Avascular Necrosis

[HeavyHitter]

After two surgeries on both my pec majors... (first one at the beginning of my 08 summer, 2nd during my 09 summer) I might have to get surgery on my hip for the 2010 summer...

Lets try to get as many docs in here as possible as I would like to debate if steroids cause AVN. Because most sites claim that steroid abuse and alcoholism combined cause avn... but will then say corticosteroids are what cause it. (which is obviously not "our" kind of steroids)

I will defly admit i did alot of drinking during my younger years on steroids, but, more likely, probably hurt my hip during some kind of sport activity such as wrestling, soccer, rugby, and or mma training.

I havnt got my mri yet, but my doc wont rule out avn bc he knows about my steroid use .

He says i will most likely need surgery no matter what it is... torn labrum, avn, irregualr bone growth etc.

****MY QUESTION is... can i wait till after the summer to get the surgery? And part b-- can i still do my beautiful test/deca /var/clen /igf/hghfrag cycle if i promise not to drink and stay on my diet???

HH

[MuscleScience]

AVN is generally considered a side effect of long corticosteroid use. Most studies I have read is that Anabolic steroids generally have a positive effect on bone health. Most people when they say steroid use in the medical realm generally are referring to corticosteroids such as prednisone. However to some the terminology can escape its true meaning. However I am not a medical doctor nor am I qualified to disagree with your doctors conclusion.

[HeavyHitter]

Does anybody know what drugs will reduce fatty substances (lipids) that increase with corticosteroid treatment or to reduce blood clotting in the presence of clotting disorders?

[HeavyHitter]

bump

[HeavyHitter]

should i be in another thread?? any help? experience?

[MuscleScience]

should i be in another thread?? any help? experience?

Did you find anything out definatively yet?

[HeavyHitter]

no, i have to wait 3-4 days before i can get my mri authorized. But i have a feeling its the avn...

thanks for responding Mscience!

[RogerB17]

reduce blood clotting in the presence of clotting disorders?

aspirin

[HeavyHitter]

For anyone that cares or has been following my posts....

NO EVIDENCE for fractures or avascular necrosis!!!!!!!!! I have a torn labrum and cyst formality. I still might need surgery but I dont need it right away and my bone is NOT dying!!

Impression: These findings are consistent with the presence of a labral tear through the anterior superior and superior labrum and adjacent paralabral cyst formation.

Findings: "bony proliferation on anterior lateral aspect of femoral head/neck junction with alpha angle measuring at 79 degrees. Multioculated cyst adjacent to posterior superior aspect of glenoid labrum. These findings are consistent with tear and subsequent paralabral cyst formation"

[Swifto]

Good to see you HeavyHitter. I hope your situiation imporves.

Would you not benifit from SERMs as they increase bone mineral density (agonists in bone)?

[MuscleScience]

Thats really good news to hear, AVN would have been a very big deal. What is the time table that your doc wants you to have surgery. I would think he would want to do is sooner rather than later. Labral tears in the hip are no joke either. I bet that hurts like a bitch.

[Swifto]

You've got me thinking...Uh oh.

After a little lok into this Heavy, compounds that reduce fatty substances (lipids) and have been used in the treatment of AVN are; Statin, Enoxaparin and Alendronate.


Here are three studies for you.

1. Clin Orthop Relat Res. 2001 May;(386):173-8.

Statin therapy decreases the risk of osteonecrosis in patients receiving steroids.
Pritchett JW.

Department of Orthopaedic Surgery, University of Washington, Seattle 98104, USA.

Osteonecrosis is a devastating complication of systemic steroid use. Prolonged steroid use produces a hyperlipidemic state in most patients and puts them at risk for osteoporosis and osteonecrosis. The fat content within the femoral head increases, resulting in increased intracortical pressure that may lead to sinusoidal collapse and osteonecrosis. Statins are lipid-clearing agents that dramatically reduce lipid levels in blood and tissues. Statins are widely used to prevent cardiovascular disease and have been shown to reduce the adverse effects of steroids on lipid metabolism. The purpose of this study was to determine whether the use of statin drugs affects later development of osteonecrosis in patients receiving steroids. The records of 284 patients who were taking statin drugs at the time they were started on high dose steroids were examined to determine whether osteonecrosis had developed. The patients remained on statin drugs during the entire time of steroid exposure. Magnetic resonance imaging scans were used to verify the osteonecrosis unless it was visible by radiograph. After an average of 7.5 years (minimum followup, 5 years), only three patients (1%) from the group had osteonecrosis develop. This 1% incidence is much less than the 3% to 20% incidence usually reported for patients receiving high-dose steroids. Statins may offer some protection against having osteonecrosis develop when steroid treatment is necessary.


