KEGG   DISEASE: Glucocorticoid-induced osteonecrosis
Entry
H01709                      Disease                                

Name
Glucocorticoid-induced osteonecrosis
Description
Glucocorticoid-induced osteonecrosis is a common and severe adverse event. Glucocorticoid use is one of the most important causes of osteonecrosis. In patients receiving long-term therapy, glucocorticoids induce fractures in 30 to 50% and osteonecrosis in 9 to 40%. The pathogenesis of glucocorticoid-induced osteonecrosis is not fully understood but postulated mechanisms include hyperlipidemia, fat emboli and intravascular coagulation that reduce the supply of blood to the bones. Since not all patients who are treated with steroids develop osteonecrosis, the presence of additional risk factors or individual variation of glucocorticoids sensitivity has been suggested. The risks of this disease include advancing age, prolonged duration of treatment, increased daily dosage and cumulative dose, low body mass index, underlying disease, and polymorphisms in the glucocorticoid receptor. Bisphosphonates are first-line options for glucocorticoid-induced osteoporosis and may also be useful in glucocorticoid-induced osteonecrosis. It has been indicated that bisphosphonates may rapidly reduce pain, and delay joint collapse in patients with osteonecrosis.
Category
Musculoskeletal disease
Brite
Human diseases [BR:br08402]
 Musculoskeletal diseases
  Skeletal diseases
   H01709  Glucocorticoid-induced osteonecrosis
Human diseases in ICD-11 classification [BR:br08403]
 15 Diseases of the musculoskeletal system or connective tissue
  Osteopathies or chondropathies
   FB81  Osteonecrosis
    H01709  Glucocorticoid-induced osteonecrosis
Pathway
hsa00140  Steroid hormone biosynthesis
hsa04066  HIF-1 signaling pathway
Gene
HSD11B2 (polymorphism) [HSA:3291] [KO:K00071]
VEGF (polymorphism) [HSA:7422] [KO:K05448]
COL2A1 (polymorphism) [HSA:1280] [KO:K19719]
NR3C1 (polymorphism) [HSA:2908] [KO:K05771]
SERPINE1 (polymorphism) [HSA:5054] [KO:K03982]
ABCB1 (polymorphism) [HSA:5243] [KO:K05658]
Env factor
Glucocorticoid
Drug
Alendronate sodium [DR:D00939]
Risedronate sodium [DR:D00942]
Sodium risedronate hydrate [DR:D03234]
Zoledronic acid [DR:D01968]
Risedronate sodium monohydrate [DR:D11570]
Comment
See also H01529 Avascular necrosis of femoral head.
Other DBs
ICD-11: FB81.2
ICD-10: M87.1
MeSH: D005271
Reference
  Authors
Weinstein RS
  Title
Clinical practice. Glucocorticoid-induced bone disease.
  Journal
N Engl J Med 365:62-70 (2011)
DOI:10.1056/NEJMcp1012926
Reference
  Authors
Weinstein RS
  Title
Glucocorticoid-induced osteonecrosis.
  Journal
Endocrine 41:183-90 (2012)
DOI:10.1007/s12020-011-9580-0
Reference
  Authors
Gong LL, Fang LH, Wang HY, Peng JH, Si K, Zhu J, Han FF, Wang YH, Du GH, Pei LX, Liu LH
  Title
Genetic risk factors for glucocorticoid-induced osteonecrosis: a meta-analysis.
  Journal
Steroids 78:401-8 (2013)
DOI:10.1016/j.steroids.2013.01.004
Reference
PMID:22877431 (drug)
  Authors
Weinstein RS
  Title
Glucocorticoid-induced osteoporosis and osteonecrosis.
  Journal
Endocrinol Metab Clin North Am 41:595-611 (2012)
DOI:10.1016/j.ecl.2012.04.004
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