treat disease, they may also cause harm, and there is no medication without side effects.
Therefore, when the condition is unstable, extending the duration of corticosteroid use or increasing the dosage may be unavoidable, at which point various side effects, including avascular necrosis, may occur.
Nevertheless, we always aim to treat patients with the lowest possible corticosteroid dosage, so the chance of experiencing this side effect should be low.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2017/07/18

More Info


The use of corticosteroids is indeed associated with an increased risk of osteonecrosis, particularly in the hip joint. However, it is important to note that not everyone who uses corticosteroids will develop this condition. The risk of osteonecrosis from steroid use can depend on several factors, including the dosage and duration of steroid therapy, the individual's underlying health conditions, and their overall susceptibility to bone health issues.

Osteonecrosis, also known as avascular necrosis, occurs when blood flow to a bone is disrupted, leading to the death of bone tissue. In the case of the hip, this can result in severe pain, limited mobility, and eventually the need for surgical intervention, such as hip replacement. The exact mechanism by which corticosteroids contribute to osteonecrosis is not fully understood, but it is believed that they may affect the blood supply to the bone and alter bone metabolism.

While long-term use of high-dose corticosteroids is a significant risk factor, it is not an absolute guarantee that osteonecrosis will occur. Some individuals may take corticosteroids for extended periods without developing any bone-related complications, while others may experience osteonecrosis after a shorter duration or lower doses. Factors such as genetic predisposition, lifestyle choices (like smoking and alcohol consumption), and the presence of other medical conditions (such as diabetes or rheumatoid arthritis) can also influence the risk.

To mitigate the risk of osteonecrosis while on corticosteroid therapy, it is crucial to follow your healthcare provider's recommendations. If you are prescribed corticosteroids, discuss with your doctor the possibility of using the lowest effective dose for the shortest duration necessary. Additionally, regular monitoring of bone health through imaging studies or bone density tests may be warranted, especially if you are on long-term corticosteroid therapy.

If you are concerned about the risk of osteonecrosis, it may be beneficial to explore alternative treatments for your condition that do not involve corticosteroids. There are various non-steroidal anti-inflammatory drugs (NSAIDs) and other medications that can help manage inflammation and pain without the same risks associated with steroids.

In conclusion, while long-term corticosteroid use does increase the risk of osteonecrosis, it is not a certainty that it will occur in every individual. The decision to use corticosteroids should be made in consultation with a healthcare provider, weighing the benefits against the potential risks. If you have concerns about your treatment plan or the risk of osteonecrosis, do not hesitate to discuss these with your doctor, who can provide personalized advice based on your health history and current condition.

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