What is AvascularNecrosis-Osteonecrosis

What is this rare Disease- Disorder called Avascular Necrosis 💀💀💀💀Osteonecrosis ?!

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Link to current eBooklet – New edition came out in February 2020 and will be updated in blog by November 15, 2020 and posted here. Here is 1st edition link below great info, the new edition is mostly the same just expanded by a few pages.

eBooklet Link

https://avascularnecrosiseducation.files.wordpress.com/2018/04/avn-awareness-booklet.pdf

Hi I am Deborah Andio and I have Avascular Necrosis-Osteonecrosis, as well as Osteoarthritis and Spondylolisthesis.

I am also the Founder of the International Support Group called  Avascular Necrosis-Osteonecrosis Support Int’l.

I am here to educate and raise awareness on this rare condition Osteonecrosis that unless you are diagnosed or know someone with this condition you most likely never heard of it.

Avascular necrosis aka Osteonecrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone starts to collapse.

This condition can happen in any bone. It commonly happens in the ends of a long bone. But it can happen to any bone or joint. It may affect one or several bones at one time, or different bones at different times. If diagnosed with AVN its always best to get the other bone checked out as well .

Example AVN in Rt knee best to also get left knee check because often it can be  bilateral (both sides)

What causes Avascular Necrosis?

Avascular necrosis may be the result of the following:

  • Injury
  • Fracture
  • Damage to blood vessels
  • Long-term use of medicines, such as corticosteroids
  • Excessive, long-term use of alcohol
  • Specific chronic medical conditions

What are the risk factors for avascular necrosis?

Risk factors include:

  • Injury
  • Steroid use
  • Gaucher disease
  • Caisson disease
  • Alcohol use
  • Blood disorders, such as factor v lieden, factor iii, mthfr, eNOS,sickle cell anemia
  • Radiation treatments
  • Chemotherapy
  • Pancreatitis
  • Decompression disease
  • Hypercoagulable state
  • Hyperlipidemia
  • Autoimmune disease
  • HIV
  • Vasculitis
  • Pregnancy

What are some of the symptoms of avascular necrosis?

The following are the most common symptoms of avascular necrosis. However, each person may experience symptoms differently.

  • Minimal early joint pain
  • Increased joint pain as disorder progresses
  • Limited range of motion due to pain
  • chronic pain

The symptoms of avascular necrosis may look like other medical conditions or other bone conditions. Always talk to your primary care provider for a diagnosis and make sure you seek an orthopedic who is knowledgeable in current treatments and has experience in treating patients with avascular necrosis-osteonecrosis.

How is avascular necrosis diagnosed?

Along with your complete medical history and physical exam, you may have one or more of the following tests:

  • X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film. Its not accurate in diagnosing early stage avascular necrosis.
  • Computed tomography scan (also called a CT or CAT scan). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
  • Magnetic resonance imaging (MRI).  This test uses large magnets, radio frequencies, and a computer to make detailed images of organs and structures within the body.
  • Radionuclide bone scan. This nuclear imaging technique uses a very small amount of radioactive material, which is injected into the blood to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.
  • Biopsy. A procedure in which tissue samples are removed (with a needle or during surgery) from the body for exam under a microscope. It’s done to find cancer or other abnormal cells or remove tissue from the affected bone.
  • Functional evaluation of bone. Tests that usually involve surgery to measure the pressure inside the bone.

How is avascular necrosis treated?

Specific treatment for avascular necrosis will be determined by your healthcare provider based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Location and amount of bone affected
  • Underlying cause of the disease
  • Your tolerance for specific medicines, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

The goal of treatment is to improve functionality and stop further damage to the bone or joint. Treatments are needed to keep joints from breaking down, and may include:

  • Medicines. These are used to control pain.
  • Assistive devices. These are used to reduce weight on the bone or joint.
  • Core decompression. For this surgical procedure, the inner layer of bone is removed to reduce pressure, increase blood flow, and slow or stop bone and/or joint destruction.
  • PRP platlett rich plasma.  Platelet-rich plasma, or PRP, is a substance that’s thought to promote healing when injected. Plasma is a component of your blood that contains special “factors,” or proteins, that help your blood to clot. It also contains proteins that support cell growth. Researchers have produced PRP by isolating plasma from blood and concentrating it.
  • Stem Cell Injections  Stem cells live in all of us and they act as the repairmen of the body. However, as we age or get injuries, we sometimes can’t get enough of these critical repair cells to the injured area. Medical technology now has promising results in stem cell injections for stage 1-2 stage of avn. And often some surgeons will also use it with surgery or as a non surgical treatment on its own.
  • Osteotomy. This procedure reshapes the bone and reduces stress on the affected area.
  • Bone graft. In this procedure, healthy bone is transplanted from another part of the body into the affected area.
  • Joint replacement. This surgical procedure removes and replaces an arthritic or damaged joint with an artificial joint. This may be considered only after other treatment options have failed to relieve from pain and/or disability.

