Abstract
Background
Glucocorticoid usage, a leading cause of osteonecrosis of the femoral head (ONFH),
and its prevalence was reported in 25%-50% of non-traumatic ONFH patients. Nevertheless,
there have been no unified criteria to classify glucocorticoid-associated ONFH (GA-ONFH).
In 2015, the Association Research Circulation Osseous addressed the issue of developing
a classification scheme.
Methods
In June 2017, a task force was set up to conduct a Delphi survey concerning ONFH.
The task force invited 28 experts in osteonecrosis/bone circulation from 8 countries.
Each round of the Delphi survey consists of questionnaires, analysis of replies, and
feedback reports to the panel. After 3 rounds of the survey, the panel reached a consensus
on the classification criteria. The response rates were 100% (Round 1), 96% (Round
2), and 100% (Round 3), respectively.
Results
The consensus on the classification criteria of GA-ONFH included the following: (1)
patients should have a history of glucocorticoid use >2 g of prednisolone or its equivalent
within a 3-month period; (2) osteonecrosis should be diagnosed within 2 years after
glucocorticoid usage, and (3) patients should not have other risk factor(s) besides
glucocorticoids.
Conclusion
Association Research Circulation Osseous established classification criteria to standardize
clinical studies concerning GA-ONFH.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- An evidence-based guide to the treatment of osteonecrosis of the femoral head.Bone Joint J. 2017; 99-B: 1267-1279
- Multifocal osteonecrosis related to corticosteroid: ten years later, risk of progression and observation of subsequent new osteonecroses.Int Orthop. 2016; 40: 669-672
- The epidemiology of osteonecrosis: findings from the GPRD and THIN databases in the UK.Osteoporos Int. 2010; 21: 569-577
- Temporal trends in characteristics of newly diagnosed nontraumatic osteonecrosis of the femoral head from 1997 to 2011: a hospital-based sentinel monitoring system in Japan.J Epidemiol. 2015; 25: 437-444
- Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update.J Bone Joint Surg Am. 2015; 97: 1604-1627
- Clinical and basic research on steroid-induced osteonecrosis of the femoral head in Japan.J Orthop Sci. 2016; 21: 407-413
- An epidemiological study of etiology and clinical characteristics in patients with nontraumatic osteonecrosis of the femoral head.J Res Med Sci. 2017; 22: 15
- Epidemiology of traumatic and nontraumatic osteonecrosis.Clin Orthop Relat Res. 1978; 130: 51-67
- Glucocorticoids (as an etiologic factor).in: Koo K.H. Osteonecrosis. 2nd ed. Springer, Berlin, Heidelberg2014: 81-90
- Genetic association study of polymorphisms in the catalase gene with the risk of osteonecrosis of the femoral head in the Korean population.Osteoarthr Cartil. 2008; 16: 1060-1066
- Genetic variation in the coagulation factor V gene and risk of femoral head osteonecrosis.Mol Med Rep. 2015; 12: 4434-4440
- The Delphi technique in health sciences education research.Med Teach. 2005; 27: 639-643
- Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation.Meas Eval Couns Dev. 2014; 47: 79-86
- Multicentric epidemiologic study on six thousand three hundred and ninety five cases of femoral head osteonecrosis in China.Int Orthop. 2016; 40: 267-276
- Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment.Ann Rheum Dis. 2001; 60: 1145-1148
- The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review.J Bone Joint Surg Am. 2010; 92: 2165-2170
- Endothelial nitric oxide synthase gene polymorphisms in patients with nontraumatic femoral head osteonecrosis.J Orthop Res. 2006; 24: 1722-1728
- Vascular endothelial growth factor polymorphisms in patients with steroid-induced femoral head osteonecrosis.J Orthop Res. 2012; 30: 21-27
- Thrombophilia, hypofibrinolysis, the eNOS T-786C polymorphism, and multifocal osteonecrosis.J Bone Joint Surg Am. 2008; 90: 2220-2229
- The role of the factor V Leiden mutation in osteonecrosis of the hip.Clin Appl Thromb Hemost. 2013; 19: 499-503
- Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone.Lancet. 1987; 1: 902-906
- Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study.Rheumatology (Oxford). 2011; 50: 2023-2028
- Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis.Acta Orthop. 2014; 85: 266-270
- Oral glucocorticoid use and osteonecrosis in children and adults with chronic inflammatory diseases: a population-based cohort study.BMJ Open. 2017; 7: e016788
- Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment.Clin Rheumatol. 2002; 21: 299-303
- The natural history of asymptomatic osteonecrosis of the femoral head.Int Orthop. 2013; 37: 379-384
- Clinical analysis of osteonecrosis of the femoral head induced by steroids.Orthop Surg. 2012; 4: 28-34
- Epidemiology of nontraumatic osteonecrosis of the femoral head in Japan.Mod Rheumatol. 2015; 25: 278-281
- Labour market intelligence partnership. Using the Delphi method to select key indicators for skills planning.
