What is osteonecrosis?
Your bones are made up of living cells that need a blood supply to stay healthy. In osteonecrosis, blood flow to part of a bone is reduced. This causes death of bone tissue, and the bone can eventually break down and the joint will collapse.
Osteonecrosis can happen to any bone, but most often it develops in the ends of long bones, such as the:
- Thigh bone.
- Upper arm bone.
Less often, the bones of the elbows, ankles, feet, wrists, and hands are affected.
When the disease involves part of a bone in a joint, it can lead to the breakdown of the bone and osteoarthritis.
Who gets osteonecrosis?
People of any age can get osteonecrosis, but it is most common in people in their 30s and 40s.
Several factors may increase the chance a person will get osteonecrosis. However, some people who do not have any of these factors may still get the disease. Factors that may increase the chance of getting osteonecrosis include:
- Injury, such as a broken or dislocated bone or a joint injury.
- Medications, such as corticosteroids that are used for long periods at high doses.
- Excessive alcohol and tobacco use.
- Certain medical conditions and treatments, such as chemotherapy.
What are the types of osteonecrosis?
Health care providers describe two types of osteonecrosis:
- Traumatic, which follows an injury. The most common causes of traumatic osteonecrosis are a bone fracture (break) or dislocation.
- Nontraumatic, when there is no history of injury.
What are the symptoms of osteonecrosis?
There may be no symptoms of osteonecrosis at first, but you may gradually start to feel pain. At first, you may feel pain when you use the affected joint. As the disease gets worse, you may feel pain even when you are at rest.
Over time, the joint may stiffen and lose its range of motion, and osteoarthritis may set in. If the end of the bone collapses, the pain may get worse quickly.
What causes osteonecrosis?
Osteonecrosis happens when the blood supply to part of a bone is reduced. This keeps the bone tissue from getting nutrients and oxygen.
Is there a test for osteonecrosis?
If your doctor suspects you have osteonecrosis, he or she may take your medical history and do a physical exam.
Your doctor may also order the following imaging tests to see which bones are affected and to view the bone or joint damage:
- Magnetic resonance imaging (MRI).
- Computed tomography (CT) scan.
How is osteonecrosis treated?
The goal of treatment is to keep the joint working for as long as possible. In some cases, the bone may heal on its own, and your doctor may recommend nonsurgical treatment options. But in most cases, treatment involves surgery.
Nonsurgical treatment options include:
- Medicines, to reduce pain and swelling.
- Physical therapy, to help decrease joint tenderness and stiffness, and to increase the joint’s range of motion.
- Use of a cane or crutches, to provide support and help relieve pain and weakness when walking.
Most people with osteonecrosis eventually need surgery to repair the bone as the disease gets worse. Eventually, you may need joint replacement surgery.
Who treats osteonecrosis?
Osteonecrosis is usually treated by:
- Orthopaedic surgeons, who specialize in treatment and surgery for bone and joint diseases.
- Mental health professionals, who provide counseling and treat mental health disorders such as depression and anxiety.
- Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
- Physical therapists, who can help strengthen your muscles and improve joint function.
- Primary care doctors, such as a family physician or internal medicine specialist, who coordinates care between the different health providers and treats other problems as they arise. Primary care doctors can provide nonsurgical treatment for osteonecrosis.
- Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles and can provide nonsurgical care for osteonecrosis.
Living with osteonecrosis
Having a painful disease like osteonecrosis can be hard, but you can do the following to help cope with the disease:
- Talk to your doctor about the types of exercises that are best for you, as well as activities or exercises you should avoid.
- Care for your joints by using cold packs to ease swelling and numb pain. Heat treatments, such as hot showers or heating pads, help soothe stiff joints and muscles.
- If you experience emotional or mental health problems, consider seeking help from a mental health professional or joining a support group, which can help you learn more about coping and living with the disease.
Remember to follow the recommendations of your health care providers.