Avascular necrosis (Osteonecrosis): Symptoms, Causes, Treatment & Prevention

 

Avascular necrosis is a debilitating bone disease that can impair your mobility and worsen over time. It happens when something stops one of your bones' blood supply. Broken bones, dislocated hips, radiation therapy, and alcohol abuse are among the causes. To reduce discomfort and increase mobility, the majority of individuals require surgery, occasionally joint replacement.

Bone tissue that dies from a lack of blood flow is known as avascular necrosis. It can result in small fractures and bone collapse and is also known as osteonecrosis. Months or years may pass during the process.

Blood flow to a portion of bone may be stopped by a fractured bone or a dislocated joint. Long-term usage of high-dose steroid medications and excessive alcohol use are also linked to avascular necrosis.

Anyone can be impacted. However, those between the ages of 30 and 50 are more likely to have the illness.

Also Read: Bone pain: Causes, Diagnosis, Treatment & Prevention

What is Avascular necrosis?

 When anything stops blood flow to your bone tissue, avascular necrosis occurs.  Your skeletal system produces new bone tissue to replace aging bone tissue that eventually degrades and dies, so your bones are always changing.

Consider this a cycle in which your body produces new tissue to replace the deteriorating and dying tissue.  For your bones to remain strong and healthy, this routine must be followed exactly.  The nutrients and oxygen that bones require to remain healthy and regenerate are carried by blood.  Your skeletal system cannot produce new bone tissue quickly enough without a blood supply.  The withering bone starts to break apart and finally falls apart.

Symptoms:

During the early stages of avascular necrosis, some patients show no symptoms. Affected joints may only painful when weight is placed on them as the illness worsens. At some point, the discomfort may even be felt while you're lying down.

Pain can range from minor to severe. It frequently develops gradually. Avascular necrosis of the hip may cause pain that is concentrated in the buttocks, groin, or thigh. The hand, foot, knee, and shoulder may also be impacted in addition to the hip.
Avascular necrosis may develop in both hips or knees in certain individuals.

Causes:

When blood supply to a bone is limited or stopped, avascular necrosis develops. A decreased blood supply may result from:

• Bone or joint injury. An injury, such as dislocated joint, could demage blood vessels in the affected area.

• Radiation therapy is used to treat cancer. Radiation therapy can damage blood vessels and weaken bones.

• Deposits of fat in blood vessels. Lipids, or fat, have can obstruct tiny blood vessels. Blood flow to the bones may be decreased as a result.

• Certain diseases. Blood flow to bone can also be reduced by medical diseases such as Gaucher disease, lupus, antiphospholipid syndrome, and sickle cell anemia, among others.

• It's not always clear what causes avascular necrosis that isn't caused by trauma. Genetics, excessive alcohol consumption, certain medications, and other diseases probably all play a part.

Risk factors:

The following are risk factors for avascular necrosis:

• Trauma. Hip dislocations and fractures are examples of injuries that can damage surrounding blood vessels and reduce blood supply to the affected bones.

• Use of steroids. Avascular necrosis is frequently brought on by the use of high-dose corticosteroids, such as prednisone. Although the exact cause is uncertain, some experts think that corticosteroids may cause blood lipid levels to rise, which would decrease blood flow.

• Excessive alcohol consumption. Fatty deposits in blood vessels can also develop as a result of years of consuming many alcoholic beverages daily.

• Use of bisphosphonates. Osteonecrosis of the jaw may develop as a result of long-term usage of medications intended to improve bone density. Some patients receiving large dosages of these medications for malignancies including multiple myeloma and metastatic breast cancer have had this uncommon side effect.

• Specific medical procedures. Bone deterioration may result from cancer radiation treatment. Avascular necrosis is often linked to organ transplants, particularly kidney transplants.

Avascular necrosis is linked to the following medical conditions:

• Pancreatitis

• Gaucher disease

• HIV/AIDS

• Lupus erythematosus systemic

•  Sickle cell anemia

• The bends or diver's disease are other names for decompression sickness

• Leukemia is one of the cancer types

How is the diagnosis of avascular necrosis made?

