Tag: Educate

NOVEMBER 29: AVASCULAR NECROSIS–OSTEONECROSIS AWARENESS DAY

A Rare, Painful Disease That Deserves More Attention, More Research, and Better Treatment Options

By Deb Andio | Patient Advocate

Imagine being told that part of your bone is dying because it is no longer receiving enough blood.

Now imagine hearing that the damage could become permanent, your joint could collapse, and you might eventually need major surgery or a joint replacement.

For people living with avascular necrosis (AVN), also known as osteonecrosis, this is not an imaginary scenario. It is a frightening and painful reality.

November 29 is Avascular Necrosis–Osteonecrosis Awareness Day, a day dedicated to educating the public, supporting patients and families, and bringing much-needed attention to a disease that far too many people have never heard of.

As a patient advocate, I believe awareness is only the beginning. We need earlier diagnoses, better treatment options, increased research funding, and greater involvement from our elected officials.

Because having a rare disease should never mean being forgotten.

WHAT IS AVASCULAR NECROSIS?

Avascular necrosis occurs when the blood supply to an area of bone is reduced or interrupted.

Bone is living tissue. Just like other parts of our bodies, it requires oxygen and nutrients delivered through the bloodstream to remain healthy.

When that blood supply is disrupted, bone tissue begins to die.

Over time, the affected bone can weaken, fracture, and eventually collapse. When this occurs near a joint, it can cause severe pain, arthritis, disability, and loss of mobility.

Although AVN is most commonly associated with the hips, it can also affect the knees, shoulders, ankles, wrists, feet, and other bones.

Some people experience significant pain early in the disease. Others may have very few symptoms until substantial damage has already occurred.

That is one of the reasons early diagnosis is so important.

THE STATISTICS: RARE DOES NOT MEAN INSIGNIFICANT

Let’s talk about some numbers.

  • Approximately 20,000 to 30,000 new cases of osteonecrosis are commonly estimated to occur annually in the United States, although estimates vary and often focus on osteonecrosis of the hip.
  • Historically, osteonecrosis has been associated with approximately 5% to 10% of total hip replacements in the United States.
  • The condition frequently affects adults between the ages of 20 and 50, although it can occur in children and older adults.
  • Both hips can be affected, even when symptoms initially appear on only one side.
  • Some patients develop osteonecrosis in multiple joints.
  • Without appropriate management, progressive disease can result in joint collapse and the need for surgery.

These figures are estimates drawn from published medical literature, not a complete national count of everyone living with osteonecrosis.

And that brings up another concern.

We need better patient data and more comprehensive research to understand exactly how many people are affected.

Behind every statistic is a real person.

A parent struggling to pick up a child.

A grandparent who can no longer enjoy a walk with the grandchildren.

A worker trying to make it through another shift despite severe pain.

A young adult facing joint replacement decades earlier than expected.

These are the people behind the numbers.

ONE DISEASE FAMILY, MANY DIFFERENT NAMES

One of the most confusing things about avascular necrosis is that it goes by several names.

You may hear physicians use the terms:

  • Avascular Necrosis (AVN)
  • Osteonecrosis (ON)
  • Aseptic Necrosis
  • Ischemic Necrosis of Bone
  • Bone Infarction

There are also specific conditions associated with osteonecrosis or related disorders of bone development and circulation.

These include:

1. Legg-Calvé-Perthes Disease

Primarily affects children and involves disruption of the blood supply to the femoral head, the ball-shaped portion of the hip joint.

2. Kienböck Disease

Affects the lunate bone in the wrist and can lead to pain, stiffness, weakness, and difficulty using the hand.

3. Freiberg Disease

Affects the metatarsal head in the foot, most commonly near the second toe. It can cause forefoot pain and difficulty walking.

4. Preiser Disease

An uncommon form of osteonecrosis involving the scaphoid bone in the wrist.

5. Köhler Disease

A childhood condition affecting the navicular bone in the foot.

6. Mueller-Weiss Disease

A rare condition involving collapse and deformity of the navicular bone in adults.

7. Chandler Disease

An older medical term used for osteonecrosis of the femoral head in adults.

