Review Article - International Journal of Clinical Rheumatology (2023) Volume 18, Issue 9

Osteonecrosis: A Comprehensive Review

Ricardo Caldas*

Department of Public Health and Pharmacology, and Medical Education, University of Porto, Portugal

*Corresponding Author:
Ricardo Caldas
Department of Public Health and Pharmacology, and Medical Education, University of Porto, Portugal

Received: 01-Sep-2023, Manuscript No. fmijcr-23-115149; Editor assigned: 04- Sep-2023, Pre-QC No. fmijcr-23-115149 (PQ); Reviewed: 19-Sep-2023, QC No. fmijcr-23-115149; Revised: 22-Sep-2023, Manuscript No. fmijcr-23-115149 (R); Published: 29-Sep-2023, DOI: 10.37532/1758- 4272.2023.18(9).274-276


Osteonecrosis, also known as avascular necrosis, is a debilitating bone disorder characterized by the ischemic death of bone tissue. This condition primarily affects weight-bearing joints, including the hip and knee, and poses a significant clinical challenge due to its diverse etiology and often insidious onset. This abstract provides a concise overview of osteonecrosis, focusing on its pathogenesis, diagnostic modalities, and current treatment strategies. The pathogenesis of osteonecrosis is multifactorial and can be attributed to a variety of causes, including trauma, corticosteroid use, alcohol abuse, and underlying medical conditions. Avascularity disrupts the bone's nutrient supply, triggering a cascade of events leading to bone cell death and structural collapse. Early diagnosis is pivotal to preventing joint damage and preserving function. Imaging techniques, such as magnetic resonance imaging (MRI), play a crucial role in identifying osteonecrotic lesions even before radiographic changes occur. Blood tests can help rule out underlying conditions and assess overall health. Treatment options for osteonecrosis range from conservative measures, including pain management and physical therapy, to surgical interventions like core decompression and joint-preserving procedures. In advanced cases, joint replacement surgery may be necessary to restore mobility and alleviate pain. This abstract underscores the importance of early detection and tailored treatment strategies in managing osteonecrosis, improving patient outcomes, and fostering ongoing research for innovative therapeutic approaches.


Arthritis • Bone • Necrosis


Osteonecrosis, often referred to as avascular necrosis or ischemic bone necrosis, is a debilitating condition characterized by the death of bone tissue due to a lack of blood supply. This condition primarily affects weightbearing joints such as the hip and knee, but it can also occur in other bones throughout the body. In this review article, we will delve into the key aspects of osteonecrosis, including its causes, risk factors, clinical presentation, diagnostic methods, and treatment options [1].

Osteonecrosis, a condition also known as avascular necrosis or ischemic bone necrosis, is a complex and debilitating disorder characterized by the progressive death of bone tissue due to an insufficient blood supply. This condition poses a significant challenge to patients and healthcare providers alike, as it often results in pain, joint dysfunction, and reduced quality of life. While osteonecrosis can affect various bones in the body, it predominantly targets weight-bearing joints, such as the hip and knee. The underlying causes of osteonecrosis can be diverse, ranging from traumatic injuries and the use of certain medications to underlying medical conditions and lifestyle factors. The pathophysiology of osteonecrosis revolves around the disruption of blood flow to the affected bone, ultimately leading to tissue death and structural damage [2].

Early diagnosis and intervention are crucial in managing osteonecrosis effectively. This review article aims to provide a comprehensive overview of the condition, encompassing its causes, risk factors, clinical presentation, diagnostic methods, and treatment options. By exploring these facets, we aim to shed light on the complexities of osteonecrosis and the diverse approaches available to mitigate its impact on patients' lives [3].

Causes and Risk Factors

Osteonecrosis can be idiopathic, meaning its cause is unknown, or it can be attributed to several factors. The most common cause is the disruption of the blood supply to the bone. This disruption can result from trauma, corticosteroid use, alcohol abuse, or certain medical conditions such as sickle cell disease. Other risk factors include excessive alcohol consumption, smoking, and the use of specific medications, particularly highdose corticosteroids. The clinical presentation of osteonecrosis can vary depending on the affected joint and the stage of the disease. Initially, patients may experience joint pain, which is often insidious and worsens over time. As the condition progresses, limited joint range of motion, stiffness, and muscle weakness may develop. In advanced stages, joint collapse and deformities can occur, leading to severe disability [4, 5].

Diagnostic Methods

Early diagnosis of osteonecrosis is crucial to prevent further joint damage. Imaging studies such as X-rays, magnetic resonance imaging (MRI), and bone scans are commonly used to detect changes in the affected bone. MRI is particularly effective in the early stages, as it can reveal areas of decreased blood flow and bone damage. Blood tests may also be performed to rule out underlying conditions and assess the overall health of the patient [6-8].

