Research progress in the pathogenesis of hormone-induced femoral head necrosis based on microvessels: a systematic...

Area of Science:

• Orthopedics
• Vascular Biology
• Endocrinology

Background:

• Hormonal necrosis of the femoral head is a common non-traumatic condition linked to glucocorticoid use, abnormal bone and lipid metabolism, and impaired microcirculation.
• Impaired blood circulation is a critical factor in femoral head necrosis pathogenesis, particularly affecting the femoral head's microvasculature.
• H-type vessels are crucial for the "angiogenesis and osteogenesis coupling," significantly influencing the development of femoral head necrosis.

Purpose of the Study:

• To review the current understanding of the mechanisms behind hormone-induced femoral head necrosis, focusing on microvascular blood flow.
• To explore how glucocorticoids impact femoral head microcirculation and bone metabolism.
• To provide insights for future research and clinical strategies for treating femoral head necrosis.

Main Methods:

• Literature review of domestic and international studies on hormone-induced femoral head necrosis.
• Analysis of the role of microvascular dysfunction, including H-type vessels, in necrosis development.
• Examination of glucocorticoid-induced changes in coagulation, endothelial function, and angiogenesis.

Main Results:

• Glucocorticoids contribute to femoral head blood flow injury through coagulation and endothelial dysfunction, and impaired angiogenesis.
• Glucocorticoids may inhibit H-type vessel formation by downregulating key factors like HIF-1α, PDGF-BB, and VEGF.
• This disruption damages the "angiogenesis-osteogenesis coupling," hindering the femoral head's natural repair and reconstruction capabilities.

Conclusions:

• Impaired microvascular blood flow, especially the dysfunction of H-type vessels, is central to glucocorticoid-induced femoral head necrosis.
• Understanding the molecular mechanisms, such as the reduced expression of angiogenesis factors, is key to addressing this condition.
• This review offers a foundation for developing novel therapeutic approaches for hormonal femoral head necrosis.