8. Kümmell Disease

A condition involving delayed collapse of a vertebral body, often associated with osteonecrosis following a spinal compression fracture.

9. Panner Disease

A childhood condition affecting the capitellum, a portion of the elbow joint.

10. Osteonecrosis of the Jaw (ONJ)

A condition involving exposed or damaged jawbone that fails to heal normally. Medication-related osteonecrosis of the jaw (MRONJ) is associated with certain medications and has different risk factors and treatment considerations.

Not all these conditions are medically identical. Some are classified as osteochondroses or other related bone disorders rather than conventional adult AVN.

However, understanding these names helps patients recognize the broader family of conditions involving bone injury, disrupted circulation, and bone deterioration.

It also reminds us that osteonecrosis is not simply a disease of the hip.

WHAT CAUSES AVASCULAR NECROSIS?

There are several recognized risk factors and associated medical conditions.

These include:

  • Traumatic injuries, fractures, and dislocations
  • Prolonged or high-dose corticosteroid use
  • Heavy alcohol consumption
  • Sickle cell disease
  • Lupus and certain autoimmune conditions
  • Blood-clotting disorders
  • Certain cancer treatments
  • Decompression sickness
  • Other conditions affecting circulation

And sometimes?

There is no identifiable cause.

This is called idiopathic osteonecrosis.

Imagine being diagnosed with a disease that is damaging your bones and not even knowing why it happened.

For many patients, that uncertainty is another difficult part of living with AVN.

WHY EARLY DIAGNOSIS MATTERS

AVN can sometimes be mistaken for other orthopedic conditions, particularly in its early stages.

A person experiencing hip pain might initially be evaluated for arthritis, bursitis, or a muscle injury.

The problem is that early AVN may not appear on ordinary X-rays.

MRI is especially useful because it can identify osteonecrosis before significant bone damage becomes visible on X-rays.

Early detection may provide opportunities for treatments designed to preserve the natural joint before collapse occurs.

Unfortunately, some people do not receive their diagnosis until the disease has already progressed.

We need greater awareness among healthcare professionals and patients so that concerning symptoms receive appropriate evaluation.

WHAT TREATMENTS ARE AVAILABLE?

Treatment depends on the location of the disease, its severity, whether the bone has collapsed, and the patient’s individual circumstances.

Current options may include:

  • Pain management
  • Reduced weight-bearing and mobility aids
  • Physical therapy and activity modification
  • Core decompression surgery
  • Bone grafting procedures
  • Selected joint-preserving surgical techniques
  • Joint replacement when damage is advanced

Researchers are also studying biological and regenerative approaches, including treatments involving bone marrow-derived cells.

However, many emerging treatments remain experimental, and their long-term effectiveness is still being investigated.

There is currently no single proven treatment that reliably reverses established osteonecrosis in every patient.

That is why research is so important.

We need treatments that do more than manage symptoms.

We need to investigate ways to preserve blood flow, protect healthy bone, prevent collapse, and reduce the need for major surgery.

Imagine how many lives could be changed if more patients had effective options before their joints were permanently damaged.

WE NEED OUR ELECTED OFFICIALS TO UNDERSTAND THIS DISEASE

This is where advocacy becomes especially important.

Awareness campaigns help educate the public, but scientific progress also requires funding, research infrastructure, clinical trials, and access to appropriate medical care.

Our elected officials need opportunities to hear from people living with osteonecrosis.

Patients and families can help explain why rare musculoskeletal diseases deserve consideration in federal and state healthcare discussions.

Important areas for public policy discussion include:

1. Increased Research Opportunities

Encouraging greater attention to osteonecrosis research through the National Institutes of Health and other appropriate research programs.

2. Better Diagnostic Education

Supporting medical education that helps healthcare professionals recognize osteonecrosis earlier.

3. Improved Treatment Development

Encouraging clinical research into bone preservation, improved circulation, regenerative approaches, and surgical innovations.

4. Better Access to Healthcare

Examining barriers to medically necessary imaging, specialist care, rehabilitation, and treatment.

