Osteonecrosis – Careful, it may Crack!

Osteonecrosis is a disease where bone death occurs due to interrupted blood supply. It is estimated to afflict approximately 10,000 to 20,000 new patients each year in the United States alone. Majority of those affected are during their young adult years (20-40’s) and even into their 50’s. Other terms for this disease are avascular necrosis, aseptic necrosis and ischemic necrosis.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, when your bones lose their blood supply, osteonecrosis occurs. Because of this, the bones die and eventually collapse, leading to pain and arthritis. This can occur in one or more bones; however the most common site affected is the upper leg. The upper arm, knees, shoulders and ankles are other common sites. Unaffected people have healthy bones where there is constant replacement of old bones or injured bones making them strong and healthy again. In osteonecrosis on the other hand, bone breaks down faster than it can generate new one.

There is no known reason for the existence of this disease; however there are some people who are at greater risks because of:
• Long-term steroid treatment

• Excessive alcohol intake

• Constant increased pressure inside the bone

• Smoking

• Kidney and other organ transplants

• Previous joint injuries

• Having certain other diseases (e.g. arthritis, cancer, vasculitis, osteoarthritis, osteoporosis, blood disorders etc.)

• Exposure to radiation treatment

• Chemotherapy

At first, the person affected is asymptomatic. Later, you will probably have joint pain that becomes more severe as the disease gets worse even when at rest. When weight is put in a joint, one will feel pain ranging from mild to severe. If the disease progresses and starts to break down bones, there is already a loss of function of the affected part (e.g. hips).

With the advent of technology, osteonecrosis can be diagnosed by the doctor through different means such as X-ray, CT scan, bone scan, and MRI. However, the doctor still needs to perform a complete medical history and physical examination. If the disease is diagnosed early, treatments can be more effective.

The goal of treatment for this disease is to improve the quality of life of the patient. Further damage should be stopped, and bones and joints should be always protected to maintain their functionality. Usually, patients are treated with:

• Medications (NSAID)

• Electrical Stimulations

• Range of motion exercises

• Walking aids such as crutches

• Surgery for advanced stage of the disease (total hip replacement, osteotomy, bone graft, etc.)

As a preventive measure, it is best to avoid the possible risk factors stated earlier. Take medications only as advised by a physician. Most importantly, always visit the doctor on regular basis to update the current condition of your body, and not just when you feel something is wrong.

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