Single article

DOI: 10.47026/2413-4864-2021-4-39-53

Bashkova I.B., Madyanov I.V.

Alcohol Abuse as an Underestimated Cause of Non-Traumatic Osteonecrosis of the Femoral Head (Description of Clinical Cases)

Keywords: osteonecrosis of the femoral head, multifocal osteonecrosis, endoprosthetics, risk factors, alcohol abuse, glucocorticoids

Osteonecrosis of the femoral head is a severe degenerative-dystrophic disease, which is characterized by the destruction of the bone substance in the head in the most vulnerable (loaded) parts. Due to a rapid progression in the absence of proper surgical treatment, osteonecrosis of the femoral head, as a rule, results in disability. There is a wide range of causes that cause the development of osteonecrosis. According to the authors, alcohol abuse should be attributed to the underestimated causal factors of this pathology. The article presents two clinical observations which convincingly demonstrate the role of alcohol abuse as a cause of osteonecrosis. In a 44-year-old man prolonged alcohol abuse led to a progressive (within a year) advance of osteonecrosis in the heads of both femurs, and in a 26-year-old woman, along with a short-term intake of glucocorticoids, it contributed to the formation of multifocal non-traumatic osteonecrosis with damage to the pelvic, right knee, shoulder joints. The authors explain underestimated role of alcohol abuse as a causal factor of osteonecrosis as follows. Firstly, patients, as a rule, try not to display their addiction, and therefore, unlike other predictors of developing femoral bone osteonecrosis (injuries, serious somatic diseases, taking glucocorticoids), this fact is not reflected in medical documentation. Secondly, patients with idiopathic forms of osteonecrosis often do not have an "assigned" doctor who could dynamically follow up the patient and, consequently, monitor more carefully his condition and risk factors for osteonecrosis. When consulting such a patient, a subspecialist, as a rule, sets himself the task first of all to exclude "his disease", which makes the patient vulnerable in terms of finding out the causes of osteonecrosis. These clinical cases demonstrate the need to take into account alcohol abuse as a significant causal factor in the development of osteonecrosis.