5. Improved Patient Data

Supporting research registries and better data collection to understand how many people live with AVN and which treatments provide the best outcomes.

6. Greater Recognition of Chronic Pain and Disability

Helping policymakers understand how osteonecrosis can affect employment, independence, financial stability, and everyday life.

These are conversations worth having with elected officials at every level of government.

Patients can contact their congressional representatives, senators, and state legislators to share their experiences and ask what opportunities exist to support rare disease research and healthcare access.

You can locate your elected officials at:

https://www.usa.gov/elected-officials

WHAT CAN WE DO ON NOVEMBER 29?

You do not need to be a medical professional or an experienced advocate to make a difference.

You can share educational information about osteonecrosis.

You can tell your story if you feel comfortable.

You can support someone who is newly diagnosed.

You can encourage patients to ask questions and seek appropriate medical evaluations.

You can learn about research and clinical trials.

And you can contact your elected officials to explain why this disease deserves greater attention.

Every voice contributes to awareness.

Every shared story helps someone else feel less alone.

And every informed conversation creates another opportunity for understanding.

TO EVERYONE LIVING WITH AVASCULAR NECROSIS

I want you to know that your pain matters.

Your struggles matter.

Your quality of life matters.

You deserve physicians who listen, accurate information, access to appropriate care, and hope for better treatment options.

Living with a disease that many people have never heard of can be incredibly isolating.

There are people who do not understand how painful AVN can be or how dramatically it can change someone’s life.

But your disease does not become less serious simply because it is uncommon.

You are not just a diagnosis or a statistic.

You are a person with a family, responsibilities, dreams, and a life you want to continue living.

As an advocate, I want to see a future where osteonecrosis is diagnosed earlier, where patients have more choices, and where fewer people must face the possibility of joint collapse and replacement.

I want researchers to have opportunities to pursue promising treatments.

I want healthcare professionals to recognize the warning signs.

And I want our elected officials to understand the real-life impact of this painful disease.

November 29 is Avascular Necrosis–Osteonecrosis Awareness Day.

Let’s use this day to educate, share our experiences, support research, and make sure the voices of people living with osteonecrosis are heard.

Because rare does not mean insignificant.

Pain should never be invisible simply because a disease is unfamiliar.

And every patient deserves hope for a better tomorrow.

Awareness begins with education. Progress requires research. And meaningful change begins when people are willing to listen.

Deb Andio

Patient Advocate

EDUCATIONAL RESOURCES

National Institutes of Health — Osteonecrosis

https://www.niams.nih.gov/health-topics/osteonecrosis

American Academy of Orthopaedic Surgeons — Osteonecrosis of the Hip

https://orthoinfo.aaos.org/en/diseases–conditions/osteonecrosis-of-the-hip/

ClinicalTrials.gov — Osteonecrosis Research

https://clinicaltrials.gov/search?cond=Osteonecrosis

Find Your Elected Officials

https://www.usa.gov/elected-officials

Disclaimer: This article is intended for educational and advocacy purposes only and does not replace professional medical advice.

Podcast Episode: Living With Chronic Pain

Pip: If you have ever tried to explain avascular necrosis to someone and watched their eyes glaze over, this episode is for you — and honestly, for them.

Mara: ChronicallyGratefulDeb covers a lot of ground here — chronic pain awareness, what it actually means to manage it, and what AVN treatment options are worth bringing to your doctor. Let's start with the mindset and the medicine of living with chronic pain.

Chronic Pain: Gratitude, Awareness, and the Management Toolbox

Pip: There is a tension at the center of chronic pain writing — between honesty about how hard it is and the instinct to find something worth holding onto. That is exactly the territory this segment lives in.

Mara: The post "Living a Life of Chronic Gratitude" names it directly: "gratitude is not just a fleeting emotion evoked by fleeting circumstances; it is a state of being, a conscious decision to acknowledge and appreciate the blessings that surround us, no matter how small or seemingly insignificant they may appear."

Pip: That framing matters because it is not toxic positivity. It is not pretending the pain is gone. It is choosing a posture toward life while the pain is still very much present.

