Exploring the link between brucellosis and osteonecrosis: A scoping review of current evidence

Brucellosis is a zoonotic infection that can lead to various musculoskeletal complications, including osteonecrosis of the femoral head. While osteonecrosis is commonly associated with corticosteroid use, alcohol consumption, or trauma, emerging evidence suggests that Brucella infection may contribute to its pathogenesis. This scoping review aims to explore the relationship between brucellosis and osteonecrosis by synthesizing data from case reports, case series, and observational studies. A comprehensive literature search was conducted in PubMed, EMBASE, ScienceDirect, and the Cochrane Library, identifying studies that reported brucellosis-associated osteonecrosis. The review highlights potential mechanisms linking Brucella infection to bone ischemia, including immune-mediated osteoclast activation, cytokine-induced bone resorption, and chronic inflammatory damage. Most patients presented with progressive hip pain, often accompanied by systemic brucellosis symptoms, and were diagnosed at advanced disease stages. Imaging findings frequently demonstrated femoral head collapse, subchondral cyst formation, and joint effusion, with MRI proving to be the most sensitive diagnostic tool. Treatment typically involved prolonged antimicrobial therapy, but many patients required surgical intervention, including total hip arthroplasty. This review underscores the need for in-creased clinical awareness of brucellosis as a potential contributor to osteonecrosis, particularly in endemic regions, and highlights the importance of early diagnosis and targeted treatment strategies.