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Yu X, Zhang S, Zhang B, Dai M. Relationship of idiopathic femoral head necrosis with blood lipid metabolism and coagulation function: A propensity score-based analysis. Front Surg 2023; 9:938565. [PMID: 36684312 PMCID: PMC9852306 DOI: 10.3389/fsurg.2022.938565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/10/2022] [Indexed: 01/09/2023] Open
Abstract
Background Nontraumatic osteonecrosis of the femoral head (ONFH) can be corticosteroid-induced, alcohol-induced, and idiopathic ONFH (IONFH). Although corticosteroid- and alcohol-induced ONFH has been investigated extensively regarding its relationship with blood lipids and coagulation factor levels. However, the effect of blood lipid metabolism and coagulation function on IONFH has rarely been studied. Therefore, this study aimed to analyse the relationship of IONFH with blood lipid and coagulation indicators. Methods Total 680 patients diagnosed with IONFH in our institution during January 2011-June 2019 who met the inclusion criteria composed the case group; 613 healthy persons who underwent physical examination at our institution during the same period composed the control group. Propensity scores were used for baseline feature matching, and two matching groups each with 450 patients were established. After the matching, blood lipid and coagulation factor levels of both groups were comparatively analysed. Results The case group showed significantly higher total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) levels, low-density/high-density lipoprotein (LDL/HDL) ratio, and apolipoprotein B (Apo-B) levels than the control group (p < 0.05). Conversely, the HDL and apolipoprotein A (Apo-AI) levels in the case group were significantly lower than those in the control group (p < 0.05). Regarding coagulation indicators, the activated partial thromboplastin time and prothrombin time were lower in the case group than in the control group; however, the differences were insignificant (p > 0.05). Furthermore, fibrinogen (FIB) levels and thrombin time (TT) in the case group were higher than those in the control group. There were significant differences between the two groups only in terms of FIB levels (p < 0.05), while TT was not significantly different (p > 0.05). Conclusions IONFH has strong associations with blood lipid metabolism and coagulation function, which provide an avenue for exploring the mechanism of IONFH.
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Baek SH, Kim KH, Lee WK, Hong W, Won H, Kim SY. Abnormal Lipid Profiles in Nontraumatic Osteonecrosis of the Femoral Head: A Comparison with Osteoarthritis Using Propensity Score Matching. J Bone Joint Surg Am 2022; 104:19-24. [PMID: 35389903 DOI: 10.2106/jbjs.20.00520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Abnormal lipid metabolism may play an important role in the development of nontraumatic osteonecrosis of the femoral head (ON). By comparing lipid biomarkers in patients with ON and osteoarthritis (OA) after propensity score matching, we sought to reveal (1) common lipid biomarkers that are abnormal in ON regardless of the etiology and (2) specific lipid biomarkers associated with ON according to the etiology. METHODS Among 2,268 patients who underwent primary THA, 1,021 patients were eligible for this study. According to the Association Research Circulation Osseous criteria, ON was classified as either idiopathic (n = 230), alcohol-associated (n = 293), or glucocorticoid-associated ON (n = 132). Most common cause of OA was hip dysplasia in 106 patients (47%). We investigated patient lipid profiles by assessing total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), apolipoprotein (Apo) A1 and B, lipoprotein (a) levels and ApoB/A1 ratio. Since age and body mass index affect the lipid profile, we performed propensity score matching to select 304 patients for final analysis and compared lipid profiles between the ON and OA groups. We also compared biomarkers between the ON subgroups and the OA group. RESULTS Overall, the ON group showed lower HDL-C (p < 0.001), higher TGs (p = 0.001) levels and higher ApoB/A1 ratio (p = 0.003). Idiopathic ON patients demonstrated lower HDL-C (p = 0.032), higher TGs (p = 0.016), ApoB (p = 0.024) levels and ApoB/A1 ratio (p = 0.008). The alcohol-associated ON subgroup showed lower HDL-C (p < 0.001), higher TGs (p = 0.010) levels and ApoB/A1 ratio (p = 0.030). Finally, the steroid-associated ON subgroup demonstrated lower HDL-C (p = 0.003), higher TGs (p = 0.039), lower TC (p = 0.022), LDL-C (p = 0.021), and ApoA1 (p = 0.004) levels. CONCLUSIONS Higher TGs and lower HDL-C levels were associated with nontraumatic ON regardless of the etiology. Additionally, idiopathic ON was associated with higher ApoB levels and ApoB/A1 ratio. Alcohol-associated ON was related to higher ApoB/A1 ratio, and steroid-associated ON paired with decreased TC, LDL-C, and ApoA1 levels. Our findings may support future efforts for prevention and management of nontraumatic ON. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
- Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Kwang-Hwan Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Won Kee Lee
- Medical Research Collaboration Center, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Wonki Hong
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Heejae Won
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Shin-Yoon Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Yan Y, Wang J, Huang D, Lv J, Li H, An J, Cui X, Zhao H. Plasma lipidomics analysis reveals altered lipids signature in patients with osteonecrosis of the femoral head. Metabolomics 2022; 18:14. [PMID: 35147763 DOI: 10.1007/s11306-022-01872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although studies have established a link between lipid metabolism disorder and osteonecrosis of the femoral head (ONFH), the characteristics of the circulating lipidome signature of ONFH have not yet been investigated and need to be explored. OBJECTIVES We aimed to explore the plasma lipidome signatures in patients with ONFH, and to identify specific lipid biomarkers of ONFH. METHODS In this study, a comprehensive detection and analysis of plasma lipidomics was conducted in clinical human cohort, including 32 healthy normal control (NC) subjects and 91 ONFH patients in different subgroups [alcohol-induced ONFH (AONFH), steroid-induced ONFH (SONFH), and traumatic-induced ONFH (TONFH)] or at different disease stages (stage I, II, III and IV of ONFH) using ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). RESULTS Overall, the plasma lipidome profile differs between ONFH and NC samples. Lipidome signature including 22 common differentially expressed lipids (DELs) in all three subgroups (variable importance in projection > 1, P < 0.05, fold change > 1.5 or < 0.67, compared to the NC group) was identified. Besides, the subtype-specific lipidome profiles for each ONFH subgroup were also analyzed. Generally, the AONFH subgroup has the largest number of DELs, and the plasma levels of triacylglycerol lipid compounds increased obviously in the AONFH samples. In the subgroup of SONFH, the relative abundance of lipid 4-Aminobenzoic acid increased significantly with changes in the expression of several of its interactive genes. We have identified that 9 stage-positive and 2 stage-negative lipids may function as novel biomarkers predicting the progression of ONFH. CONCLUSION Our study presents an overview of the phenotype-related plasma lipidome signature of patients with ONFH. The results will provide insight into the mechanisms underlying the metabolism of lipids in the pathogenesis and progression of ONFH and help identify novel lipids biomarkers or disease diagnosis and treatment targets.
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Affiliation(s)
- Yuzhu Yan
- Clinical Laboratory of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Jihan Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Dageng Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Jing Lv
- Clinical Laboratory of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Hui Li
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Jing An
- Translational Medicine Center, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Xiaojian Cui
- Department of Radiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Heping Zhao
- Clinical Laboratory of Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
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Association of Specific Genetic Polymorphisms with Atraumatic Osteonecrosis of the Femoral Head: A Narrative Review. Indian J Orthop 2022; 56:771-784. [PMID: 35547337 PMCID: PMC9043172 DOI: 10.1007/s43465-021-00583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/25/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Atraumatic ONFH is one of the leading cause of hip morbidity in the working-age group. It is a multi-factorial disease whose root cause can be attributed to single-nucleotide polymorphism. Identifying such polymorphisms could pave the way for new modalities of treatment for ONFH. METHODOLOGY Two databases were electronically searched for relevant articles. The articles were screened through titles, abstract and full texts to include the relevant studies. A secondary search was done through the reference list of selected articles. RESULTS A total of 52 studies were included among the 181 hits. All 181 were case-control studies. Summary of these studies identifies multiple SNPs which can cause ONFH. There were 117 SNPs in all 181 studies, of which 92 were associated with the causation of ONFH and 25 were protective against ONFH. CONCLUSION SNPs play an essential role in causing atraumatic ONFH. Identification of SNP that contribute to causing ONFH may help reduce the disease burden by early identification, diagnosis and treatment, including targeted gene therapy.