Mara: Right — the post is explicit that being chronically grateful does not mean denying the challenges. It calls gratitude "an act of defiance against despair." That is a meaningful distinction for anyone who has been told to just think positive.

Pip: Which is a very different thing from deciding, daily, to look for what remains.

Mara: The companion post, "Chronic Pain Awareness," picks up the clinical side of that same reality. It runs through the full landscape — arthritis, osteoarthritis, AVN, nerve disorders, spinal conditions — and makes the point that chronic pain does not have one cause, so it cannot have one solution.

Pip: The toolbox metaphor they use is apt. Physical therapy, occupational therapy, movement, nutrition, topical treatments, medications — none of these is a cure, but together they can protect function and quality of life.

Mara: One line from the awareness post stands out as something worth taking into a doctor's appointment: it draws a hard line between pain management and disease treatment, asking both "how can we help control my pain" and "what are we doing about the condition causing my pain."

Pip: Those are two genuinely different questions, and conflating them is where a lot of people get stuck.

Mara: The post also pushes back on the zero-to-ten pain scale as the whole story — it asks whether you can sleep, walk through a grocery store, climb stairs, play with your grandchildren. Function, not just sensation.

Pip: Measuring pain by what it takes from you rather than by how much it hurts — that reframe alone is worth the read.

Mara: Both posts are doing the same work from different angles: one emotional, one clinical. Together they make the case that managing chronic pain is neither purely a medical problem nor purely a mindset problem. It is both, handled at the same time.

Pip: And knowing your actual diagnosis — what is causing the pain — turns out to be the bridge into what comes next.

What AVN Treatment Can Actually Look Like

Pip: Once someone has an AVN diagnosis, the question shifts from what is wrong to what can still be done — and the answer depends heavily on how early you are asking.

Mara: The post on AVN treatment options puts it plainly: "Being diagnosed with AVN does not mean that every patient immediately needs a joint replacement." It walks through options from 3D-guided core decompression and BMAC to hyperbaric oxygen therapy and focused shock wave therapy.

Pip: The stage of disease is doing a lot of work in that list — some of those options close once collapse has occurred.

Mara: That is the exact point the post makes. It urges patients to ask their orthopedic specialist where the AVN is, how large the lesion is, whether any collapse has occurred, and whether the window for joint-preserving treatment is still open. The November 29 Osteonecrosis Awareness Day post reinforces this — early detection through MRI is called the gold standard precisely because more options exist before the bone fails.

Pip: So the treatment conversation and the awareness conversation are really the same conversation, just at different points on the timeline.

Mara: Knowing your stage, knowing your options, and knowing what questions to ask — that is the throughline across both posts.

Pip: Gratitude as defiance, pain as more than a number, and treatment as a set of questions worth asking before the window closes.

Mara: There is more to explore here — on bone health, on navigating the healthcare system, on what life looks like on the other side of a diagnosis. We will be back with more from this site.

Shining Light on Avascular Necrosis-Osteonecrosis Awareness Day: A Call for Unity

As we approach November 29, a day etched on our calendars as Avascular Necrosis-Osteonecrosis Awareness Day, the enthusiasm is palpable. Originating in states like Ohio, Pennsylvania, Iowa, Georgia, and Tennessee, and several other states this day has grown beyond its regional roots, capturing hearts and minds across the nation. A celebration of resilience, unity, and the strength of those battling this rare disease, the journey has just begun. We still have many states that have yet to recognize this awareness day.

In the spirit of reflection and progress, let’s take a closer look at what Avascular Necrosis-Osteonecrosis is and why it deserves the spotlight. Osteonecrosis occurs when the blood supply to a bone is disrupted, leading to the death of bone tissue. While it can affect anyone at any age, the rarity of this condition often results in delayed diagnosis and limited awareness.

Imagine a disease that doesn’t discriminate by age, gender, or background—a condition that can strike unexpectedly, altering lives in its wake. Avascular Necrosis-Osteonecrosis fits this description, emphasizing the importance of education and advocacy. It’s crucial to understand the pain that accompanies this condition. The affected bones, deprived of essential blood supply, lead to excruciating pain, impacting mobility and quality of life.

