Avascular Necrosis (osteonecrosis) cause Symptoms

Avascular necrosis is when bone cells die because they don’t get enough blood. It is also called osteonecrosis, and it can cause tiny cracks in the bone and make the bone fall apart. Most of the time, the process takes months to years.

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If a bone is broken or a joint is out of place, blood can’t get to that part of the bone. Avascular necrosis is also linked to taking high-dose steroid drugs for a long time and drinking too much.

It can happen to anyone. But most people with this condition are between the ages of 30 and 50.

Avascular Necrosis


In the early stages of avascular necrosis, some people don’t feel anything. As the condition gets worse, the joints that hurt might only hurt when weight is put on them. At some point, the pain might bother you even when you’re lying down.

Pain can be light or very bad. It usually gets worse over time. Avascular necrosis of the hip can cause pain in the groin, the thigh, or the buttock. It can also affect the shoulder, knee, hand, and foot, in addition to the hip.

Some people get avascular necrosis on both sides, like in both hips or both knees.

When to go to the doctor:

If you have pain in any joint that doesn’t go away, you should see a doctor. Get medical help right away if you think you may have broken a bone or moved a joint out of place.


Avascular necrosis occurs when bone blood supply decreases. Joint or bone injury lowers blood flow. If your joint pops, it could damage neighboring blood vessels.Β Radiation used to treat cancer can also weaken bones and hurt blood vessels.

  • Deposits of fat in the blood vessels. Small blood vessels can be blocked by the fat. This can make bones get less blood.
  • Certain diseases. Some diseases, like sickle cell anemia and Gaucher’s disease, can also make it harder for blood to get to bones.

When avascular necrosis is not cause by an injury, the cause isn’t always clear. There may be a role for genetics, drinking too much, taking certain medicines, and having other diseases.

Risk factors:

Some things that could cause avascular necrosis are:

  • Trauma. If you break or dislocate your hip, for example, it can damage nearby blood vessels and cut off blood flow to the bones.
  • Using steroids. Avascular necrosis is often cause by taking high doses of corticosteroids like prednisone. No one knows why, but some experts think that corticosteroids can raise the amount of fat in the blood, which slows down the flow of blood.
  • Having too much to drink. Having a few alcoholic drinks every day for a long time can also cause fat to build up in blood vessels.
  • Use of bisphosphonates. Long-term use of medicines that make bones stronger could make osteonecrosis of the jaw more likely. High-dose chemotherapy for multiple myeloma and metastatic breast cancer has caused this unusual side effect. When used to treat cancer, radiation can weaken bones. Avascular necrosis can also happen after an organ transplant, especially a kidney transplant.

Avascular necrosis can be caused by medical conditions like pancreatitis and Gaucher’s disease.

  • HIV/AIDS β€’ Systemic lupus erythematosus β€’ Sickle cell anemia β€’ Decompression sickness, also called divers’ disease or the bends
  • Some kinds of cancer, like leukemia


Avascular necrosis gets worse if it is not treated. At some point, the bone can break. Avascular necrosis also makes bones lose their smooth shape, which can make arthritis worse.


To lower the chance of getting avascular necrosis and improve health in general:

  • Limit alcohol. Avascular necrosis is more likely to happen to people who drink a lot.
  • Keep your cholesterol low. The most common thing that stops blood from getting to bones is small bits of fat.
  • Monitor steroid use. Make sure your doctor knows if you have used or are using high-dose steroids. With repeated high-dose steroid treatments, the damage to bones seems to get worse.
  • Don’t smoke. When you smoke, your blood vessels get smaller, which can slow blood flow.


A healthcare practitioner will press around your joints during a physical exam to look for discomfort. They may also move the joints into various positions to see if the range of motion is reduce.

Imaging examinations

Joint pain can be cause by a variety of conditions. Imaging examinations can assist in determining the source of pain.

  • X-rays are one type of test. They can detect bone abnormalities that develop later in the course of avascular necrosis. X-rays normally show no issues in the early stages of the illness.
  • An MRI and CT scan. These procedures generate precise pictures that can reveal early abnormalities in bone that may suggest avascular necrosis.
  • A bone scan. In a vein, a little amount of radioactive material is injected. This tracer travels to the wounded or healing sections of the bones. It appears on the imaging plate as bright dots.


The goal is to avoid more bone loss.


Certain drugs may help relieve symptoms of avascular necrosis in the early stages:

  • Nonsteroidal anti-inflammatory medications (NSAIDs). Over-the-counter drugs such as ibuprofen (Advil, Motrin IB, and others) or naproxen sodium (Aleve) may help reduce avascular necrosis discomfort. Prescription-only NSAIDs are available.
  • Osteoporosis medications. These treatments may reduce the progression of avascular necrosis, however the evidence is conflicting.
  • Cholesterol-lowering medications. Reduced levels of cholesterol and fat in the circulation may aid in the prevention of artery blockages that can lead to avascular necrosis.
  • Blood vessel dilation medications. Iloprost (Ventavis) has the potential to enhance blood flow to the afflicted bone. More research is required.
  • Blood thinning medications. Blood thinners, such as warfarin (Jantoven), may help prevent clots in the veins that feed the bones in people with clotting issues.


Your doctor may advise you to do the following:

  • Rest. Restricting physical activity or using crutches to keep weight off the joint for several months may help halt bone deterioration.
  • Exercises. A physical therapist can provide exercises to assist maintain or improve the joint’s range of motion.
  • Stimulation using electricity. Electrical currents may stimulate the body to produce new bone to replace injured bone. During surgery, electrical stimulation can be delivere directly to the injured area. It can also be given by electrodes connected to the skin.

Surgical and non-surgical procedures

Because most people do not have symptoms until avascular necrosis has progressed, your doctor may advise surgery.

  • Core decompression is one of the choices. A surgeon removes a portion of the bone’s inner layer. Aside from relieving pain, the increased space inside the bone stimulates the growth of healthy bone tissue and new blood vessels.
  • Bone transplantation (graft). This technique can aid in the strengthening of the bone damaged by avascular necrosis. The graft is a healthy bone fragment removing from another region of the body.
  • Reshaping of bones (osteotomy). To help redistribute weight away from the injure bone, a wedge of bone is removing above or below a weight-bearing joint. Bone contouring may assist delay joint replacement.
  • Joint replacement surgery. If the injured bone has collapsed or other therapies aren’t working, surgery can replace the damaged components of the joint with plastic or metal elements.
  • A recent treatment, bone marrow aspiration and concentration, may aid in the early stages of hip avascular necrosis.
  • During surgery, the surgeon removes a sample of a dead hipbone and replaces it with stem cells extracted from bone marrow. This may allow for the formation of new bone. More research is required.

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