Believe it or not, all 206 bones in the body are composed of living tissue that need blood to function and survive. In fact, red blood cells, platelets and most white blood cells are born in the marrow of bones. If a problem with blood supply within the bones presents itself, the bones can literally die. “Death to a bone” is known as necrosis.
Avascular necrosis or osteonecrosis, is a serious condition that occurs when there is loss of blood to a bone. This loss of blood supply can cause a bone to become so brittle and weak that it may collapse. Thankfully, for most people, this is pretty rare. It is believed that as few as 20,000 people between the ages of 30-60 develop avascular necrosis each year. Sadly, for those with lupus, the risk is higher. Some researchers believe that having lupus alone increases the risk for developing this condition, due to such factors as antiphospholipid syndrome and vasculitis. Although, most medical professionals concur that the number one reason why those with SLE are more susceptible to AVN is mainly due to one thing – STEROIDS. Long-term use of corticosteroids (either in pill or intravenous form) is associated with 35% of all AVN cases. Why do steroids cause this? The exact reason is not entirely clear, although some have hypothesized that it is attributed to an increase of lipid levels in the blood, leading to a reduction in blood flow.
So what do you do about this? The best thing to do is to be informed.
Below, we will delve into the symptoms, diagnostics and treatments for AVN.
The scary thing is, when you first develop AVN, you may not have any symptoms. One of the first things people notice is pain or discomfort when weight is put on their joint. As the conditions progresses, the pain may not go away when at rest. The pain may also increase from mild discomfort to severe.
AVN is most common in the hip joint, (although it can happen in any bone) and can cause the bone and joint to collapse in on itself. When that happens, you may not be able to walk. Additionally, it can cause a severe lack of range of motion in the joint. AVN may affect some bilaterally, which means it can affect both hips or knees at once.
Diagnosing AVN will require you to be provocative. If you feel something is off, and your pain is different than your normal lupus pain or fibromyalgia pain, tell your doctor. Your doctor will most likely listen to your medical history, do a physical exam, and order some diagnostic tests. These may include:
- Magnetic resonance imaging (MRI)
- X- Ray
- Computed tomography (CT) scan
- Bone biopsy
- Bone scan
- Bone pressure test
It is important to seek treatment for AVN, because if left untreated, it will worsen with time and may cause permanent bone loss and joint damage.
- Medications: Nonsteroidal anti-inflammatory drugs (Advil, Naproxen, Motrin), blood thinners (Coumadin, Jantoven), osteoporosis drugs (Binosto, Fosamax), and cholesterol-lowering drugs (Simvastatin).
- Rest: Reducing pressure on the affected bone.
- Electrical stimulation: Electrical impulses are used to encourage the body to grow new bone.
- Exercise: A physical therapist may recommend certain safe exercises to help maintain the range of motion in the affected joint.
Since most people don’t know they have avascular necrosis until it is more advanced, sometimes surgery is recommended. Some options are:
- Joint replacement: This is a surgery where the damaged parts of the joint are replaced with plastic or metal parts. 10% of all hip replacement surgeries in the U.S. are due to AVN.
- Core decompression: This procedure removes part of the inner layer of the bone. This helps stimulate the birth of bone tissues and blood vessels and helps to reduce pain.
- Bone Osteotomy: This is a reshaping procedure where a piece of bone is removed on the weight bearing joint. This is a procedure done to help postpone hip replacement surgery.
- Bone Graft: This procedure is done by taking a section of healthy bone from another part of the body to help strengthen the affected bone area.
- Regenerative medicine treatment: This is one of the newest treatments for AVN involving stem cells that are harvested from the patient’s own bone marrow. During the procedure, dead bone is removed and stem cells are placed in the affected area to hopefully allow new bone growth.
How well someone with AVN does long-term depends on:
- The main reason why they developed it on the first place
- Stage of the disease when it was diagnosed
- Amount of bone involved
- The overall health and age of the patient at diagnosis
To reduce your chance of developing AVN, reduce your alcohol intake, eat well, and talk to your doctor about long term steroid use. Remember you have 206 bones counting on you for their care.