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Liu T, Cao Y, Han C, An F, Wang T, Sun M, Ma C, Dong Q, Wang J. Association of MIR17HG and MIR155HG gene variants with steroid-induced osteonecrosis of the femoral head in the population of northern China. J Orthop Surg Res 2021; 16:673. [PMID: 34781979 PMCID: PMC8594148 DOI: 10.1186/s13018-021-02669-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/11/2021] [Indexed: 01/05/2023] Open
Abstract
Introduction Steroid-induced osteonecrosis of the femoral head (ONFH) is a disease of the bone. Metabolism and genetic factors are generally considered to play an important role. The purpose of this study was to investigate the relationship between single-nucleotide polymorphisms (SNPs) in MIR17HG and MIR155HG and the risk of steroid-induced ONFH in the population of northern China. Methods A total of 199 steroid-induced ONFH patients and 506 healthy controls were recruited for the study. Four SNPs of MIR17HG and seven SNPs of MIR155HG were genotyped by Sequenom MassARRAY. ORs and 95% CIs were used to evaluate the relationship between these SNPs and steroid-induced ONFH. Results In the codominant model, patients with the MIR17HG SNPs (rs7318578) AA genotype had an increased risk of steroid-induced ONFH (OR = 1.79, p = 0.039); in the recessive model, patients with the MIR17HG SNP (rs7318578) AA genotype had an increased risk of steroid-induced ONFH (OR = 1.78, p = 0.032). Stratified analysis showed that a MIR17HG SNP (rs7318578) and the MIR155HG SNPs (rs77218221, rs11911469, rs34904192 and rs4143370) were closely related to different unornamented phenotypes of steroid-induced ONFH. Analysis of the clinical indicators revealed significant differences in high-density lipoprotein (HDL-C) levels between the ONFH group and the control group (p = 0.005). In the MIR17HG SNP (rs75267932), patients with different genotypes had different levels of triglyceride (TG). The MIR155HG SNPs (rs77699734, rs1893650, and rs34904192) showed differences in triglyceride (TG), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) levels in patients with different genotypes. Conclusion Our results confirm that MIR17HG and MIR155HG gene mutations are associated with steroid-induced ONFH susceptibility in the population of northern China, providing new evidence for the early detection and prevention of ONFH.
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Affiliation(s)
- Tingting Liu
- Inner Mongolia Medical University, Hohhot, 010110, Jinshan Development Zone, China.,The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1, Yingfang Road, Huhhot, 010030, Hui District, China
| | - Yuju Cao
- Zhengzhou Traditional Chinese Medicine (TCM) Traumatology Hospital, No.1266, First Street, Hanghai East Road, Zhengzhou, 450009, China
| | - Changxu Han
- The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1, Yingfang Road, Huhhot, 010030, Hui District, China
| | - Feimeng An
- Inner Mongolia Autonomous Region Hospital of Traditional Chinese Medicine, No. 11, Xingcheng District, Hohhott, 010010, China
| | - Tiantian Wang
- Inner Mongolia Medical University, Hohhot, 010110, Jinshan Development Zone, China.,The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1, Yingfang Road, Huhhot, 010030, Hui District, China
| | - Menghu Sun
- Inner Mongolia Medical University, Hohhot, 010110, Jinshan Development Zone, China.,The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1, Yingfang Road, Huhhot, 010030, Hui District, China
| | - Chao Ma
- The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1, Yingfang Road, Huhhot, 010030, Hui District, China
| | - Qiumei Dong
- College of Traditional Chinese Medicine, Inner Mongolia Medical University, Hohhot, 010110, Jinshan Development Zone, China.
| | - Jianzhong Wang
- The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1, Yingfang Road, Huhhot, 010030, Hui District, China.
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Cui Q, Jo WL, Koo KH, Cheng EY, Drescher W, Goodman SB, Ha YC, Hernigou P, Jones LC, Kim SY, Lee KS, Lee MS, Lee YJ, Mont MA, Sugano N, Taliaferro J, Yamamoto T, Zhao D. ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head. J Korean Med Sci 2021; 36:e65. [PMID: 33724736 PMCID: PMC7961868 DOI: 10.3346/jkms.2021.36.e65] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.
