Challenges in identifying the underlying cause of extensive osteonecrosis: an illustrative example and clinical guide

The authors present a case of a female patient in her early forties diagnosed with an exceptionally extensive manifestation of osteonecrosis, with bilateral involvement across several major joints and bone regions, including the proximal femur, distal femur, proximal tibia, patella, and the foot/ankle area. The widespread pattern suggested a severe systemic compromise in blood flow, leading to ischemic bone damage. To elucidate the underlying pathology, a comprehensive array of tests and investigations were conducted. As the case advanced, a potential elementary cause for the osteonecrosis was identified: alcohol abuse.