[en] INTRODUCTION: Osteonecrosis (ON) of the femoral head can lead to femoral head
collapse, necessitating total hip replacement. Reports of patients suffering from
both ON and Inflammatory Bowel Diseases (IBD) have prompted us to evaluate the
relationship between ON and IBD, especially Crohn's disease and ulcerative
colitis. METHODS: A review of the data from three new cases, along with data from
all the published cases of patients presenting ON and IBD found through a
systematic search of the Pub Med database. RESULTS: We encountered some
diagnostic problems: The ON diagnosis could not be confirmed in some patients who
did not meet the ON diagnostic criteria. Reviewed data was too weak to assess the
exact incidence of ON in IBD. Corticosteroid therapy, especially in high dose
regimens, is likely the most important etiological factor. No evidence supporting
other physiopathological hypothesis, such as total parenteral nutrition,
osteoporosis, or coagulation disorders, was found. Finally, the multifocal form
of ON appears particularly common in IBD, with some patients presenting multiple
lesions of the hip, shoulder, knee and talus. CONCLUSIONS: ON in IBD, which is
frequently multifocal, appears to be a complication of corticosteroid therapy,
especially when high doses are used. We recommend regular ON checkups for
corticosteroid-treated IBD patients.
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