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Affiliation(s)
- Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Woo Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Kyung Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, Korea
| | - Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Wolf Drescher
- Department of orthopedic surgery, RWTH University Hospital, Aachen, Germany
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
| | - Yong Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | | | - Lynne C Jones
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shin Yoon Kim
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mel S Lee
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yun Jong Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital and Medical College of Seoul National University, Seongnam, Korea
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Nobuhiko Sugano
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - John Taliaferro
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
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Nicchio IG, Cirelli T, Nepomuceno R, Hidalgo MAR, Rossa C, Cirelli JA, Orrico SRP, Barros SP, Theodoro LH, Scarel-Caminaga RM. Polymorphisms in Genes of Lipid Metabolism Are Associated with Type 2 Diabetes Mellitus and Periodontitis, as Comorbidities, and with the Subjects' Periodontal, Glycemic, and Lipid Profiles. J Diabetes Res 2021; 2021:1049307. [PMID: 34805411 PMCID: PMC8601849 DOI: 10.1155/2021/1049307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/25/2021] [Accepted: 10/19/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and periodontitis (P) commonly occur as comorbidities, but the commonalities in the genetic makeup of affected individuals is largely unknown. Since dyslipidemia is a frequent condition in these individuals, we investigate the association of genomic variations in genes involved in lipid metabolism with periodontal, glycemic, lipid profiles, and the association with periodontitis and T2DM (as comorbidities). METHODS Based on clinical periodontal examination and biochemical evaluation, 893 subjects were divided into T2DM+P (T2DM subjects also affected by periodontitis, n = 205), periodontitis (n = 345), and healthy (n = 343). Fourteen single-nucleotide polymorphisms (SNPs) were investigated: LDLR gene (rs5925 and rs688), APOB (rs676210, rs1042031, and rs693), ABCC8 (rs6544718 and 6544713), LPL (rs28524, rs3735964, and rs1370225), HNF1A (rs2650000), APOE (rs429358 and rs7412), and HNF4A (rs1800961). Multiple linear and logistic regressions (adjusted for covariates) were made for all populations and stratified by sex and smoking habits. RESULTS Individuals carrying APOB-rs1042031-CT (mainly women and never smokers) had a lower risk of developing periodontitis and T2DM (T2DM+P); altogether, this genotype was related with healthier glycemic, lipid, and periodontal parameters. Significant disease-phenotype associations with gene-sex interaction were also found for carriers of APOB-rs1676210-AG, HNF4A-rs1800961-CT, ABCC8-rs6544718-CT, LPL-rs13702-CC, and LPL-rs285-CT. CONCLUSIONS Polymorphisms in lipid metabolism genes are associated with susceptibility to T2DM-periodontitis comorbidities, demonstrating gene-sex interaction. The APOB-rs1042031 was the most relevant gene marker related to glucose and lipid metabolism profiles, as well as with obesity and periodontitis.
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Affiliation(s)
- Ingra G. Nicchio
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
| | - Thamiris Cirelli
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
| | - Rafael Nepomuceno
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
| | - Marco A. R. Hidalgo
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
| | - Carlos Rossa
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
| | - Joni A. Cirelli
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
| | - Silvana R. P. Orrico
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
- Advanced Research Center in Medicine, Union of the Colleges of the Great Lakes (UNILAGO), São José do Rio Preto, SP 15030-070, Brazil
| | - Silvana P. Barros
- Department of Periodontology, University of North Carolina at Chapel Hill-UNC, School of Dentistry, Chapel Hill, NC, USA
| | - Letícia H. Theodoro
- Department of Diagnosis and Surgery, São Paulo State University-UNESP, School of Dentistry at Araçatuba, Araçatuba, SP, Brazil
| | - Raquel M. Scarel-Caminaga
- Department of Morphology, Genetics, Orthodontics and Pediatric Dentistry, São Paulo State University-UNESP, School of Dentistry at Araraquara, Araraquara, SP, Brazil
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Mont MA, Salem HS, Piuzzi NS, Goodman SB, Jones LC. Nontraumatic Osteonecrosis of the Femoral Head: Where Do We Stand Today?: A 5-Year Update. J Bone Joint Surg Am 2020; 102:1084-1099. [PMID: 32282421 PMCID: PMC7508290 DOI: 10.2106/jbjs.19.01271] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➢. Clinicians should exercise a high level of suspicion in at-risk patients (those who use corticosteroids, consume excessive alcohol, have sickle cell disease, etc.) in order to diagnose osteonecrosis of the femoral head in its earliest stage. ➢. Nonoperative treatment modalities have generally been ineffective at halting progression. Thus, nonoperative treatment is not appropriate in early stages when one is attempting to preserve the native joint, except potentially on rare occasions for small-sized, medially located lesions, which may heal without surgery. ➢. Joint-preserving procedures should be attempted in early-stage lesions to save the femoral head. ➢. Cell-based augmentation of joint-preserving procedures continues to show promising results, and thus should be considered as an ancillary treatment method that may improve clinical outcomes. ➢. The outcomes of total hip arthroplasty in the setting of osteonecrosis are excellent, with results similar to those in patients who have an underlying diagnosis of osteoarthritis.
