Osteonecrosis in inflammatory bowel diseases: a review of the literature

Osteonecrosis (ON) of the femoral head can lead to femoral head collapse, necessitating total hip replacement. Reports of patients suffering from both ON and Inflammatory Bowel Diseases (IBD) have prompted us to evaluate the relationship between ON and IBD, especially Crohn's disease and ulcerative colitis.

A review of the data from three new cases, along with data from all the published cases of patients presenting ON and IBD found through a systematic search of the Pub Med database.

We encountered some diagnostic problems: The ON diagnosis could not be confirmed in some patients who did not meet the ON diagnostic criteria. Reviewed data was too weak to assess the exact incidence of ON in IBD. Corticosteroid therapy, especially in high dose regimens, is likely the most important etiological factor. No evidence supporting other physiopathological hypothesis, such as total parenteral nutrition, osteoporosis, or coagulation disorders, was found. Finally, the multifocal form of ON appears particularly common in IBD, with some patients presenting multiple lesions of the hip, shoulder, knee and talus.

ON in IBD, which is frequently multifocal, appears to be a complication of corticosteroid therapy, especially when high doses are used. We recommend regular ON checkups for corticosteroid-treated IBD patients.