References
- Corticosteroid administration within 2 weeks after renal transplantation affects the incidence of femoral head osteonecrosis.Acta Orthop. 2014; 85: 266-270
- Osteonecrosis of the femoral head in SARS patients: seven years later.Eur J Orthop Surg Traumatol. 2013; 23: 671-677
- Pathomorphological changes of bone marrow adipocytes in process of steroid-associated osteonecrosis.Int J Clin Exp Pathol. 2013; 6: 1046-1050
- The effect of alcohol intake and the use of oral corticosteroids on the risk of idiopathic osteonecrosis of the femoral head: a case-control study in Japan.Bone Joint J. 2013; 95-B: 320-325
- Incidence of osteonecrosis associated with corticosteroid therapy among different underlying diseases: prospective MRI study.Rheumatology (Oxford). 2011; 50: 2023-2028
- Corticosteroid-associated avascular necrosis: dose relationships and early diagnosis.Ann N Y Acad Sci. 2011; 1240: 38-46
- Impact of oral corticosteroid use for idiopathic osteonecrosis of the femoral head: a nationwide multicenter case-control study in Japan.J Orthop Sci. 2010; 15: 185-191
- Avascular necrosis of the femoral head in patients with Hodgkin's disease.Hip Int. 2010; 20: 473-481
- Age at time of corticosteroid administration is a risk factor for osteonecrosis in pediatric patients with systemic lupus erythematosus: a prospective magnetic resonance imaging study.Arthritis Rheum. 2010; 62: 609-615
- Spontaneous repair of asymptomatic osteonecrosis associated with corticosteroid therapy in systemic lupus erythematosus: 10-year minimum follow-up with MRI.Lupus. 2010; 19: 1307-1314
- Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head.Acta Orthop. 2008; 79: 631-636
- Avascular necrosis of femoral and/or humeral heads in multiple myeloma: results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy.J Clin Oncol. 2005; 23: 5217-5223
- Osteonecrosis of hip and knee in patients with severe acute respiratory syndrome treated with steroids.Radiology. 2005; 235: 168-175
- Long-term observation of avascular necrosis of the femoral head in systemic lupus erythematosus: an MRI study.Clin Exp Rheumatol. 2002; 20: 525-530
- Osteonecrosis of the femoral head after solid organ transplantation: a prospective study.J Bone Joint Surg Am. 2002; 84-A: 2145-2151
- Risk period for developing osteonecrosis of the femoral head in patients on steroid treatment.Clin Rheumatol. 2002; 21: 299-303
- Osteonecrosis in patients with systemic lupus erythematosus develops very early after starting high dose corticosteroid treatment.Ann Rheum Dis. 2001; 60: 1145-1148
- Osteonecrosis of the femoral head: a prospective study with MRI.J Bone Joint Surg Br. 1997; 79: 213-219
- Prognostication of osteonecrosis of the femoral head in patients with systemic lupus erythematosus by magnetic resonance imaging.Clin Orthop Relat Res. 1994; 305: 190-199
- Risk factors of avascular necrosis of the femoral head in patients with systemic lupus erythematosus under high-dose corticosteroid therapy.Clin Orthop Relat Res. 1992; 277: 89-97
- Across-study evaluation of association between steroid dose and bolus steroids and avascular necrosis of bone.Lancet. 1987; 1: 902-906
- Corticosteroid therapy associated with ischemic necrosis of bone in systemic lupus erythematosus.Am J Med. 1985; 79: 596-604
- Aseptic necrosis of bone in systemic lupus erythematosus. Relationship to corticosteroid therapy.Arch Intern Med. 1978; 138: 750-754
Article info
Publication history
Published online: September 21, 2018
Accepted:
September 10,
2018
Received in revised form:
August 28,
2018
Received:
July 18,
2018
Footnotes
Byung-Ho Yoon and Lynne C. Jones contributed equally to this work, and should be considered co-first authors.
Source of Funding: No external funding was received in support of this work and the Association Research Circulation Osseous.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.09.005.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