References

  1. Bashkova I.B., Madjanov I.V. Mnozhestvennye netravmaticheskie osteonekrozy krupnykh sustavov u molodogo cheloveka, sprovocirovannye neprodolzhitel’nym lecheniem gljukokortikoidami [Multiple non-traumatic osteonecrosis of large joints in a young man, provoked by short-term treatment with glucocorticoids]. RMJ, 2016, vol. 24, no. 2, рр. 125–128.
  2. Borodin S.V., Volkov E.E., Gordeev M.V., Goloshhapov A.P. Faktornyi analiz biohimicheskikh i klinicheskikh pokazatelei asepticheskogo nekroza golovki bedrennoi kosti [Factor analysis of biochemical and clinical indicators of aseptic necrosis of the femoral head]. Genii ortopedii, 2018, no. 4, рр. 487–491. DOI: 10.18019/1028-4427- 2018-24-4-487-491.
  3. Dzhuraev A.M., Rahmatullaev H.R., Tilavov R.H. et al. Hirurgicheskoe lechenie asepticheskogo nekroza golovki bedrennoj kosti u detej [Surgical treatment of aseptic necrosis of the femoral head in children]. Genii ortopedii, 2015, no. 4, рр. 17–20. DOI: 10.18019/1028-4427-2015-4-17-20.
  4. Il’inyh E.V., Barskova V.G., Lidov P.I., Nasonov E.L. Chast’ 1. Faktory riska i patogenez [Osteonecrosis. Part 1. Risk factors and pathogenesis]. Sovremennaja revmatologiya, 2013, no. 1, рр. 17–24.
  5. Klippel J.H., Stone J.H., Crofford L.J., White P., eds. Primer on the Rheumatic Diseases. 30th New York, Springer, 2008, 739 p. (Russ. ed.: Nasonov E.L., Nasonova V.A., Olyunina Yu.A. Revmaticheskie zabolevaniya. V 3 t. T. II. Zabolevanyja kostei i sustavov. Moscow, GEOTAR-Media Publ., 2012).
  6. Kovalenko A.N., Ahtjamov I.F. Etiologija i patogenez asepticheskogo nekroza golovki bedrennoj kosti [Etiology and pathogenesis of aseptic necrosis of the femoral head]. Genii ortopedii, 2010, no. 2, рр. 138–144.
  7. Tikhilov R.M., Shubnyakov I.I., Mjasoedov A.A., Irzhanskii A.A. Sravnitel’naya kharakteristika rezul’tatov lecheniya rannikh stadii osteonekroza golovki bedrennoi kosti razlichnymi metodami dekompressii [Comparative characteristics of the results of treatment of early stages of osteonecrosis of the femoral head by various decompression methods]. Travmatologiya i ortopediya Rossii, 2016, vol. 22, no. 3, рр. 7–21. DOI: 10.21823/2311-2905-2016-22-3-7-21.
  8. Torgashin A.N., Rodionova S.S., Shumskii A.A. et al. Lechenie asepticheskogo nekroza golovki bedrennoj kosti. Klinicheskie rekomendacii [Treatment of aseptic necrosis of the femoral head. Clinical recommendations]. Nauchno-prakticheskaja revmatologiya, 2020, vol. 58, no. 6, рр. 637–645.
  9. West S.G., ed. Rheumatology Secrets, 3rd Mosby, 2014, 744 p. (Russ. ed.: Lesnyak O.M., ed. Sekrety revmatologii. Moscow, GEOTAR-Media Publ., 2018).
  10. Shusharin A.G., Birjukova M.S., Polovinka M.P. et al. Issledovanie degenerativnykh processov v golovke bedrennoi kosti na fone dlitel’noi alkogol’noi intoksikacii [Investigation of degenerative processes in the femoral head against the background of prolonged alcohol intoxication]. Sibirskii nauchnyi medicinskii zhurnal, 2015, vol. 35, no. 4, pp. 4–8.
  11. Chan V.W., Chan P.K., Chiu K.Y. et al. Why do Hong Kong patients need total hip arthroplasty? An analysis of 512 hips from 1998 to 2010. Hong Kong Med J., 2016, vol. 22, no. 1, pp. 11–15. DOI: 10.12809/hkmj144483.
  12. Chen Y.X., Zhu D.Y., Xu Z.L. et al. The protective effect of cordycepin on alcohol-induced osteonecrosis of the femoral head. Cell Physiol Biochem, 2017, vol. 42, no. 6, pp. 2391–2403. DOI: 10.1159/000480181.
  13. Flouzat-Lachaniette C.H., Roubineau F., Heyberger C. et al. Multifocal osteonecrosis related to corticosteroid: ten years later, risk of progression and observation of subsequent new osteonecrosis. Int Orthop., 2016, vol. 40, no. 4, pp. 669–672. DOI: 10.1007/s00264-015-3060-8.
  14. Fukushima W., Fujioka M., Kubo T. et al.Nationwide epidemiologic survey of idiopathic osteonecrosis of the femoral head. Clin Orthop Relat Res., 2010, vol. 468, no. 10, pp. 2715–2724. DOI: 10.1007/s11999-010-1292-x.
  15. Guo Y.J., Luo S.H., Tang M.J. et al. Muscone exerts protective roles on alcohol-induced osteonecrosis of the femoral head. Biomed Pharmacother, 2018, vol. 97, pp. 825–832. DOI: 10.1016/j.biopha.2017.11.025.
  16. Hamada H., Ando W., Takao M., Sugano N. Gamma-glutamyl transferase: a useful marker of habitual drinking in cases of alcohol-associated osteonecrosis of the femoral head. Alcohol. 2021, vol. 56, no. 2, pp. 175– doi: 10.1093/alcalc/agaa117.