This awareness day isn’t just a commemoration; it’s a call to action. The commendable efforts of states like Ohio, Pennsylvania, Iowa, Georgia, and Tennessee have set the stage for a nationwide movement. Proclamations have been issued, voices have been amplified, and the journey towards recognition has begun.

As we celebrate the strides made, it’s essential to acknowledge the work that lies ahead. Advocacy is a journey, not a destination, and the goal is clear: to have all 50 states recognize and celebrate Avascular Necrosis-Osteonecrosis Awareness Day by 2024. This ambitious vision requires a collective effort.

To our esteemed congressmen, senators, and the President of the United States, we extend an invitation to join us in this noble cause. Avascular Necrosis-Osteonecrosis doesn’t discriminate based on political affiliations, and neither should our pursuit of awareness. We implore you to consider the impact of this rare disease on your constituents, urging you to champion the cause for an awareness day in every state.

It’s not a daunting task; it’s an opportunity for bipartisan collaboration, demonstrating a commitment to the health and well-being of the American people. A simple proclamation can go a long way in raising awareness, fostering empathy, and providing support to those affected by Avascular Necrosis-Osteonecrosis.

In the coming year, let’s collectively work towards making November 29 a day of national significance. Together, we can ensure that the stories of those touched by Avascular Necrosis-Osteonecrosis are heard, recognized, and celebrated from coast to coast. The journey has just begun, and with your support, we can light up the map with awareness, compassion, and unity.

Sincerely

Deb Andio

Founder

Avascular Necrosis-Osteonecrosis SuppooInt’l

http://www.avascularnecrosiseducation.com

“Like the majestic Phoenix that rises from the ashes, those of us living with Osteonecrosis are on a journey of resilience and hope. As we continue to advocate for awareness, we believe that our Awareness Day will soon shine worldwide, illuminating the path for understanding, support, and compassion. Together, our voices will soar, echoing the strength that lies within each of us.”

Avascular Necrosis-Osteonecrosis Awareness Day 2021

Hard to believe another awareness day has arrived.

It’s been a struggle and challenge to get all 50 states to issue a proclamation: but being persistent is becoming rewarding. We now have about 1/2 the USA on board as 29 November being AVN-ON

To all those living with Osteonecrosis like myself, know I will not give up until every state has issued the proclamation.

We live with pain and uncertainty every day. But I assure you I will not give up until it’s recognized in every state.

Happy AVN-ON Awareness Day.

Wish you all a pain free day

Thank You Arizona

The good news keeps rolling in

Rare Disease Day is February 29 usually 28 on non leap years.

So as you know I have been working very hard on November 29 being National – Avascular Necrosis Osteonecrosis awareness day and all states have come on board so far but still waiting to hear from maybe 10 states.

They are doing all they can. And I am so pleased many states have issues proclamations for November 29 and many still are in the process.

Today The State of Arizona sent a proclamation for rare disease awareness we got the entire week February 20-27

And they will also be recognizing November 29

So blessed.

Hard work pays off

Thank you State of Arizona

Deb Andio

Founder Avascular Necrosis Osteonecrosis Support Int’l

#Osteonecrisis #AvascularNecrosis

Thank You Proud Moment

Thank you to Youngstown Ohio Mayor Jamael Tito Brown and Senator Michael Rulli and Senate President Larry Obhof

What an honor

Help me raise awareness today and please like and share this post.

Thank You.

1st annual

#AvascularNecrosis #Osteonecrosis

#AwarenessDay #November29

AvascularNecrosis/Osteonecrosis Support Int’l

https://www.vindy.com/news/local-news/2019/11/city-state-recognize-poland-woman-with-rare-disease/

Please Help Me Raise Awareness©

I need you to help me get to my goal

I have started a petition to get the rare disease Osteonecrosis recognized by asking for an awareness month week or day. If they won’t allow a month.

I could use as many supporters as possible to help me and share this.

No money at all is needed.

