[Osteonecrosis following short-term, high-dosage steroid therapy]

Osteonecrosis of the femoral head is one of many well documented side effects of long term steroid (glucocorticoid) use. Studies have reported on the skeletal effects of short term, high dose steroid therapy. This paper illustrates that short term (up to 6 weeks), high dose steroid therapy, utilized in neurotraumatology or central nervous system disease, can lead to necrosis of bone at multiple sites. This retrospective review of 6 patients supports the 18 previously reported cases: there were 5 male and one female patient, with a mean age of 32.2 years. The patients received an average dose of 5100 mg methylprednisolone for 23 days. The average interval between steroid administration and the onset of symptoms was 28 months. There was radiographic evidence of osteonecrosis of both femoral heads in all 6 patients. The female patient also had osteonecrosis of both humeral heads and both femoral condyles. Five of twelve hip joints were healed by intertrochanteric osteotomy and revascularization. One patient underwent total hip replacement. We were unable to find risk factors in these 6 patients which would make them susceptible to belated osteonecrosis of the femoral head. It is reasonable to conclude that there is a substantial risk of osteonecrosis in patients treated with high dose steroids even on a short term basis.