In addition to conducting a physical examination, your healthcare provider will evaluate your symptoms. One or more of these tests could be administered to you:

• X-rays to find arthritic symptoms and fractures

• MRI  magnetic resonance imaging

Treatment:

How is avascular necrosis treated by medical professionals?

The extent of your bone injury will determine how you are treated. If your bone deterioration is restricted to tiny, non-weight-bearing bones, you may be able to get the following treatments:

• Packs that are cold

• Heating

• Get some rest

• NSAIDs, or nonsteroidal anti-inflammatory medications

• Physical therapy helps improve range of motion and reduce joint pain

• Walking assistance such as crutches and canes

How can more severe types of avascular necrosis be treated?

Surgery is typically required to treat avascular necrosis. Options for surgery include:

• Core decompression: To increase blood flow to the damaged bone, your surgeon will drill tiny holes, or cores, in it. To encourage recovery, this treatment may be used in conjunction with bone grafts or injections.

• Joint replacement: An artificial joint is used to replace your injured joint. In patients with avascular necrosis, hip and knee replacements are 95% successful in reducing pain and restoring mobility.

• Osteotomy: This procedure involves removing a wedge of bone above or below a weight-bearing joint to shift weight off the damaged bone. It may help delay joint replacement.

• Substitutes. Bone transplantation (graft): This procedure can help strengthen the area of bone affected by avascular necrosis. The graft is a section of healthy bone taken from another part of the body.

• Treatment with regenerative medicine. A more recent technique that may aid in the early stages of hip avascular necrosis is bone marrow aspiration and concentration. A sample of dead hipbone is removed during surgery, and bone marrow-derived stem cells are used to replace it. This could promote the growth of new bone. More study is needed.

Prevention:

To enhance overall health and lower the risk of avascular necrosis:

• Don't drink too much. One of the main risk factors for avascular necrosis is heavy drinking.

• Keep low cholesterol levels. The most frequent material obstructing the blood circulation to bones is tiny pieces of fat.

• Keep an eye on steroid use. Make sure your doctor is aware of any high-dose steroid use you may have had in the past or present. Repeated high-dose steroid courses seem to exacerbate steroid-induced bone deterioration.

• Avoid smoking. Smoking can lower blood flow because it narrows blood vessels.

References:

• Jones LC, et al. Treatment of nontraumatic hip osteonecrosis (avascular necrosis of the femoral head) in adults. https://www.uptodate.com/contents/search. Accessed Nov. 26, 2024.

• Ferri FF. Osteonecrosis. In: Ferri's Clinical Advisor 2025. Elsevier; 2025. https//www.clinicalkey.com. Accessed Nov. 26, 2024.

• Osteonecrosis. Merck Manual Professional Version. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/osteonecrosis/osteonecrosis-on. Accessed Nov. 26, 2024.

• Barney J, Piuzzi NS, Akhondi H. Femoral Head Avascular Necrosis. (https://www.ncbi.nlm.nih.gov/books/NBK546658/)Femoral. In: StatPearls. Accessed 9/30/2021.

• Osteonecrosis. Dorland's Medical Dictionary Online. https://www.dorlandsonline.com. Accessed Dec. 3, 2024.

• National Institute of Arthritis and Musculoskeletal and Skin Diseases. Avascular necrosis (https://www.niams.nih.gov/health-topics/osteonecrosis). Accessed 9/30/2021.

• Osteonecrosis. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteonecrosis. Accessed Nov. 26, 2024.

• American Academy of Orthopaedic Surgeons. Avascular necrosis of the Hip (https://orthoinfo.aaos.org/en/diseases--conditions/osteonecrosis-of-the-hip/). Accessed 9/30/2021.

• National Organization for Rare Disorders. Avascular necrosis (https://rarediseases.org/rare-diseases/osteonecrosis/). Accessed 9/30/2021.