I hope you will help me raise awareness

Take Action: We Need Osteonecrosis Awareness To Have The Month Of October to Recognized & raise awareness #Osteonecrosis #AvascularNecrosis please help and sign and share

Link requesting osteonecrosis awareness-month-october

Or copy and paste

https://www.petition2congress.com/ctas/osteonecrosis-awareness-month-october

To President Donald Trump, The U.S. House and The U.S. Senate
We, the patients of a rare disease called Osteonecrosis respectfully ask the United States of America in this petition to the US Congress to pass legislation to establish and recognize October as Osteonecrosis Awareness Month in the United States.
The people of the United States are called upon to observe the month of October with appropriate educational and awareness opportunities, and recognition.
With hundreds of thousands of US residents suffering from this disease and more being diagnosed everyday , there is a need for this community to have an active voice and recognition.
It is happening in all age groups from child to elderly

Osteonecrosis, also known as Avascular necrosis (AVN), aseptic necrosis or ischemic bone necrosis, is a disease resulting in the death of bone cells. If the process involves the bones near a joint, it often leads to collapse of the joint surface and subsequent debilitating often crippling arthritis due to an irregular joint surface.

Although it can happen in any bone, osteonecrosis most commonly affects the ends (epiphysis) of long bones such as the femur (thigh bone). Commonly involved bones are the upper femur (ball part of the hip socket) the lower femur (a part of the knee joint), the upper humerus (upper arm bone involving the shoulder joint), and the bones of ankle joint. The disease may affect just one bone, more than one bone at the same time, or more than one bone at different times.
Osteonecrosis can cause severe pain and disability. Early diagnosis and early treatment may improve the outcome.
Osteonecrosis may result from use of glucocorticoid (sometimes called corticosteroid) medicine or from drinking too much alcohol but there are many causes and also some that are unknown.
Though osteonecrosis can occur in almost any bone of the body, the hips, knees,ankle and shoulders are the most common sites affected.
The cause and treatment for osteonecrosis of the jaw differs from that for osteonecrosis found elsewhere.

The most common causes of osteonecrosis are:

Serious trauma to bone or joint (injury), which interrupts a bone’s blood supply
Corticosteroid medications (such as prednisone, cortisone or methylprednisolone), mainly when a high dose is used for a prolonged period of time
Excess alcohol consumption
Systemic lupus erythematosus

Other risk factors for osteonecrosis include:
Decompression disease (also called the “Bends” that can occur with scuba diving)
Blood disorders such as sickle cell anemia, antiphospholipid antibody syndrome (APS) and lupus anticoagulant, factor v leiden, and others
HIV infection (the virus that causes AIDS)
Radiation and Chemotherapy
Bisphosphonates, which may be linked to osteonecrosis of the jaw
Organ transplants

Osteonecrosis is not life-threatening, but it is debilitating and hurts our quality of life. Although it isn’t well-known and its exact cause is unknown, AVN-ON affects 10,000-to-20,000 Americans annually. Between 30 and 60 percent of patients will experience AVN-ON bi-laterally, which means both sides so if one hip or knee has it most likely so will the other.

Please help those of us that suffer from this condition by creating more research , funding studies and allowing us the recognition, as only through education, research and awareness can we get better treatment options, earlier diagnosis and hopefully prevention.

Thank You

Deb

Hip Osteonecrosis -Stages- Info

Osteonecrosis of the Hip

Osteonecrosis of the hip is a painful condition that occurs when the blood supply to the head of the femur (thighbone) is disrupted. Because bone cells need a steady supply of blood to stay healthy, osteonecrosis can ultimately lead to destruction of the hip joint and severe arthritis.

Osteonecrosis is also called avascular necrosis (AVN) or aseptic necrosis. Although it can occur in any bone, osteonecrosis most often affects the hip. More than 20,000 people each year enter hospitals for treatment of osteonecrosis of the hip. In many cases, both hips are affected by the disease. 

Doctor Examination

After discussing your symptoms and medical history, your doctor will examine your hip to discover which specific motions cause your pain.

Patients with osteonecrosis often have severe pain in the hip joint but relatively good range of motion. This is because only the femoral head is involved in the earlier stages of the disease. Later, as the surface of the femoral head collapses, the entire joint becomes arthritic. Loss of motion and stiffness can then develop.

