Old-growth research at the H

Osteonecrosis has long been recognized as a compli-cation of systemic steroid use and was initially be-lieved to occur only in patients who received high doses (equivalent to more than 4000 mg of prednisone) for extended periods (3 months or longer).1–6 Previous sporadic case reports have described patients in whom osteonecrosis developed following relatively brief courses (7 days) of low-dose, orally administered steroid medication.7–11 The exact mechanism by which these medications cause osteonecrosis remains elusive.1,3,5,7,12,13 Current research has focused on the development of a hypercoaguable state, with subsequent impaired fibrinolysis and venous thrombosis in bone.14,15 At a tertiary care, university-affiliated orthopedic unit specializing in the treatment of osteonecrosis of the femoral head, we reviewed the charts of patients who pre-sented from 1986 to 1996 with osteonecrosis of the femoral head who had received a single short-course of cortico-steroid medication within the 3 years before presentation (Table 1). We identified 15 patients who met the inclusion criteria. An exhaustive examination for other potential risk factors revealed only 3 patients with such factors; none of these risk factors was felt to be sufficient, in isolation, to cause osteonecrosis.13–21 All 15 patients were male. Their mean age was 32.2 (range 20–41) years. The mean steroid dose in equivalent milligrams of prednisone was 850 (range 290–3300) mg. The mean duration of drug therapy was 20.5 (range 7–39) days. The mean time from administration of steroids to the development of hip symptoms was 16.6 (range 6–33) months. There was significant diagnostic delay in the ma-Osteonecrosis of the femoral head in men following short-course corticosteroid therapy: a report of 15 case