Avascular Necrosis (Osteonecrosis): What is it and why is it on the rise post covid?
Avascular necrosis (AVN) is a serious condition causing the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years.
A broken bone or dislocated joint can stop the blood flow to a section of bone. Avascular necrosis is also associated with long-term use of high-dose steroid medications and too much alcohol.
What are the causes of avascular necrosis?
Avascular necrosis mainly affects young people in the age group of 20 to 50 years. This condition usually develops due to an injury or underlying health condition, such as:
- Fracture
- Dislocation
- Long-term use of steroid drugs
- Medical treatments like radiation therapy for cancer, organ transplant
- Excessive alcohol consumption
- Inflammation, blood clots, or damage to the arteries can block the blood supply to your bones
- Certain chronic diseases including diabetes, HIV, osteoporosis, lupus, and sickle cell anemia
Where does avascular necrosis develop?
Avascular necrosis can affect bone tissue in any joint, but typically targets your hip. Other joints that can develop avascular necrosis include:
- Ankles.
- Jaw.
- Knees.
- Upper arm (humerus) and shoulders.
Symptoms and Causes
What causes avascular necrosis?
Bone fractures or disease that prevent blood flow to bone tissue causes avascular necrosis. About 20% of avascular necrosis cases happen without an obvious cause. Known causes of avascular necrosis are:
- Traumatic avascular necrosis: This can happen after you break a bone or dislocate a joint.
- Nontraumatic avascular necrosis: This happens if you have an illness or medical condition that keeps blood from flowing to your bone tissue. Nontraumatic avascular necrosis often affects the same bones on both sides of the body. For example, if you have avascular necrosis in your right shoulder, you're likely to have it in your left shoulder.
What are the symptoms of avascular necrosis?
It might be weeks or months before you notice symptoms that might indicate you have avascular necrosis. Here are some symptoms that appear over time that could be signs of avascular necrosis:
- Intermittent pain that appears and eases when you put pressure on your bone and then remove the pressure.
- Increasing pain and stiff joints.
- Limited range of motion.
- Limping if you have avascular necrosis in your hips or knees.
- Difficulty climbing stairs, standing or walking.
How is avascular necrosis diagnosed?
When you go for diagnosis, your orthopedist will conduct a physical exam, checking for tender spots by pressing your joints. He will also move your joints in different positions to see the range of motion. Further, he may ask you to undergo a few tests to find the root cause of your pain:
- X-rays
- CT scan and MRI
- Bone scan
What are the treatment options for avascular necrosis?
The doctor will focus on easing the pain, improving the joint, and stopping further bone damage. Your treatment will depend on various factors, such as:
- Cause of avascular necrosis
- Stage of the condition
- Location of the affected bone
- Degree of bone damage
- Your age
If the condition is detected early, your treatment will include taking medications and minimizing the use of the affected area. You may have to use crutches if your hip, ankle, or knee is affected to avoid putting weight on the damaged joint. Your doctor may ask you to exercise to keep your joints mobile.
Medications
If there is an underlying cause for your avascular necrosis, your doctor may prescribe medications to manage and treat it. They include:
- Pain Relief Gels: They help ease the pain
- Blood thinners: If the cause of avascular necrosis is blood clots, then blood thinners are prescribed.
- Cholesterol drugs: These medicines help reduce the cholesterol level and fat in your blood, thereby preventing blockages that can result in avascular necrosis.
Rise Post Covid
Orthopaedic surgeons are seeing a rise in AVN recently in Covid-19 patients treated with steroids. Another reason is that since the clotting tendency of the body generally increases due to Covid, the blood supply to some areas stops in some patients who have also taken steroids.
Dr Kailash Patil, arthroscopy and joint replacement surgeon at Sancheti Hospital, stated there is a significant rise in the number of patients coming with AVN, majorly the surge is due to steroids used during their treatment in the pandemic.
Prevention
To reduce the risk of avascular necrosis and improve general health:
- Limit alcohol. Heavy drinking is one of the top risk factors for developing avascular necrosis.
- Keep cholesterol levels low. Tiny bits of fat are the most common substance blocking blood supply to bones.
- Monitor steroid use. Make sure your health care provider knows about your past or present use of high-dose steroids. Steroid-related bone damage appears to worsen with repeated courses of high-dose steroids.
- Don't smoke. Smoking narrows blood vessels, which can reduce blood flow.
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Medical Review: This article is written by Dr Nishtha Mittal (Senior Health Content Editor at Zanskar Health) and has been medically reviewed by the medical team at Zanskar Health. This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.