What is osteonecrosis?
Bone is composed of living cells that need blood flow support. When the blood flow to the bone is cut off for any reason, the death of bone cells and the collapse/destruction of the bone is called osteonecrosis. Osteonecrosis causes pain in the bone and limitation of joint movements. It occurs in the (epiphyseal) end region of the bone, causing degenerative arthritis in that joint. It most often develops in the hip and knee joints; Shoulders, hands and feet are less affected joints. Osteonecrosis rarely develops in the jaw.
Why does osteonecrosis develop?
The most common causes of osteonecrosis:
-Serious traumas that cut off the blood supply to the bone
-Corticosteroid use (long-term and high-dose)
-Excessive alcohol consumption
-Smoking
Less common:
-Lupus, haemorrhage (as in divers with sudden pressure change), some blood diseases (such as sickle cell anemia), HIV infection , radiation therapy, bisphosphonates (necrosis of the jaw) cause osteonecrosis.
Who develops osteonecrosis?
Each year, osteonecrosis develops with a frequency of 1/10 000-20 000. Although it can be seen at any age, it is more common between the ages of 20-50. It is seen in both sexes. The risk of development is higher in those who carry the risk factors listed above, such as trauma, corticosteroid use, and excessive alcohol use. The common feature of cases with osteonecrosis of the jaw reported with the use of bisphosphonates; cases using zolendronate or pamidronate for cancer.
How is osteonecrosis diagnosed?
In the early stage, patients do not have many complaints. Patients have complaints of increasing joint pain. Joint pain tends to increase as weight is placed on that joint. In the early stages, direct radiographs are normal; however, the diagnosis can be made with magnetic resonance imaging (MRI).
How is osteonecrosis treated?
In the early period of osteonecrosis;
Analgesics
Weight loss
Avoiding exercises that force the range of motion of the joint and reducing activities that stress the joint (such as jumping, running)
Electrical stimulation (TENS) -has a bone growth stimulating effect
Lipid-lowering drugs
Anticoagulants
Hyperbaric oxygen therapy
Electromagnetic therapy
Alcohol and smoking should be stopped. Steroid dose should be minimized or substitute treatments should be preferred.
Surgical treatment: In advanced osteonecrosis cases, surgical treatment is applied.
Core decompression
Osteotomy
Non-vasularized bone grafting
Total arthroplasty (prosthetic surgeries)
Generally conservative (protective) in osteonecrosis of the jaw ) treatments are applied. Such as pain relief treatments, debridement (removal of dead tissue), antibiotics and antiseptic mouthwashes.