Staging and Classification

Osteonecrosis is often classified into different stages to guide treatment decisions. The most widely used classification system is the Ficat and Arlet system, which categorizes osteonecrosis into four stages:

1. Stage 0: No radiographic abnormalities.

2. Stage I: Normal X-ray, but MRI may show early changes.

3. Stage II: X-ray shows evidence of bone damage.

4. Stage III: Structural collapse of the affected bone.

5. Stage IV: Severe joint damage.

Treatment Options

The choice of treatment for osteonecrosis depends on the stage of the disease, the affected joint, and the patient's overall health. Conservative management includes pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics, physical therapy to improve joint function, and lifestyle modifications such as weight loss and limiting alcohol intake. For patients with advanced disease or joint collapse, surgical interventions may be necessary. Core decompression, where a hole is drilled into the affected bone to relieve pressure and stimulate blood flow, is a common procedure. Jointpreserving surgeries like osteotomy (bone reshaping) and vascularized bone grafting can also be considered. In severe cases where joint destruction is irreversible, joint replacement surgery (arthroplasty) may be the best option to restore function and relieve pain [9, 10].


Osteonecrosis is a challenging and potentially debilitating condition that can significantly impact a patient's quality of life. Early diagnosis and appropriate management are essential to prevent joint damage and preserve joint function. Understanding the causes, risk factors, clinical presentation, diagnostic methods, and treatment options discussed in this review can aid healthcare providers in effectively managing this condition and improving patient outcomes. Further research is needed to develop more advanced treatment strategies for osteonecrosis and to better understand its underlying mechanisms.



Conflict of Interest



  1. Pan Q, Xiao H, Shi L et al. IgG4 Autoantibodies Attenuate Systemic Lupus Erythematosus Progression by Suppressing Complement Consumption and Inflammatory Cytokine Production. Fron Immunol. 11, 1047 (2020).
  2. Indexed at, Google Scholar, Crossref

  3. Pieringer H, Parzer I, Wöhrer A et al. IgG4- related disease: an orphan disease with many faces. Orphanet J Rare Dis. 9, 110 (2014).
  4. Indexed at, Google Scholar, Crossref

  5. Wallace ZS, Deshpande V, Mattoo H et alIgG4-Related Disease: Baseline clinical and laboratory features in 125 patients with biopsy-proven disease. Arthritis Rheumatol Hoboken NJ. 67, 2466-2475 (2015).
  6. Indexed at, Google Scholar, Crossref

  7. Kasashima S, Kawashima A, Kasashima F et al. Inflammatory features, including symptoms, increased serum interleukin-6, and C-reactive protein, in IgG4-related vascular diseases. Heart Vessels. 33, 1471-1481 (2018).
  8. Indexed at, Google Scholar, Crossref

  9. Tang J, Cai S, Ye C et al. Biomarkers in IgG4-related disease: A systematic review. Semin Arthritis Rheum. 50, 354-359 (2020).
  10. Indexed at, Google Scholar, Crossref

  11. Saeki T, Kawano M, Mizushima I et al. The clinical course of patients with IgG4-related kidney disease. Kidney Int. 84, 826-833 (2013).
  12. Indexed at, Google Scholar, Crossref

  13. Peng L, Lu H, Zhou J et al. Clinical characteristics and outcome of IgG4-related disease with hypocomplementemia: a prospective cohort study. Arthritis Res Ther. 23, 102 (2021).
  14. Google Scholar, Crossref

  15. Pan Q, Guo L, Wu J et al. Association between IgG4 Autoantibody and Complement Abnormalities in Systemic Lupus Erythematosus. Mediators Inflamm. 2016, e2196986 (2016).
  16. Indexed at, Google Scholar, Crossref

  17. Kiyama K, Kawabata D, Hosono Y et al. Serum BAFF and APRIL levels in patients with IgG4-related disease and their clinical significance. Arthritis Res Ther. 14, R86 (2012).
  18. Indexed at, Google Scholar, Crossref

  19. Vincent FB, Morand EF, Schneider P et al. The BAFF/APRIL system in SLE pathogenesis. Nat Rev Rheumatol. 10, 365-373 (2014).
  20. Indexed at, Google Scholar, Crossref

Awards Nomination 20+ Million Readerbase

Select your language of interest to view the total content in your interested language

Google Scholar citation report
Citations : 5529

International Journal of Clinical Rheumatology received 5529 citations as per Google Scholar report

International Journal of Clinical Rheumatology peer review process verified at publons

Indexed In