Corticosteroid-associated osteonecrosis in paediatric compared with adult patients: are they the same disease?

Osteonecrosis of the femoral head (ONFH) is a debilitating condition with a poorly characterized pathogenesis. Among the reported aetiologies, excessive alcohol consumption and corticosteroid administration are leading causes. Corticosteroids are often administered as a life-saving treatment for primary oncological or autoimmune conditions, but the subsequent development of ONFH can significantly impair the quality of life of both paediatric and adult patients. This review provides a comprehensive summary and critical analysis of recent advances in the understanding of corticosteroid-associated ONFH, with a focus on the distinctions between paediatric and adults patients. By elucidating age-dependent biological mechanisms and clinical characteristics, this work aims to enhance understanding of the disease's pathogenesis. These insights may facilitate the development of improved strategies for early diagnosis and timely intervention, with the goal of preserving the functional and biomechanical integrity of the femoral head and improving patient outcomes across different ages.