2. Clin Orthop Relat Res. 2005 Jun;(435):164-70.

Enoxaparin prevents progression of stages I and II osteonecrosis of the hip.

Glueck CJ, Freiberg RA, Sieve L, Wang P.

Cholesterol Center, Jewish Hospital, 3200 Burnet Avenue, Cincinnati, OH 45229, USA. [email protected]

In a prospective pilot study, we hypothesized that enoxaparin (60 mg/day for 12 weeks) would prevent progression of Stages I and II osteonecrosis of the hip associated with thrombophilia or hypofibrinolysis or both over > or = 108 weeks of followup versus untreated historic controls, with different treatment responses in primary versus corticosteroid-associated secondary osteonecrosis. Patients with one or more thrombophilic-hypofibrinolytic disorder and Ficat Stages I or II osteonecrosis of at least one hip were included. A blinded committee interpreted anteroposterior and frog-leg lateral radiographs at entry in the study and every 36 weeks to > or = 108 weeks. Maintenance of the disease at Stages I and II versus progression of the osteonecrosis to Stages III and IV requiring total hip replacement was the major end point. Sixteen patients had primary osteonecrosis (25 hips; 13 Stage I, 12 Stage II), and 12 had secondary osteonecrosis (15 hips; five Stage I, 10 Stage II). With no Enoxaparin-related complications, 19 of 20 hips (95%) with primary osteonecrosis were unchanged from Stages I and II osteonecrosis at > or = 108 weeks; 12 of 15 hips (80%) with secondary osteonecrosis progressed to Stages III and IV osteonecrosis. In primary osteonecrosis at > or = 108 weeks, survival of 95% hips, or 76% (19/25 hips, based on intent to treat), compared favorably with untreated historical controls (approximately 20% 2-year survival), comparable to 20% survival in secondary hip osteonecrosis. Enoxaparin may prevent progression of primary hip osteonecrosis, decreasing the incidence of total hip replacement. LEVEL OF EVIDENCE: Therapeutic study, II-1 (prospective cohort study).



3. The Use of Alendronate to Prevent Early Collapse of the Femoral Head in Patients with Nontraumatic Osteonecrosis
A Randomized Clinical Study - http://www.ejbjs.org/cgi/content/abstract/87/10/2155





You owe me a pint.

[HeavyHitter]

Good to see you HeavyHitter. I hope your situiation imporves.

Would you not benifit from SERMs as they increase bone mineral density (agonists in bone)?

THanks Swifto! I honestly dont know anything about SERMS... I will now research and see what i can find!! thanks

[Swifto]

THanks Swifto! I honestly dont know anything about SERMS... I will now research and see what i can find!! thanks

I looked and found nothing, dont bother.

Those above 3 compounds showed decent enough results.

[HeavyHitter]

Thats really good news to hear, AVN would have been a very big deal. What is the time table that your doc wants you to have surgery. I would think he would want to do is sooner rather than later. Labral tears in the hip are no joke either. I bet that hurts like a bitch.

THanks brutha! I actually got the diagnosis from the rad tech directly. My doc appt is this friday. Yeah, it hurts but its bearable. Bearable enough to tell the doc I will get the surgery after the summer!! lol

Actually, im going to do whatever my doc says, but atleast i know i can try to delay it now!!

[HeavyHitter]

You've got me thinking...Uh oh.

After a little lok into this Heavy, compounds that reduce fatty substances (lipids) and have been used in the treatment of AVN are; Statin, Enoxaparin and Alendronate.


Here are three studies for you.

1. Clin Orthop Relat Res. 2001 May;(386):173-8.

Statin therapy decreases the risk of osteonecrosis in patients receiving steroids.
Pritchett JW.

Department of Orthopaedic Surgery, University of Washington, Seattle 98104, USA.

