CORRELATION BETWEEN CORTICOSTEROID THERAPY AND AVASCULAR NECROSIS OF THE FEMORAL HEAD: A CRITICAL LITERATURE REVIEW

Abstract

Objectives: The aim of this study was to explore the correlation between corticosteroid use and the occurrence of avascular necrosis of the femoral head (ANFH), identify the underlying biological mechanisms explaining this correlation, and assess the incidence and additional risk factors associated with the development of ANFH in patients undergoing corticosteroid therapy.

Methods: A critical literature review was conducted by selecting relevant studies that investigate the relationship between corticosteroid therapy and ANFH. The literature search included databases such as PubMed and MEDLINE, using specific terms related to osteonecrosis, corticosteroid therapy, and risk factors. The selected studies were analyzed for methodological quality and relevance to the study's objectives.

Results: The review revealed a strong dose-dependent correlation between corticosteroid administration and the risk of developing ANFH, with osteocyte apoptosis and reduced angiogenesis emerging as central pathogenic mechanisms. Additionally, alternate-day dosing regimens significantly reduced the risk of ANFH in patients with systemic lupus erythematosus. Additional risk factors, such as alcohol consumption and coagulopathies, were identified as significant amplifiers of ANFH risk when combined with corticosteroid therapy.

Conclusion: The consolidated analysis of the reviewed studies reinforces the need for personalized corticosteroid treatment plans, considering dose, duration, and individual patient risk factors to mitigate the risk of ANFH.