Other treatments may include electrical stimulation and combination therapies to promote bone growth.

Avascular necrosis goes by many names -Osteonecrosis-Aseptic Necrosis-Bone infarction-  ischemic necrosis

ONJ- BRONJ- MRONJ Osteonecrosis Jaw

Osteonecrosis Of The Jaw OSTEONECROSIS OF THE JAW (ONJ)By Robert Rosenberg, MD, FACR, CCD
Osteonecrosis of the jaw (ONJ) was first associated with antiresorptive therapy (preventing or slowing the destruction of bone using bisphosphonate drugs, such as Fosamax, Actonel, Boniva and zoledronic acid) in 2003. At that time, dentists and oral surgeons at a dental clinic specializing in the treatment of cancer patients noted an increased incidence of ONJ in their patients who were receiving high doses of bisphosphonates and subsequently had dental surgery such as tooth extraction or implantation. High doses of antiresorptive drugs (such as bisphosphonates and denosumab/Prolia) are also used to treat certain cancers.

It is worth noting that some patients who did not have recent dental surgery also developed ONJ. ONJ is defined as exposed necrotic jaw bone that has still not healed eight weeks after dental surgery in patients who have received potent antiresorptive drugs and have not also undergone radiation therapy of the jaw. Cancer patients may receive doses of antiresorptive therapy that are 10-12 times higher than the doses used to treat osteoporosis. Still, some patients receiving traditional osteoporosis treatment doses of these medications have experienced ONJ.

The risk of ONJ in the general population has been reported at less than .001% and taking osteoporosis medications only marginally raises the risk to between .001 and .01%. Evidence does suggest some association between the risk of ONJ in patients on long-term bisphosphonate and denosumab (Prolia) therapy. The highest risk group for ONJ is cancer patients on bisphosphonates with rises to 1 to 15%.

ONJ often is without symptoms initially but symptoms may appear weeks to months later due to local inflammation. Symptoms may include jaw pain, loose teeth, jaw bone enlargement, red gums and gum ulcers. ONJ may occur at the site of a recent dental surgery and occurs more frequently in the lower versus the upper jaw.

In addition to the association of ONJ with chronic bisphosphonate and denosumab use in the treatment of osteoporosis, other risk factors include smoking, poor oral hygiene, diabetes, steroids, chemotherapy and dental surgery. Fortunately, the course of ONJ in most patients is limited, with more than 90% of patients responding to conservative management using antibiotics and oral rinses. In rare cases, limited surgical debridement of oral tissue is necessary.

Prevention of ONJ in osteoporosis patients on antiresorptive treatments involves regular prophylactic dental care and avoidance of invasive dental procedures, if possible. Even proper fitting of dentures is important. Routine dental care, such as cleaning, cavity remediation, crowns, whitening and even root canal surgery, do not appear to increase the risk.

ONJ Info Above Provided by OSTEONECROSIS OF THE JAW (ONJ)By Robert Rosenberg, MD, FACR, CCD

The cause of ONJ is not understood. Some theories include over-suppression of bone production, dental infection, inhibition of new blood vessel growth, soft tissue injury and compromised immunity. ONJ has been seen in a variety of cancers as well as following head and neck radiation therapy. While there appears to be an association between antiresorptive drugs and ONJ, the evidence is unclear.

If you develop ONJ while on antiresorptive therapy, a number of clinical decisions need to be addressed. Patients with metastatic cancer to their bones may not be able to stop their antiresorptive therapy safely. Osteoporosis patients may be able to stop their antiresorptive treatment and/or substitute bone active therapy with Forteo (teriparatide), which has not been associated with ONJ. These clinical decisions need to be made with your physician.

Osteoporosis patients on medication who are facing elective dental procedures (extraction and implantation) should discuss options with their physician and their dentist. Antiresorptive therapy may be stopped two to three months prior to dental surgery and restarted two to three months following the dental procedures, provided mouth tissues have healed completely. However, this will depend on the medication the patient is taking, the severity of their osteoporosis, the risk of fracture and the urgency of the dental problems. There is no evidence that stopping osteoporosis medication prior to dental surgery reduces the risk of ONJ even though this is a common practice. Some dentists recommend bone resorption marker measurement to help determine the risk of ONJ in advance of dental surgery. Although theoretically an attractive concept, the effectiveness of this strategy is unknown.

How long should patients on bone-active osteoporosis medications continue their medications? Most of the benefit from long-term bisphosphonate use is realized in the first five years of oral treatment and the first three years of IV therapy (with zoledronic acid). Patients at lower risk of osteoporotic fracture (those with no previous fractures) might be able to take a drug holiday of two years with reassessment of fracture risk and bone density. Patients at high fracture risk (those who’ve had previous and/or multiple fractures) probably should continue with medication and be reassessed every one to two years. It is very important that each patient is assessed independently, with treatment and follow-up tailored to that unique patient.