[Short-term steroid therapy, sometimes with long-term sequelae]

Two patients developed osteonecrosis, respectively one and two years after the short-term intravenous use of dexamethasone. A 35-year-old man received 150 mg over a period of 3 weeks associated with a craniotomy for a subarachnoidal haemorrhage. He developed bilateral osteonecrosis of the femoral and humeral heads, which necessitated bilateral hip replacement surgery. He still experiences pain in both shoulders. A 45-year-old woman received 42.5 mg over a period of 1 week as a treatment for reflex dystrophy with oedema. She developed bilateral osteonecrosis in the femoral condyles, the talus and the calcaneus and after treatment she continued to experience pain in her right knee and ankle whilst walking. The only other risk factor for osteonecrosis identified in these patients was hyperlipidaemia in the man. Corticosteroid-induced osteonecrosis is typically multifocal and usually occurs 0.5 to 3 years after the therapy was initiated. There is a relationship with the dose and length of therapy. Even the short-term use of corticosteroids for 3 weeks or less, may lead to this dehabilitating complication.