Corticosteroid dose reporting in atraumatic osteonecrosis of the humeral head: a scoping review

Steroid-induced avascular necrosis of the humeral head is an uncommon but clinically important complication of corticosteroid exposure. Although steroid-associated osteonecrosis has been extensively studied in the femoral head, considerably less attention has been directed toward the shoulder, particularly regarding whether a dose-response relationship or clinically meaningful corticosteroid threshold exists. This scoping review aimed to map the available literature on steroid-induced humeral head avascular necrosis and evaluate how corticosteroid dose, duration, route of administration, and timing have been reported.

A structured literature search was conducted across PubMed/MEDLINE, Embase, the Cochrane Library, and Google Scholar in accordance with scoping review methodology. Eligible studies included adult patients with humeral head avascular necrosis associated with corticosteroid exposure. Data were charted regarding study design, patient population, corticosteroid exposure, diagnostic approach, disease stage, management, and reported outcomes.

Fifty-two sources of evidence were included; the literature was limited and heterogeneous, consisting largely of case reports, case series, and retrospective studies. Corticosteroid exposure was frequently identified as a risk factor, but dose reporting was inconsistent. Few studies provided sufficient detail regarding cumulative dose, peak dose, daily dose, route, duration, or timing of therapy. No consistent corticosteroid dose threshold for humeral head avascular necrosis could be identified.

Current evidence suggests an association between corticosteroid exposure and humeral head avascular necrosis, but the literature remains insufficient to define a reliable dose-response relationship or clinically useful dose threshold. Future studies should standardize reporting of corticosteroid exposure, including cumulative dose, peak dose, route, duration, and timing relative to symptom onset or diagnosis.