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.
Similar Q&A
Understanding Osteoporosis Treatments: Risks of Bisphosphonates vs. Alternatives
Thank you for the doctor's response regarding osteoporosis. I would like to ask if the injection is also a bisphosphonate medication? Does it carry the same risk of osteonecrosis? I discussed this with my dentist, and he strongly opposes bisphosphonate medications. I also le...
Dr. Shi Guozheng reply Orthopedics
Raloxifene (Evista) is a selective estrogen receptor modulator that can inhibit bone resorption. Its side effect may include a slight increase in the risk of thrombosis, but this risk is not considered high. It can be used in individuals without coronary heart disease or hyperlip...[Read More] Understanding Osteoporosis Treatments: Risks of Bisphosphonates vs. Alternatives
Managing Hip Joint Necrosis: Tips for Pain Relief and Mobility
Symptoms: Left hip joint necrosis, pain while walking, leg length discrepancy (limping), orthopedic surgeon recommends joint replacement. Due to age factors, planning to endure as long as possible before undergoing replacement. Questions: (1) Regarding the leg length discrepancy ...
Dr. Shi Guozheng reply Orthopedics
Custom-made insoles can be beneficial and can be ordered from stores that provide crutch supports or prosthetics. Exercises for thigh extension, adduction, abduction, and flexion can be performed to strengthen the muscles. If the degree of joint necrosis is not severe, considerin...[Read More] Managing Hip Joint Necrosis: Tips for Pain Relief and Mobility
Impact of Surgery on Osteoporosis: Concerns and Considerations
Dear Director, I previously underwent an ultrasound bone density test, which indicated that I have osteoporosis. You suggested that I get a more accurate measurement of my hip joint or spine through a full-body lying down scan. Additionally, I have a question regarding my upcomi...
Dr. Shi Guozheng reply Orthopedics
If the bone is too osteoporotic, the screws may not be able to secure properly during surgery. The physician should assess the condition, and if the bone is too fragile, it may not be suitable for this method. There are also other surgical options available to address the issue.[Read More] Impact of Surgery on Osteoporosis: Concerns and Considerations
Understanding Osteoarthritis: Pain Management Beyond Steroids and Topicals
Hello Dr. Li: My mother is 48 years old and frequently experiences joint pain in her legs. She has been diagnosed with osteoarthritis, and the doctor prescribed pain relievers for her. However, she believes that pain relievers are equivalent to steroids, so she has not taken them...
Dr. Li Wenlin reply Orthopedics
Hello, in response to your question... The treatment for degenerative arthritis includes the following options: 1. Pain relief and anti-inflammatory medications: Modern medications have made significant advancements. Orthopedic doctors prescribe non-steroidal anti-inflammatory ...[Read More] Understanding Osteoarthritis: Pain Management Beyond Steroids and Topicals
Related FAQ
(Orthopedics)
Osteomyelitis(Orthopedics)
Steroids(Internal Medicine)
Femoral Fracture(Orthopedics)
Joint(Internal Medicine)
Endocrine Disorder(Internal Medicine)
Bone Spur(Orthopedics)
Foot(Internal Medicine)
Ankle Joint Injury(Orthopedics)
Ankylosing Spondylitis(Orthopedics)