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Pathogenesis of Steroid-Induced Avascular Necrosis and Its Response to Lipid Clearing Agent

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Trends in Research and Treatment of Joint Diseases

Summary

Steroid-induced avascular necrosis of bone is a fascinating and complex disease entity. While the mechanism of the disease is controversial, previous studies in the rabbit have shown that high doses of steroids caused significant alterations in lipid metabolism. The study described here was designed to show the effects of steroid therapy on serum lipids, liver morphology, marrow volume changes, and eventually on femoral head pressure and its blood flow changes. With prolonged steroid treatment it was noted that the fat droplets that were observed in small vessels of the treated rabbits led to eventual focal occlusion of the subchondral arterioles. There was also a persistent elevation of serum cholesterol and a gradual increase of fat cell size, from 60 µm in the normal untreated 0rabbit to 70 µm after 7 weeks of treatment. There was a concomitant increase of femoral head pressure, from 24.6 ± 5.5 cm of water in controls, to 60 cm of water in treated rabbits at 10 weeks of treatment. Simultaneously it was observed that the blood flow of the femoral head decreased from 0.23ml/min per g in the control to 0.16ml/min per g after 10 weeks of steroid treatment. An antilipid agent was used in an attempt to reverse the ongoing process. The result of simultaneous use of a steroid and a lipid clearing agent indicated that there was a slight improvement in cholesterol level, but that the intrafemoral head pressure was maintained. Measurement of blood flow also indicated that the femoral head blood flow was preserved. Concomitant study of fat vacuoles within the osteocytes revealed modification of fatty accumulation within these cells. We fell that lipid clearing agents are beneficial in preventing steroid-induced avascular necrosis.

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Authors and Affiliations

  1. Department of Orthopaedics, University of Virginia Medical Center, Charlottesville, VA, 22908, USA

    Gwo-Jaw Wang

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  1. Gwo-Jaw Wang
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Editors and Affiliations

  1. Department of Orthopedic Surgery, Kobe University School of Medicine, Chuo-ku, Kobe, 650, Japan

    Kazushi Hirohata M.D. (Chairman of Orlhopedic Surgery), Kosaku Mizuno M.D.  & Tsukasa Matsubara M.D. (Chairman of Orlhopedic Surgery),  & 

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© 1992 Springer-Verlag Tokyo

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Wang, GJ. (1992). Pathogenesis of Steroid-Induced Avascular Necrosis and Its Response to Lipid Clearing Agent. In: Hirohata, K., Mizuno, K., Matsubara, T. (eds) Trends in Research and Treatment of Joint Diseases. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68192-2_8

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  • DOI: https://doi.org/10.1007/978-4-431-68192-2_8

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68194-6

  • Online ISBN: 978-4-431-68192-2

  • eBook Packages: Springer Book Archive

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