Osteo-What? Osteonecrosis or avascular necrosis?


At first it was a dull ache; gradually the pain In your knee became quite severe. "Aha!" said your doctor after reading an x-ray that didn't show any fracture or dislocation. Thinking that you had sprained your knee and that it would heal on it's own, she prescribed
non- steroidal anti-inflammatory medications (ibuprofen, for example), Ice and rest. When this was not effective in treating your pain, she wrote an order for physical therapy because surely this was tendonitis. Unfortunately, after 6 weeks you still had pain in your knee.

The next test in her bag of tricks was an MRI and it showed something quite different: osteonecrosis (avascular necrosis). What was the name again? What is osteonecrosis?

Definition and Causes

Osteonecrosis is a condition that results when blood flow to bones is cut off. Blood flow to bones? Yes, bones are just as alive as any other structure in the body; this blood carries necessary oxygen and nutrients. If the blood doesn't get to the bones, they die.

So, there you have it: osteo= bone and necrosis = death. So, osteonecrosis means dead bone. How do you got osteonecrosis? Germs on the doorknob? Is it a virus like the common cold?

No. Some people just develop osteonecrosis because they might have a condition that predisposes them. For example, there might be a fracture of the long bones in your leg (your thigh or calf bone). If these bones fracture, tiny little bone chips may form blood clots in arteries and veins resulting inA decreased blood supply yet again.

Divers who surface too rapidly and develop “the bends” often form nitrogen bloodclots which obstruct blood vessels and have the same result. Individuals with sickle cell anemia can develop osteonecrosis due to the shape of their red blood cells. The shape may block the blood vessel, again depriving bone of blood.

People with autoimmune diseases develop osteonecrosis for several reasons. Autoimmune diseases are frequently treated with corticosteroids, such as prednisone. 35% of
medication-induced osteonecrosis is caused by corticosteroids. Scientists aren't really sure how prednisone might cause osteonecrosis; but, one theory is that corticosteroids cause the formation of fatty blood clots.

Also, several autoimmune diseases cause blood clots, in the absence of corticosteroids. the autoimmune disease lupus provides one example of this in antiphospholipid syndrome (the subject of another hub).

What causes osteonecrosis?


So, now that you know you have osteonecrosis, how is it treated? Doctors first prescribe rest, acetaminophen, ice or non steroidal medications. By rest, they just don't mean for you to minimize usage of the joint; ofttimes they mean not putting weight on it at all for a few months.

Sometimes osteonecrosis needs to be treated surgically. Often, the first surgery offered might be one called a core decompression. in this surgery, minute-sized holes (cores) are drilled into the bones, releasing gases and other necrotic debris: thereby decreasing the pain.

Several other surgical treatments are available including complete or partial joint replacement. Research shows promise in treating osteonecrosis with stem cells, coral matrix and bone grafts and human growth hormone.

Comments 19 comments

Happyboomernurse profile image

Happyboomernurse 4 years ago from South Carolina

Hi Annie,

This was a very comprehensive hub about osteonecrosis or avascular necrosis, and I loved the title which is exactly what the average person would think if they heard those words.

I didn't know about some of the new treatments available and found this article very interesting, plus I felt the lead paragraph really captured the reader's attention with a vivid scenario.

Voted up, useful and interesting.

teamrn profile image

teamrn 4 years ago from Chicago Author

Thank you for the votes, boomer. Osteonecrosis is a pain in the budinski! Not a 'pain' a very disabling condition and the reason I can no longer practice nursing or hold down a job (there are too many days when I can barely walk). I didn't even delve into the psychosocial aspects of the disease. Thank goodness my husband has an income, so even though we struggle, others loose their homes, put off needed medical care: because they can't hold down a job which offers them medical benefits and their application for social security disability benefits has not yet been approved, entitling them to Medicare.

I was all against entitlement spending until I needed it! I considered anyone who didn't work and collected disability, a malingerer. Then, it happened to me and I COMPLETELY rethought my position. I truly can't work. There is freelance writing I can do, but when one is limited to the home and isn't that good anyway... Thank you for your compliments. They made my day!!

Nell Rose profile image

Nell Rose 4 years ago from England

Hi, I agree with Happy, above, it really drew me in, and I wanted to read about it. I hadn't heard of it before, so its something well worth knowing, thanks for the great info on this, voted up! cheers nell

Nell Rose profile image

Nell Rose 4 years ago from England

Thanks for the link, it didn't bring yours up unfortunately but it did bring his up, but thats fine, should be no problems, okay? take care, nell

Natashalh profile image

Natashalh 4 years ago from Hawaii

Oh, goodness! This sounds kind of terrifying to me! My eyes were glued to the screen for every word. Voted up, interesting and useful.

teamrn profile image

teamrn 4 years ago from Chicago Author

It is a terrifying disease. I used to be pretty athletic and now, none of that can happen, I've been on disability for the past 10 years, have had 2 joint replacements and the osteonecrosis is in 7 more joints. Osteonecrosis in ankles? Running AT ALL is out and lots of days I don't know if I can walk without falling. It's made a cripple of lots of people. One thing that works is knowing that people who don't have this disease UNDERSTAND. It means a lot to me; thanks! And thanks for voting up. Annie

Laura in Denver profile image

Laura in Denver 4 years ago from Aurora

Good information. Sounds like more than just my achy knees in the morning! Thanks!

teamrn profile image

teamrn 4 years ago from Chicago Author

Hi, Laura from Denver-I'm Annie from the Springs. Yep, unfortunately it's more than achy knees-but it starts that way!