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Affiliation(s)
- Michael A. Mont
- Lenox Hill Hospital, New York, NY,Cleveland Clinic, Cleveland, Ohio,Email address for M.A. Mont:
| | | | | | | | - Lynne C. Jones
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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9
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Chang C, Greenspan A, Gershwin ME. The pathogenesis, diagnosis and clinical manifestations of steroid-induced osteonecrosis. J Autoimmun 2020; 110:102460. [PMID: 32307211 DOI: 10.1016/j.jaut.2020.102460] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/28/2022]
Abstract
Corticosteroid associated osteonecrosis is bone death resulting from the use of chronic glucocorticoids and most commonly affects the femoral head, although the bones such as around knee joint, wrist joint and ankle joint can be affected. The pathogenesis is likely multifactorial, with genetic and environmental factors playing a role. Epigenetics may be the mechanism by which environment exerts it effects. In spite of recent discoveries, the exact pathogenesis of corticosteroid associated osteonecrosis is unknown. Over the past few years, more miRNA's have been found to be associated with osteonecrosis. The older mechanisms such as a coagulopathy, abnormalities in apoptosis and lipid metabolism dysfunction are still believed to play a role. The role of inflammatory pathways including the PDK1/AKT/mTOR signaling pathway, the PERK and Parkin pathways have been increasingly recognized as playing a mechanistic role. Histological damage to the joint can occur before the presence of symptoms. The most common symptoms are pain and an inability to bear weight. Differential diagnosis includes infection, bone marrow edema syndrome or subchondral fracture. Early detection is important for successful management of the condition. MRI is the best radiologic technique to diagnosis femoral head osteonecrosis. Multiple staging systems for osteonecrosis have been used over the years, including the Ficat and Arlet system and the Steinberg criteria. The later stages of these staging systems are irreversible. Both non-surgical (conservative) and surgical modes of therapy are used in the treatment of osteonecrosis.
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Affiliation(s)
- Christopher Chang
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA; Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis, Davis, CA, 95616, USA.
| | - Adam Greenspan
- Department of Radiology, University of California, Davis School of Medicine, Sacramento, CA, 95817, USA
| | - M Eric Gershwin
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children's Hospital, Hollywood, FL, 33021, USA.
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10
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Bai H, Chen T, Lu Q, Zhu W, Zhang J. Gene expression profiling of the bone trabecula in patients with osteonecrosis of the femoral head by RNA sequencing. J Biochem 2019; 166:475-484. [PMID: 31518413 DOI: 10.1093/jb/mvz060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/26/2019] [Indexed: 01/17/2023] Open
Abstract
Early diagnosis and treatment of osteonecrosis of the femoral head (ONFH) is challenging. Bone trabecula play a vital role in the severity and progression of ONFH. In the present study, the investigators used gene expression profiling of bone trabecula to investigate gene alterations in ONFH patients. Osteonecrotic bone trabecula (ONBT) such as necrosis, fibrosis, and lacuna were confirmed by histological examination in the patients. The adjacent 'normal' bone trabecula (ANBT) did not show any pathological changes. Gene sequencing data revealed that although ANBT showed no significant histological changes, alteration of mRNA profiling in ANBT was observed, similar to that in ONBT. Our results indicated that the alteration of mRNA profiling in ANBT may cause normal bone tissue to develop into necrotic bone. RNA-seq data indicated that 2,297 differentially abundant mRNAs were found in the ONBT group (1,032 upregulated and 1,265 downregulated) and 1,523 differentially abundant mRNAs in the ANBT group (744 upregulated and 799 downregulated) compared with the healthy control group. Gene ontology (GO) enrichment analysis suggested that fatty acid metabolism and degradation were the main zones enriched with differentially expressed genes (DEG). Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis indicated that peroxisome proliferator-activated receptor γ (PPAR-γ) pathway was the most significantly regulated pathway. Lipocalin-2 (LCN2), an osteoblast-enriched secreted protein, was significantly decreased in ONBT suggesting that downregulation of LCN2 might affect lipid metabolism and lead to hyperlipidemia, and thus promote pathogenesis of ONFH.