Osteonecrosis is typically seen as a wedge-shaped area with a dense whitish sclerotic border in the superior lateral portion of the femoral head. On lateral view, a lucent line called a “crescent sign” can often be seen just below the surface of the femoral head. 

Magnetic resonance imaging (MRI) scans.Early changes in the bone that may not show up on an x-ray can be detected with an MRI scan. These scans are used to evaluate how much of the bone is affected by the disease. An MRI may also show early osteonecrosis that has yet to cause symptoms (for example — osteonecrosis that may be developing in the opposite hip joint). 

Stages of Avascular Necrosis-Osteonecrosis Hip

photo credit AAOS American Academy of Orthopaedic Surgeons

Video Link of Stages of Avascular Necrosis-Osteonecrosis Hip

Dr Nabil Ebraheim Shows Info on Hip Avascular Necrosis

You can have Avascular Necrosis in one hip or both , if in both hips it’s called bilateral which means both sides.

And if you have Avascular Necrosis- osteonecrosis in more that 3 different joints

Multifocal osteonecrosis is defined as disease involving three or more anatomic sites.

Example

Hips

Knees

Shoulder

That is called multi focal Avascular Necrosis- Osteonecrosis

Read more

Multifocal osteonecrosis Article in The Journal of Rheumatology 25(10):1968-74 · November 1998

Multifocal ON, which ON involves three or more distinct anatomical sites [5], is rare, being seen in only approximately 3% of all ON patients [5]. Corticosteroid use is a known risk factor for multifocal ON [5,6], as are certain comorbidities, including systemic lupus erythematosus (SLE), renal failure, leukemia, and lymphoma [5,7,8]. However, almost all studies of multifocal ON are case reports and case series, so the inci- dence and clinical characteristics of the condition remain poorly defined [5,[8][9][10][11][12][13]. …

Non-operative Treatment

There is no known pharmaceutical cure for osteonecrosis. Several non-operative treatments have been studied including hyperbaric oxygen therapy, shock wave therapy, electrical stimulation, pharmaceuticals (anticoagulants, bisphosphonates, vasodilators, lipid lowering agents), physiotherapy and muscle strengthening exercises, and combinations thereof. There are conflicting results for some of these treatments, therefore, rigorous, randomized controlled trials with large numbers of patients are still needed to determine the effectiveness of these treatments. Non-operative treatment may be part of a wait-and-see approach based on the size of the area of dead bone. Non-operative treatments cannot be labeled as conservative, since many of them do not slow the progression of the disease or lead to avoidance of a total hip arthroplasty. Most are simply pain-relieving at best.

Reduced weight bearing does not alter the course of the disease and is not a treatment. It may be used to simply permit the patient to better cope with pain until appropriate treatment is instituted. 

Surgical Treatment

Core decompression – This surgical procedure removes or drills a tunnel into the area of the affected bone, which reduces pressure within the bone. Core decompression works best in people who are in the earliest stages of osteonecrosis, before the collapse of the dead bone. This procedure sometimes can reduce pain and slow the progression of bone and joint destruction in these patients.

Osteotomy – This surgical procedure reshapes the bone to reduce stress on the affected area. There is a lengthy recovery period, and the patient’s activities are very limited for 3 to 12 months after an osteotomy. This procedure is most effective for patients with advanced osteonecrosis and those with a small area of affected bone.

Bone graft – Bone grafts can be used as part of the surgical treatment for osteonecrosis. Bone grafts can use bone from the same patient or donor bone. Bone graft or synthetic bone graft can be inserted into the hole created by the core decompression procedure. A specialized procedure, called vascularized bone grafting, involves moving a piece of bone from another site (often the fibula, one of the bones of the calf, or the iliac crest, a portion of the pelvic bone) with a vascular attachment. This allows for support of the diseased area as well as a new source of blood supply. This is a complex procedure and is performed by surgeons that are specially trained. Another type of bone grafting, involves scraping out all of the dead bone and replacing it with healthier bone graft, often from other portions of the patient’s skeleton. 

