The dreaded osteonecrosis of femur following chronic steroid therapy: a case series from a dermatologist’s eye

Abiram Ponnuswami; Cordelia Babitha S.; Krishnakanth Muralidhar; Murugan Sundaram

doi:10.18203/issn.2455-4529.IntJResDermatol20200609

Authors

Abiram Ponnuswami Department of Dermatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
Cordelia Babitha S. Department of Dermatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
Krishnakanth Muralidhar Department of Dermatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
Murugan Sundaram Department of Dermatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20200609

Keywords:

Avascular necrosis of femur, Osteopenia, Chronic steroid usage, DEXA scan

Abstract

Corticosteroids, undoubtedly, is the saving grace of many patients ailing from a variety of inflammatory and autoimmune dermatoses. But it is not free of side effects, some being crippling enough to subject the patient to huge amounts of morbidity. Here we report a series of cases – Vesiculobullous diseases and Lupus Erythematosus - with prolonged oral steroid therapy that lead to osteopenia and osteonecrosis of the femur.

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References

Banks HH. Factors influencing the result in fractures of the femoral neck. J Bone Joint Surg Am. 1962;44:931.

Smith FB. Effects of rotary and valgus malposition on the blood supply to femoral head. J Bone Joint Surg Am. 1959;41:800.

Garden RS. Low angle fixation in the fractures of the femoral neck. J Bone Joint Surg. 1961;313:647.

Brav EA. Traumatic dislocation of the hip: Army experience and results over a twelve year period. J Bone Joint Surg Am. 1962;44:1115.

Lowe HG. Avascular necrosis after slipping of the upper femoral epiphysis. J Bone Joint Surg Br. 1961;43:688.

Herndon JH, Autranc OE. Avascular necrosis of the femoral head in the adult: A review of its incidence in a variety of conditions. Clin Orthop Relat Res. 1972;86:43-62.

Bergstein JM, Wiens C, Fish AJ, Veinier RL, Michael A. Avascular necrosis of bone in systemic lupus erythematosus. J Pediatr. 1974;85:31-5.

Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine. 2018;61(1):7-16.

van Staa TP, Leufkens HG, Abenhaim L, Begaud S, Zhang B, Cooper C. Use of oral corticosteroids in the United Kingdom. Q Med J. 2000;93:105-11.

Fardet L, Petersen I, Nazareth I. Prevalence of long-term oral glucocorticoid prescriptions in the UK over the past 20 years. Rheumatology. 2011;50(11):1982-90.

Epstien NN, Tuffanelli DL, Epstein JH. Avascular bone necrosis: A complication of long terms corticosteroid therapy. Arch Dermatol. 1965;92:170-80.

Shim SS, Hawk HE, Yu WY. The relationship between blood flow and cavity pressure of bone. Surg Gynaecol Obstet. 1972;135:353-60.

Zizic TM, Hungerford DS, Stevens HB. Ischaemic bone necrosis in systemic lupus erythematosus: 1, The early diagnosis of ischaemic necrosis of bone. Medicine. 1980;59:134-42.

Felson DT, Anderson JJ. A cross study evaluation of association between steroid dose and bolus steroids and vascular necrosis and avascular necrosis of the bone. Lancet. 1987;1:902-6.

Manolagas SC, Weinstein RS. New developments in the pathogenesis and treatment of steroid induced osteoporosis. J Bone Miner Res. 1999;14:1061-6.