Nell Rose profile image

Nell Rose 3 years ago from England

Hi, I just came back to read again, and wondered where all your other hubs have gone? and thanks for coming back on mine, nell

teamrn profile image

teamrn 3 years ago from Chicago Author

Apparently, HubPages thought it sufficient to take a few of mine down; WHY? I don't know. Earlier on they felt that some were plagiarized until I could PROVE that they weren't. (which is why I was hesitant to comment on YOUR plagiarism hub. But, I don't think I've written a Hub lately; I've got my blog to keep me busy and I'm also taking an internet marketing course and setting up sale on E-bay.

I don't know if HP was just flexing muscle, but it seemed odd! Good to hear from you, Nell and thanks for stopping over and your scars make NELL, NELL.

Nell Rose profile image

Nell Rose 3 years ago from England

Hi team, sorry I forgot to come back! lol! are you sure they are taken down or just not showing? If they are still showing on your account page then you need to go into edit on your profile scroll down and take a look to see if it says 'show' them or not, you will see what I mean, okay?

wba108@yahoo.com profile image

wba108@yahoo.com 3 years ago from upstate, NY

As I'm reading this I think have some tendinitis or bursitis in my shoulder.

I've had some pain for about a week. Ibuprofen seems to work as it relieves the pain.

I've heard that you should beware of too much prednisone because as you've mentioned, it may cause further complications.

teamrn profile image

teamrn 3 years ago from Chicago Author

Prednisone helps a lot of things and can be a life-saver (I mean that's what they give asthmatics during an attack). Unfortunately, the choice there is 'do I want to breathe and risk the potential side effects of prednisone; or don't I want to breathe??' That is one heck of a choice and a cruel one at that.

However, not everyone who gets large doses of prednisone gets osteonecrosis, or not everyone who receives prednisone is asthmatic. I received large doses of prednisone when I developed a drug reaction that caused massive inflammation that the docs had to suppress with prednisone.

Others who may have autoimmune conditions, like lupus or crohn's disease or rheumatoid arthritis, should err on the side of caution. In fart, EVERYONE should err on the side of caution and take as little prednisone as possible.

That one-time prednisone injection for shoulder pain or knee pain won't do it, but large doses of intravenous forms of steroids (prednisone is the name for the pill-the intravenous form might be 'solu-medrol').

As long as ibuprofen works, you ought to stick with it (But make sure that you're not taking more than recommended daily amount-follow those directions on the bottle closely). And if your doctor should suggest prednisone, tell him your concerns, because they ARE BASED IN FACT. There are many out there suffering from osteonecrosis who DON'T have it because of prednisone, though.. But, you have to do what you have to do and steroids can help and save the day.

What's the saying, 'when they're good, they're very very good; but when they're bad, they're horrid!) Didn't mean to write so much, but this is a topic that I get quite passionate about-just like politics!!

V Kumar profile image

V Kumar 3 years ago

A very well written Hub about Osteonecrosis. It is always difficult from a medical consultant to explain it the first time to a patient, so I can share from experience. You have put it very well. Thanks for sharing,

murat karabatur 3 years ago

Hello, My mom is having a recurring marrow syndrome at her knee too. It was good but now they found out that the bones are dead. avascular necrosis.

My question is, when a bone dies, do they come alive after resting them?

also I have more questions like:

1. is there any other treatment rather than just resting? Any extra care shall I need?

2. the dead bones, do they generally get alive and come back normal?

3. is there any food I should eat to rapid the reproduction of my bone cells to make it alive again?

4. what are my chances for a recovery? Am I gonna be better again? If yes, how long would it take generally?

I would be more than happy if you could send me mail about this issue...


best regards,


teamrn profile image

teamrn 3 years ago from Chicago Author

VKumar, Thanks so much for your kind words. I guess it 'helps'' that I have osteonecrosis and need to teach about it from a nursing standpoint, as well. There's a forum that I co-moderate on the topic, so I've always got my ear to the latest developments.

suzettenaples profile image

suzettenaples 2 years ago from Taos, NM

I have never heard of this health condition before reading this. Thanks so much for sharing this with us and I hope you have not had this condition. This was interesting and informative and some food for thought.

Teamrns 2 years ago

Unfortunately, I have it in most joints and bones of my legs, including both ankles and heels-no fun! Kind of like a bionic woman with 3 joint replacements and more in the offing

Pamela99 profile image

Pamela99 2 years ago from United States

This is certainly a very well written article about a very painful condition. I have lupus and have had years of prednisone, thus several side effects, but not this one thank goodness. You really explained this syndrome very well and I'm sure it will help someone that has this problem. I hope they come up with some new types of treatments.

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