Prevalence rates and an evaluation of reported risk factors for osteonecrosis (avascular necrosis) in Crohn’s disease
Osteonecrosis, or nontraumatic (aseptic, avascular) bone necrosis, is estimated to account for over 10% of joint replacements. Several clinical disorders have been associated with osteonecrosis, as previously reviewed. Osteonecrosis has also rarely been reported in patients with inflammatory bowel disease, particularly Crohn’s disease. In some of these patients, treatment measures used for inflammatory bowel disease have been implicated in the pathogenesis of osteonecrosis, including corticosteroids, par- enteral nutrition with lipid emulsions or both. In some patients, other causes of osteonecrosis may be important, such as trauma or chronic alcoholism.
Most patients with inflammatory bowel disease and os- teonecrosis have been described only in case reports so that the overall rate of this disorder, specifically in patients with Crohn’s disease, has not been well established in larger patient series. Only two reports in the literature have attempted to address this issue. In 1989, Vakil and Sparberg tabulated their clinical experience with osteo- necrosis in a group of 204 consecutive patients referred with inflammatory bowel disease at a university teaching hospital during a 10-year period (1977 to 1987). In their reported group, 161 patients received corticosteroids (79%), and seven (4.3%) of these corticosteroid-treated patients developed osteonecrosis; only two patients actually had Crohn’s disease. In a report by Bello et al, data from 55 patients with Crohn’s disease treated with maintenance alternate- day prednisone, average dose 25 mg daily, for a mean duration of 6.6 years, revealed no observed instances of osteone- crosis. Neither of these studies used modern imaging methods such as magnetic resonance imaging (MRI) for diagnosis, and postoperative pathological studies on bone specimens confirming osteonecrosis were not reported.
The present report evaluates the clinical experience of osteonecrosis in 877 patients with Crohn’s disease consecutively evaluated during a 20-year clinical referral practice experience at a university teaching hospital. The results of the present study indicate that osteonecrosis is a bone disorder of unknown etiology very rarely seen in patients with Crohn’s disease. In this series of patients with Crohn’s disease, it was not possible to relate directly or even indirectly several previously hypothesized potential risk factors, such as corticosteroids or parenteral nutrition therapies, as well as intestinal resection, to this complication of osteonecrosis.
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