AVASCULAR NECROSIS DUE TO CORTICOSTEROID THERAPY IN COVID-19 AS A SYNDEMIC

Keywords: Avascular necrosis, Corticosteroid, COVID-19, Early diagnosis, Hyperbaric oxygenation, Osteonecrosis, Treatment

Abstract

To date, over 163 million confirmed cases of COVID-19 and over 3.3 million deaths from COVID-19 have been reported by the World Health Organization (WHO). However, there is still no specific treatment for the disease. Some empirical and supportive medications have been used thus far, including antivirals, antipyretics, antibiotics, and corticosteroids. Corticosteroids are anti-inflammatory and immunosuppressive medications that are used to treat several diseases. These agents can produce undesirable and occasionally severe systemic adverse effects. Although the occurrence and severity of most adverse effects are related to the dose and duration of the corticosteroid therapy, avascular necrosis is not directly associated with this dose and duration, and may occur without osteoporosis. Corticosteroids are not recommended for routine use in COVID-19 patients by the WHO. However, these medications have been widely used for their treatment. Avascular necrosis is a progressive and incapacitating condition. The causes of avascular necrosis are categorized into traumatic and non-traumatic. The majority of non-traumatic cases are associated with the use of corticosteroids. Early diagnosis and treatment is crucial owing to the rapidly progressive nature of the disease. Severe COVID-19 patients are at risk of avascular necrosis due to corticosteroid therapy. The hypothesis presented herein suggests that hyperbaric oxygenation in combination with adequate calcium and vitamin D supplementation and individualized exercise may be an effective, safe, and noninvasive  treatment modality, preventing from the progression of avascular necrosis.

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References

Read the WHO Coronavirus (COVID-19) Dashboard. [Updated May 19, 2021]. Available from: https://covid19.who.int/ [Accessed May 19, 2021].

Compston J. Glucocorticoid-induced osteoporosis: an update. Endocrine 2018;61(1):7–16.

Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin North Am 2016;42(1):157–176.

Lane NE. Glucocorticoid-induced osteoporosis: New insights into the pathophysiology and treatments. Curr Osteoporos Rep 2019;26;17(1):1–7.

Rutgeerts PJ. Review article: the limitations of corticosteroid therapy in Crohn’s disease. Aliment Pharmacol Ther 2001;15(10):1515–1525.

Keenan GF. Management of complications of glucocorticoid therapy. Clin Chest Med 1997;18(3):507–520.

Belaiche J, Louis E. Corticosteroid treatment in active Crohn’s disease. Acta Gastroenterol Belg 1998;61(2):153–157.

Weinstein RS. Glucocorticoid-induced osteonecrosis. Endocrine 2012;41(2):183–190.

Vakil N, Sparberg M. Steroid-related osteonecrosis in inflammatory bowel disease. Gastroenterology 1989;96(1):62–67.

Maldague B, Malghem J, de Deuxchaisnes C. Radiologic aspects of glucocorticoid-induced bone disease. Adv Exp Med Biol 1984;171:155–190.

Read the COVID-19 Clinical management: living guidance. [Updated Jan 25, 2021]. Available from: https://www.who.int/publications/i/item/clinical-management-of-covid-19 [Accessed May 19, 2021].

Weinstein RS. Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinol Metab Clin North Am 2012;41(3):595–611.

Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum 2003;48(11):3224–3229.

Al-Jabri T, Tan JYQ, Tong GY, Shenoy R, Kayani B, Parratt T, et al. The role of electrical stimulation in the management of avascular necrosis of the femoral head in adults: a systematic review. BMC Musculoskelet Disord 2017;18(1):319.

Lee MH, Ebeling PR, Milat F. Bilateral avascular necrosis of the femoral head in fibrous dysplasia. JBMR Plus 2017;1(1):27–30.

Lamb JN, Holton C, O’Connor P, Giannoudis P V. Avascular necrosis of the hip. BMJ 2019;365:l2178.

Petek D, Hannouche D, Suva D. Osteonecrosis of the femoral head: pathophysiology and current concepts of treatment. EFORT Open Rev 2019;4(3):85–97.

Matthews AH, Davis DD, Fish MJ, Stitson D. Avascular Necrosis. StatPearls. 2020. https://www.ncbi.nlm.nih.gov/books/NBK537007/

Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 1995;77(3):459–474.

Xie XH, Wang XL, Yang HL, Zhao DW, Qin L. Steroid-associated osteonecrosis: Epidemiology, pathophysiology, animal model, prevention, and potential treatments (an overview). J Orthop Transl 2015;3(2):58–70.

Cooper C, Steinbuch M, Stevenson R, Miday R, Watts NB. The epidemiology of osteonecrosis: findings from the GPRD and THIN databases in the UK. Osteoporos Int 2010;21:569–577.

Min BW, Song KS, Cho CH, Lee SM, Lee KJ. Untreated asymptomatic hips in patients with osteonecrosis of the femoral head. Clin Orthop Relat Res 2008;466(5):1087–1092.

Falez F, Panegrossi G, Casella F, Favetti F. (2004) Neck-Preserving Implants in the Treatment of Femoral Head Avascular Necrosis. In: Santori FS, Santori N, Piccinato A. (eds) Avascular Necrosis of the Femoral Head: Current Trends. Springer, Milano.

Carli A, Albers A, Séguin C, Harvey EJ. The medical and surgical treatment of ARCO Stage-I and II osteonecrosis of the femoral head: a critical analysis review. JBJS Rev 2014;2(2):1–10.

Shimizu K, Moriya H, Akita T, Sakamoto M, Suguro T. Prediction of collapse with magnetic resonance imaging of avascular necrosis of the femoral head. J Bone Joint Surg Am 1994;76(2):215–223.

Ahmed N, Sriskandarajah P, Burd C, Riddell A, Boyd K, Kaiser M, et al. Detection of avascular necrosis on routine diffusion-weighted whole body MRI in patients with multiple myeloma. Br J Radiol 2019;92(1097):20180822.

Tripathy SK, Goyal T, Sen RK. Management of femoral head osteonecrosis: current concepts. Indian J Orthop 2015;49(1):28–45.

Karantanas AH, Drakonaki EE. The role of MR imaging in avascular necrosis of the femoral head. Semin Musculoskelet Radiol 2011;15(3):281–300.

Ergözen S, Kaya E. Hyperbaric oxygen treatment. Muğla Tıp Dergisi 2018;5(3):46–50.

Reis ND, Schwartz O, Militianu D, Ramon Y, Levin D, Norman D, et al. Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head. J Bone Joint Surg Br 2003;85(3):371-375.

Published
2021-07-03