Osteonecrosis is a devastating complication of systemic steroid use. Prolonged steroid use produces a hyperlipidemic state in most patients and puts them at risk for osteoporosis and osteonecrosis. The fat content within the femoral head increases, resulting in increased intracortical pressure that may lead to sinusoidal collapse and osteonecrosis. Statins are lipid-clearing agents that dramatically reduce lipid levels in blood and tissues. Statins are widely used to prevent cardiovascular disease and have been shown to reduce the adverse effects of steroids on lipid metabolism. The purpose of this study was to determine whether the use of statin drugs affects later development of osteonecrosis in patients receiving steroids. The records of 284 patients who were taking statin drugs at the time they were started on high dose steroids were examined to determine whether osteonecrosis had developed. The patients remained on statin drugs during the entire time of steroid exposure. Magnetic resonance imaging scans were used to verify the osteonecrosis unless it was visible by radiograph. After an average of 7.5 years (minimum followup, 5 years), only three patients (1%) from the group had osteonecrosis develop. This 1% incidence is much less than the 3% to 20% incidence usually reported for patients receiving high-dose steroids. Statins may offer some protection against having osteonecrosis develop when steroid treatment is necessary.


2. Clin Orthop Relat Res. 2005 Jun;(435):164-70.

Enoxaparin prevents progression of stages I and II osteonecrosis of the hip.

Glueck CJ, Freiberg RA, Sieve L, Wang P.

Cholesterol Center, Jewish Hospital, 3200 Burnet Avenue, Cincinnati, OH 45229, USA. [email protected]

In a prospective pilot study, we hypothesized that enoxaparin (60 mg/day for 12 weeks) would prevent progression of Stages I and II osteonecrosis of the hip associated with thrombophilia or hypofibrinolysis or both over > or = 108 weeks of followup versus untreated historic controls, with different treatment responses in primary versus corticosteroid-associated secondary osteonecrosis. Patients with one or more thrombophilic-hypofibrinolytic disorder and Ficat Stages I or II osteonecrosis of at least one hip were included. A blinded committee interpreted anteroposterior and frog-leg lateral radiographs at entry in the study and every 36 weeks to > or = 108 weeks. Maintenance of the disease at Stages I and II versus progression of the osteonecrosis to Stages III and IV requiring total hip replacement was the major end point. Sixteen patients had primary osteonecrosis (25 hips; 13 Stage I, 12 Stage II), and 12 had secondary osteonecrosis (15 hips; five Stage I, 10 Stage II). With no Enoxaparin-related complications, 19 of 20 hips (95%) with primary osteonecrosis were unchanged from Stages I and II osteonecrosis at > or = 108 weeks; 12 of 15 hips (80%) with secondary osteonecrosis progressed to Stages III and IV osteonecrosis. In primary osteonecrosis at > or = 108 weeks, survival of 95% hips, or 76% (19/25 hips, based on intent to treat), compared favorably with untreated historical controls (approximately 20% 2-year survival), comparable to 20% survival in secondary hip osteonecrosis. Enoxaparin may prevent progression of primary hip osteonecrosis, decreasing the incidence of total hip replacement. LEVEL OF EVIDENCE: Therapeutic study, II-1 (prospective cohort study).



3. The Use of Alendronate to Prevent Early Collapse of the Femoral Head in Patients with Nontraumatic Osteonecrosis
A Randomized Clinical Study - http://www.ejbjs.org/cgi/content/abstract/87/10/2155





You owe me a pint.

thats very interesting!! im gonna look into statin therapy a little more now!! You might want to make that post a link on this site bc im sure many kids are juicing immaturely (w/ too much alcohol) and were gonna hear about Osteonecrosis, AVN more and more as time goes on...

thanks again Swifto. Anytime your in NY, you give me a shout my brutha!!

[Swifto]

thats very interesting!! im gonna look into statin therapy a little more now!! You might want to make that post a link on this site bc im sure many kids are juicing immaturely (w/ too much alcohol) and were gonna hear about Osteonecrosis, AVN more and more as time goes on...

thanks again Swifto. Anytime your in NY, you give me a shout my brutha!!

Not anytime soon my friend. I live in the UK, but I'll let you know mate.

I remember you from a long time ago when I joined as 'bigswiftos'. Your a good fella. Hope things work out mate.