Konarski Wojciech, Poboży Tomasz, Konarska Klaudia, Śliwczyński Andrzej, Kotela Ireneusz, Hordowicz Martyna, Krakowiak Jan
Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland.
Medical Rehabilitation Center, Sobieskiego 47D, 05-120 Legionowo, Poland.
Healthcare (Basel). 2023 Jun 26;11(13):1846. doi: 10.3390/healthcare11131846.
Osteonecrosis (ON) is usually a progressive disease that negatively affects the quality of life and leads to significant disability. Most patients are aged 30-50 years and require multiple surgical interventions throughout their lifetime. In non-traumatic ON, alcohol abuse and corticosteroids are involved in up to 80% of cases. This narrative review aims to summarize data on their impact on healthy bone and the development of pathophysiological processes leading to ON development. We conducted EMBASE and MEDLINE database reviews to identify relevant research. We found that for both agents, the risk was time and dose-dependent. ON in alcohol and steroid use shared many pathogenetic mechanisms leading to the development of necrosis, including increased adipogenesis, the induction of chronic inflammation, vascular alterations, and impaired bone-cell differentiation. Because both alcohol and steroid use are modifiable factors, both general physicians and orthopedic surgeons should encourage patients to limit ethanol intake and avoid corticosteroid overuse. In the presence of ON, because both alcohol- and steroid-induced disease tend to be multifocal, addiction treatment and limiting steroid use are justified.
骨坏死（ON）通常是一种进行性疾病，会对生活质量产生负面影响并导致严重残疾。大多数患者年龄在30至50岁之间，一生中需要多次手术干预。在非创伤性ON中，高达80%的病例与酗酒和使用皮质类固醇有关。本叙述性综述旨在总结关于它们对健康骨骼的影响以及导致ON发生的病理生理过程发展的数据。我们对EMBASE和MEDLINE数据库进行了检索以确定相关研究。我们发现，对于这两种因素，风险都与时间和剂量相关。饮酒和使用类固醇导致的ON有许多共同的致病机制，这些机制会导致坏死的发生，包括脂肪生成增加、慢性炎症的诱导、血管改变以及骨细胞分化受损。由于饮酒和使用类固醇都是可改变的因素，普通内科医生和骨科医生都应鼓励患者限制乙醇摄入并避免过度使用皮质类固醇。在存在ON的情况下，由于酒精和类固醇引起的疾病往往是多灶性的，因此进行成瘾治疗和限制类固醇使用是合理的。