  17. Krez A., Lane J., Heilbronner A. et al. Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis. Osteoporos Int, 2021, vol. 32, no. 10, pp. 2095–2103. doi: 10.1007/s00198-021-05947-x.
  18. Luo Z., Liu Y., Liu Y. et al. Cellular and molecular mechanisms of alcohol-induced osteopenia. Cell Mol Life Sci., 2017, vol. 74, no. 24, pp. 4443–4453. DOI:10.1007/s00018-017-2585-y.
  19. Malizos K.N., Karantanas A.H., Varitimidis S.E. et al. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol., 2007, vol. 63, № 1. Р. 16–28.
  20. Moon J.G., Shetty G.M., Biswal S. et al. Alcohol-induced multifocal osteonecrosis: a case report with 14-year follow-up. Archives of Orthopaedic and Trauma Surgery, 2008, vol. 128, no. 10, pp. 1149–1152. DOI: 10.1007/s00402-007-0563-9.
  21. Mont M., Jones L., Hungerford D. Nontraumatic osteonecrosis of the femoral head: Ten years later. Bone Joint Surg. Am., 2006, vol. 88, pp. 1117–1132.
  22. Mont M.A., Jones L.C., La Porte D.M. Symptomatic multifocal osteonecrosis. A multicenter study. Collaborative Osteonecrosis Group. Clinical Orthopaedics and Related Research, 1999, vol. 36, pp. 312–326.
  23. Nawata K., Nakamura J., Hagiwara S. et al. Predictive value of magnetic resonance imaging for multifocal osteonecrosis screening associated with glucocorticoid therapy. Mod Rheumatol., 2020, vol. 30, no. 3, pp. 586–591. DOI: 10.1080/14397595.2019.1623363.
  24. Okazaki S., Nagoya S., Tateda K. et al. Experimental rat model for alcohol-induced osteonecrosis of the femoral head. Int J Exp Pathol., 2013, vol. 94, no. 5, pp. 312–319. DOI: 10.1111/iep.12035.
  25. Roach R., Miller D., Griffiths D. Multifocal osteonecrosis predominantly affecting the knees secondary to chronic alcohol ingestion: a case report and review. Acta Orthopaedica Belgica2006, vol. 72, no. 2, pp. 234–236.
  26. Sun W., Shi Z., Gao F. et al. The pathogenesis of multifocal osteonecrosis. Sci Rep., 2016, vol. 11, no. 6, p. 29576. DOI: 10.1038/srep29576.
  27. Tan B., Li W., Zeng P. et al. Epidemiological study based on China osteonecrosis of the femoral head database. Orthop Surg, 2021, vol. 13, no. 1, pp. 153–160. doi: 10.1111/os.12857.
  28. Wang X., Chen X., Lu L., Xijie Yu. X. Alcoholism and osteoimmunology. Current Medicinal Chemistry, 2021, vol. 28, pp. 1815-1828. DOI: 10.2174/1567201816666190514101303.
  29. Wang Y., Li Y., Mao K. et al. Alcohol induced adipogenesis in bone and marrow: a possible mechanism for osteonecrosis. Clin Orthop Relat Res., 2003, vol. 410, pp. 213–224. DOI: 10.1097/01.blo.0000063602.67412.83.
  30. Yoon B.H., Kim T.Y., Shin I.S. et al. Alcohol intake and the risk of osteonecrosis of the femoral head in Japanese populations: a dose-response meta-analysis of case-control studies. Clin Rheumatol., 2017, vol. 36, no. 11, pp. 2517–2524. DOI: 10.1007/s10067-017-3740-4.
  31. Yu H., Zhu D., Liu P. et al. Osthole stimulates bone formation, drives vascularization and retards adipogenesis to alleviate alcohol-induced osteonecrosis of the femoral head. J Cell Mol Med., 2020, vol. 24, no. 8, pp. 4439–4451. DOI: 10.1111/jcmm.15103.
  32. Zhao D., Yu M., Hu K. et al. Prevalence of nontraumatic osteonecrosis of the femoral head and its associated risk factors in the Chinese population: results from a nationally representative survey. Chin Med J., 2015, vol. 128, no. 21, p. 2843.
  33. Zhao D., Zhang F., Wang B. et al. Guidelines for clinical diagnosis and treatment of osteonecrosis of the femoral head in adults (2019 version). Journal of Orthopaedic Translation, 2020, vol. 21, рp. 100–110. DOI: 10.1016/j.jot.2019.12.004.

About authors

Bashkova Inna Yu.
Candidate of Medical Sciences, Rheumatologist, Federal Center of Traumatology, Orthopedics and Endoprosthetics; Associate Professor, Department of Faculty and Hospital Therapy, Chuvash State University, Russia, Cheboksary (innabashkova@yandex.ru; ORCID: https://orcid.org/0000-0003-3509-1072)
Madyanov Igor V.
Doctor of Medical Sciences, Professor, Department of Therapy and Family Medicine, Institute of Advanced Medical Training;Professor, Department of Faculty and Hospital Therapy, Chuvash State University, Russia, Cheboksary (igo-madyanov@yandex.ru; ORCID: https://orcid.org/0000-0001-8750-2799)

Article link

Bashkova I.B., Madyanov I.V. Alcohol Abuse as an Underestimated Cause of Non-Traumatic Osteonecrosis of the Femoral Head (Description of Clinical Cases) [Electronic resource] // Acta medica Eurasica. – 2021. – №4. P. 39-53. – URL: http://acta-medica-eurasica.ru/en/single/2021/4/5/. DOI: 10.47026/2413-4864-2021-4-39-53.