Osteonecrosis: symptoms, causes and how to treat it

Definition of osteonecrosis

What is osteonecrosis (avascular necrosis)?

Osteonecrosis or avascular necrosis is the death of bone tissue due to a lack of blood supply. This musculoskeletal disorder also has another medical designation, namely aseptic necrosis or ischemic bone necrosis.

This condition results in small fractures in the bones and makes the bones porous. If the dead bone tissue is near the joint, the joint surface can collapse (move out of position).

Ischemic bone necrosis is a complication of osteomyelitis which continues to get worse.

This disease can occur in any part of the bone structure in your body. However, most often it attacks the ends of the long bones (epiphyses), for example the thighbone (femur), the armbone near the shoulder joint, and the ankle bone.

Aseptic necrosis can affect just one bone. It can also be more than one bone at the same time or at different times.

In fact, the damaged bone by itself will rebuild new, healthy bone. However, in people with avascular necrosis, this bone healing process is effective and the surrounding tissue is damaged more quickly.

How common is osteonecrosis?

Osteonecrosis is a bone problem that can happen to anyone. However, it is more common in people aged around 30 to 50 years.

Signs and symptoms of osteonecrosis

What are the signs and symptoms of osteonecrosis?

In the early stages of development, aseptic necrosis often causes no symptoms. However, over time and the condition worsens, the symptoms of ischemic bone necrosis only cause signs and symptoms.

The typical symptom of osteonecrosis (avascular necrosis) is mild to severe pain and usually develops gradually. These symptoms usually appear around the hips, groin, thighs, buttocks, shoulders, knees, and hands or feet.

Initially, pain occurs when you do activities that place additional weight on the affected bone. If it is severe, the pain also persists when you lie down to sleep.

If the disease spreads to the joints causing joint pain, the affected area of ​​the body will feel stiff and restrict your movement.

When to see a doctor?

If you experience the symptoms mentioned above, see a doctor immediately. Especially if symptoms persist and do not improve with simple treatment.

Causes of osteonecrosis

What causes osteonecrosis?

The cause of osteonecrosis (avascular necrosis) is the obstruction of blood flow to the bones, thus making the bones lack blood supply and even not getting blood at all.

There are several things that can cause the blood supply to the bones to be disrupted, including:

• Trauma to a joint or bone. Injury, such as a dislocation of a joint, can damage surrounding blood vessels.
• Certain medications. Cancer treatments such as radiotherapy to the bones can weaken the bone and damage the surrounding blood vessels.
• Fat deposits in the blood vessels. Fat can clog small blood vessels, reducing blood flow to the bones.
• Certain health problems. Blood flow to the bones can be hampered by sickle cell anemia and Gaucher disease.

Even so, as many as 25% of cases of death in this bone tissue have no known exact cause.

Osteonecrosis trigger factors

The following are factors that can increase the risk of osteonecrosis (avascular necrosis), according to the National Organization for Rare Disease website:

• Experiencing injury to the joints, most commonly the joints around the hips.
• Using corticosteroid drugs such as prednisone, which is usually used to treat inflammation. These drugs are known to interfere with the body's ability to build new bone and break down fat, possibly narrowing blood vessels.
• Having a habit of drinking alcohol can slow down bone formation, and this can increase the risk of tissue death in the bones.
• Have certain health problems, such as pancreatitis, diabetes, HIV / AIDS, and lupus.

Diagnosis and treatment of osteonecrosis

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

If your doctor suspects you have this disease, a physical examination is performed. During the physical exam, the doctor will put pressure on the joint, checking for sensitivity.

The doctor will also move the joint in various positions to see if the range of motion has decreased.

Imaging tests can show the source of the pain, options include:

• X-rays. X-rays can show bone changes that are present in the later stages of this condition. In the early stages, X-rays are usually normal.
• MRI and CT scans. These tests produce detailed images that can show early changes in bone that can indicate avascular necrosis.
• Bone scan.A small amount of radioactive material is injected into a vein. Later the material will move to the injured or white part of the bone and appear as bright spots on it imaging plate.

What are the ways to treat osteonecrosis (avascular necrosis)?

Common treatments for osteonecrosis include:

Take medicine

The doctor will prescribe drugs to help relieve symptoms, prevent loss, and treat health problems that cause them, such as:

• NSAIDs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) to relieve pain.
• Osteoporosis drugs, such as alendronic acid (Fosamax, Binosto) to prevent bone loss problems.
• Cholesterol-lowering drugs so that blood fats are better controlled.
• Blood thinners, such as warfarin (Coumadin, Jantoven), may be recommended to prevent clots in the blood vessels.

Physical therapy

Apart from taking medication, physical therapy in the form of exercise can also be a treatment for patients with avascular necrosis. The goal is to maintain and increase the range of motion of the body's joints.

In addition, electrical therapy may also need to be undertaken to encourage the growth of new bone to replace the damaged bone.

Surgical procedures

If the above treatments are not effective in dealing with tissue death in the bones, the doctor will recommend surgery such as the following:

• The doctor will remove some of the inner layer of the bone and give extra space to form healthy bone tissue.
• The doctor will perform a bone transplant, which is to remove the problem bone and replace it with healthy bone from another part of the body.
• An osteotomy (bone reshaping procedure) will be performed, so that the replacement procedure for the affected joint can be postponed.
• Procedures for replacing damaged joints with plastic or metal.

Home treatment for osteonecrosis

Apart from undergoing doctor's treatment, you must also adopt healthier lifestyle changes, such as:

• Stop smoking and preferably stop drinking alcohol so as not to interfere with the effectiveness of drugs.
• Take care of food choices so as not to increase cholesterol levels in the body.
• Adjust activities with your body condition.

Prevention of osteonecrosis

Osteonecrosis can be prevented by lowering the risk in the following ways:

• Limit alcohol consumption and stop smoking. If you have trouble getting out of this habit, consult a doctor.
• Consult a doctor before using steroid drugs. The use of this drug should be supervised by a doctor.
• Keep cholesterol levels stable by limiting foods that are high in cholesterol.