A unique type of bone graft involves the use of a patient’s own cells that are capable of making new bone. Often these cells are a type of stem cell from the bone marrow or other bodily tissues. There has been increasing interest in the potential of stem cell therapy. This is also being studied for the treatment of osteonecrosis. Mesenchymal stem cells, which are a type of ‘adult’ stem cell, can grow and develop into many different cell types in the body. Physicians take the patient’s own mesenchymal stem cells (autologous transplant) and place them into the affected bone to stimulate bone repair and regeneration.

Arthroplasty/total joint replacement – Total joint replacement is the treatment of choice in late-stage osteonecrosis when the joint is destroyed. In this surgery, the diseased joint is replaced with artificial parts. It may be recommended for people who are not good candidates for other treatments, such as patients who do not do well with repeated attempts to preserve the joint. Various types of replacements are available, and people should discuss specific needs with their doctor.

For most people with osteonecrosis, treatment is an ongoing process. Doctors may first recommend the least complex and invasive procedure, such as protecting the joint by limiting high impact activities, and watch the effect on the patient’s condition.

Other treatments then may be used to prevent further bone destruction and reduce pain such as core decompression with bone graft/stem cell therapy. Eventually patients may need joint replacement if the disease has progressed to collapse of the bone. It is important that patients carefully follow instructions about activity limitations and work closely with their doctor to ensure that appropriate treatments are used.

Investigational Therapies

Scientists, researchers, and physicians continue to pursue a better understanding of how this disease occurs as well as compare the effectiveness of current and newly developed therapies. Often, this requires a clinical trial to answer questions and gain additional knowledge.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site. 

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Toll-free: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today? A Ten-Year Update.

By Dr. Michal Mont MD

There is hope

Treatment

The goal is to prevent further bone loss.

Medications and therapy

In the early stages of avascular necrosis, symptoms might be eased with medication and therapy. Your doctor might recommend:

  • Nonsteroidal anti-inflammatory drugs.Medications, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) might help relieve the pain associated with avascular necrosis.
  • Osteoporosis drugs. Medications, such as alendronate (Fosamax, Binosto), might slow the progression of avascular necrosis, but the evidence is mixed.
  • Cholesterol-lowering drugs. Reducing the amount of cholesterol and fat in your blood might help prevent the vessel blockages that can cause avascular necrosis.
  • Blood thinners. If you have a clotting disorder, blood thinners, such as warfarin (Coumadin, Jantoven), might be recommended to prevent clots in the vessels feeding your bones.
  • Rest. Reducing the weight and stress on your affected bone can slow the damage. You might need to restrict your physical activity or use crutches to keep weight off your joint for several months.
  • Exercises. A physical therapist can teach you exercises to help maintain or improve the range of motion in your joint.
  • Electrical stimulation. Electrical currents might encourage your body to grow new bone to replace the damaged bone. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.

Surgical and other procedures

Because most people don’t develop symptoms until avascular necrosis is fairly advanced, your doctor might recommend surgery. The options include:

  • Core decompression. The surgeon removes part of the inner layer of your bone. Besides reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
  • Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of your body.
  • Bone reshaping (osteotomy). A wedge of bone is removed above or below a weight-bearing joint, to help shift your weight off the damaged bone. Bone reshaping might enable you to postpone joint replacement.
  • Joint replacement. If your diseased bone has collapsed or other treatments aren’t helping, you might need surgery to replace the damaged parts of your joint with plastic or metal parts.
  • Regenerative medicine treatment. Bone marrow aspirate and concentration is a newer procedure that might be appropriate for early stage avascular necrosis of the hip. Stem cells are harvested from your bone marrow. During surgery, a core of dead hipbone is removed and stem cells inserted in its place, potentially allowing for growth of new bone. More study is needed.

Talk to your doctor about treatment options and the stage of your Avascular Necrosis of the Hip.

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Thank You

Wishing you a pain free day

Debbie

You won’t keep me down ©

Osteonecrosis can be painful you never know when the pain will come or go.

But I do know it’s already taken my job away from me.

I love the optical field. But the pain was too intense.

Well I’m back in school learning something new.

#YourNeverToOldToLearn

 

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