Lupus And An Increased Risk Of Osteonecrosis
Sometimes, what you don’t know or understand can hurt you.
I think sometimes we like to remain blissfully unaware of what our illnesses and the medications we use to treat them bring with them.
For example, while I’ve always heard that using steroids for a prolonged period of time can cause bone health issues, I never really considered it as an issue that could impact me.
I had an opportunity to connect several months ago with several lupus patients. They were all younger than me, in their early twenties, and had all had hip replacements. This struck me as a bit strange because I tend to think of joint replacements mainly occurring in RA.
It also peaked my interest because I have been concerned that I will probably need a hip replacement someday, hopefully later rather than sooner.
Anyway, as I investigated further, I discovered that as it turns out, these women didn’t necessarily require hip replacements as a direct effect of their lupus, but rather were diagnosed with osteonecrosis/ avascular necrosis, which was attributed to their prolonged use of corticosteroids (i.e. prednisone) to treat their lupus.
According to the American College of Rheumatology (ACR), “More than 90 percent of cases of osteonecrosis result from the use of glucocorticoid (sometimes called corticosteroid) medicine [or from drinking too much alcohol]” (ACR, 2012).
While corticosteroids can be extremely useful in treating many autoimmune diseases, they are also responsible for causing changes in bone metabolism. Just 5 mg of prednisone daily can be impactful, and many Lupus patients are on much higher doses of corticosteroid medications.
Lupus, on its own, puts people at an increased risk for osteonecrosis, and the use of corticosteroids adds insult to injury (no pun intended) as that is the most common thing that leads to osteonecrosis.
Osteonecrosis is the death of bone cells caused by a decrease in blood flow (ACR, 2012), which can lead to osteoarthritis and osteoporosis, and if there is significant enough damage, can result in the need for joint replacements.
Osteonecrosis can occur in any bone, but is most common is in the leg, connecting to the hip joint (National Institute of Arthritis and Musculoskeletal and Skin Diseases, ND).
There is currently no treatment for osteonecrosis, other than pain medications and joint replacement if the damage is severe enough.
Maybe my being anti-steroid has helped me to avoid this condition so far, but who knows.
The reality is that the reliance on treating Lupus with corticosteroids can increase a condition that is already typically seen in those with Lupus, even where corticosteroids haven’t been relied upon.
This is a serious condition that leads to pain and disability, and in finding new treatments for Lupus, the incidence of osteonecrosis, as it is correlated with steroid use, needs to be taken into consideration.
American College of Rheumatology. 2012. “Osteonecrosis”. (https://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Osteonecrosis/)
National Institute of Arthritis and Musculoskeletal and Skin Diseases. ND. “Osteonecrosis”.