Posted 3/24/2015 10:12 PM (GMT 0)
Lots of evidence of osteonecrosis of the femoral head from systemic corticosteroid use:
http://www.ncbi.nlm.nih.gov/pubmed/11770392
Am J Clin Dermatol. 2001;2(6):377-88.
Relationship between systemic corticosteroids and osteonecrosis.
Gebhard KL1, Maibach HI.
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Abstract
Numerous reports describe osteonecrosis after oral corticosteroid therapy. It is still uncertain if corticosteroid treatment alone or in combination with other factors leads to the development of this condition. The literature presents controversial clinical and experimental data. The most affected site for osteonecrosis is the femoral head and therefore our considerations are concentrated at this site. Oral corticosteroids are commonly used in dermatology, especially in the treatment of connective tissue diseases and hypersensitive diseases. This clinical review evaluates the relationship between and the onset of femoral head necrosis. Although osteonecrosis of the femoral head can be caused by various conditions such as trauma, excess alcohol and hemoglobinopathies, studies indicate that treatment with corticosteroids is the most common cause of the condition. There is some controversy on the role of underlying disease and total corticosteroid dose administered, in the development of osteonecrosis of the femoral head. MRI scans are used to establish an early diagnosis. There are several surgical and nonsurgical options for disease management, dependent on the stage of disease, the age of the patient and other risk factors. In general, the risk for osteonecrosis is considered to be low under oral corticosteroid therapy. So far, no data can establish a direct relationship, but data still strongly suggest an existing cause and effect relationship. Further investigations are necessary for example, a large controlled prospective long-term study, to further refine an association between the corticosteroid dose, the duration of treatment and other risk factors. Dermatologists who prescribe oral corticosteroids, should always be aware of the potential risk of avascular femoral head necrosis and the patients should be informed about this severe complication of oral coricosteroid therapy.
http://ndt.oxfordjournals.org/content/26/9/2728
The use of systemic corticosteroids is common in patients with a variety of different renal diseases. Low-dose oral corticosteroids are part of many long-term treatment protocols for patients following renal transplantation or with different forms of glomerulonephritis and systemic autoimmune diseases, i.e. systemic lupus erythematosus or vasculitis. High-dose intravenous corticosteroids are typically used for short durations to treat transplant rejection episodes or for the induction of remission in highly active autoimmune diseases. Osteonecrosis (ON) is a well-known and feared complication in patients with renal diseases undergoing systemic corticosteroid therapy. It predominantly occurs in the femoral head (FH) (FH necrosis, FHN; Figure 1), but also in the proximal humerus, the knee and the ankle .