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Affiliation(s)
- Haobo Bai
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 1 Yi Xue Yuan Road, Yu Zhong District, Chongqing 400016, China.,Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, 1 Road Yixueyuan, Yuzhong District, Chongqing 400016, China
| | - Tingmei Chen
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, 1 Road Yixueyuan, Yuzhong District, Chongqing 400016, China
| | - Qian Lu
- Heart Centre, the Children's Hospital of Chongqing Medical University, 136 Zhongshan Er Road, Yu Zhong District, Chongqing 400016, China
| | - Weiwen Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 1 Yi Xue Yuan Road, Yu Zhong District, Chongqing 400016, China.,Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, College of Laboratory Medicine, Chongqing Medical University, 1 Road Yixueyuan, Yuzhong District, Chongqing 400016, China
| | - Jian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 1 Yi Xue Yuan Road, Yu Zhong District, Chongqing 400016, China
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Chen B, Du Z, Dong X, Li Z, Wang Q, Chen G, Zhang G, Song Y. Association of Variant Interactions in RANK, RANKL, OPG, TRAF6, and NFATC1 Genes with the Development of Osteonecrosis of the Femoral Head. DNA Cell Biol 2019; 38:734-746. [PMID: 31149839 DOI: 10.1089/dna.2019.4710] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Multiple gene polymorphisms have been demonstrated to correlate with the susceptibility to osteonecrosis of the femoral head (ONFH). However, as a complex disease induced by multiple genes, the development of ONFH has rarely been reported to involve in gene interaction. In this study, we first explored the association of 10 variants interactions in receptor activator of nuclear factor-kappa B (RANK), RANK ligand (RANKL), osteoprotegerin (OPG), tumor necrosis factor receptor-associated factor 6 (TRAF6), and nuclear factor of activated T cells cytoplasmic 1 (NFATC1) genes with the development and clinical phenotypes of ONFH in a 377 ONFH case-control study with using Mass ARRAY® platform. Our results showed that not only a total of 6 interactional variants in the paired 10 variants interactions were significantly associated with the development of ONFH (OPG rs2073617 and NFATC1 rs754093, p < 0.019; OPG rs2073618 and NFATC1 rs754093, p < 0.008; OPG rs2073617 and RANKL rs1054016, p < 0.039, respectively) but also a total of 4 paired interactional variants were found to involve significantly in the increased risk of bilateral hip lesions in ONFH (OPG rs2073617 and TRAF6 rs5030411, p = 0.044; RANK rs884205 and TRAF6 rs5030411, p = 0.045, respectively). Moreover, the results from generalized multifactor dimensionality reduction also showed that the five best models were identified and associated significantly with ONFH risk, p = 0.001, 0.01, 0.01, 0.01, and 0.01, respectively. Our results first suggest that the variants in RANK/RANKL/OPG pathway genes affected the development of ONFH in gene interaction manner through the interaction of the paired variants and multiple variants.
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Affiliation(s)
- Bingpeng Chen
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Zhenwu Du
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China.,2 Department of Research Center, Second Hospital of Jilin University, Changchun, People's Republic of China.,3 The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
| | - Xiaoming Dong
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Zhaoyan Li
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China.,2 Department of Research Center, Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Qingyu Wang
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China.,2 Department of Research Center, Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Gaoyang Chen
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China.,2 Department of Research Center, Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Guizhen Zhang
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China.,2 Department of Research Center, Second Hospital of Jilin University, Changchun, People's Republic of China.,3 The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
| | - Yang Song
- 1 Department of Orthopedics, Second Hospital of Jilin University, Changchun, People's Republic of China.,3 The Engineering Research Center of Molecular Diagnosis and Cell Treatment for Metabolic Bone Diseases of Jilin Province, Changchun, People's Republic of China
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