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Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate
Osteonecrosis is a devastating complication of long-term glucocorticoid therapy that has been described in both malignant and nonmalignant diseases. Its incidence has been found to greater than 50% using magnetic resonance imaging in asymptomatic patients, thus osteonecrosis is likely underdiagnosed...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10578391/ https://www.ncbi.nlm.nih.gov/pubmed/37908238 http://dx.doi.org/10.1210/jcemcr/luac006 |
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author | Subbu, Karthik Renner, Jordan B Rubin, Janet E |
author_facet | Subbu, Karthik Renner, Jordan B Rubin, Janet E |
author_sort | Subbu, Karthik |
collection | PubMed |
description | Osteonecrosis is a devastating complication of long-term glucocorticoid therapy that has been described in both malignant and nonmalignant diseases. Its incidence has been found to greater than 50% using magnetic resonance imaging in asymptomatic patients, thus osteonecrosis is likely underdiagnosed. Recent studies have suggested that treatment with bisphosphonates can improve pain and mobility and decrease bone marrow edema. We describe a patient with acute lymphoblastic leukemia who presented with debilitating osteonecrosis after treatment with prednisone for a total cumulative dose of 5100 mg. Magnetic resonance imaging revealed extensive infarcts of her bilateral tibiae and femora and left humerus, talus, and calcaneus consistent with osteonecrosis that had persisted for more than 2 years. Her severe knee, shoulder, and ankle pain was treated with 1 dose zolendronic acid. Despite a prolonged acute phase reaction, the patient's symptoms improved with near total resolution of pain. |
format | Online Article Text |
id | pubmed-10578391 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-105783912023-10-31 Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate Subbu, Karthik Renner, Jordan B Rubin, Janet E JCEM Case Rep Case Report Osteonecrosis is a devastating complication of long-term glucocorticoid therapy that has been described in both malignant and nonmalignant diseases. Its incidence has been found to greater than 50% using magnetic resonance imaging in asymptomatic patients, thus osteonecrosis is likely underdiagnosed. Recent studies have suggested that treatment with bisphosphonates can improve pain and mobility and decrease bone marrow edema. We describe a patient with acute lymphoblastic leukemia who presented with debilitating osteonecrosis after treatment with prednisone for a total cumulative dose of 5100 mg. Magnetic resonance imaging revealed extensive infarcts of her bilateral tibiae and femora and left humerus, talus, and calcaneus consistent with osteonecrosis that had persisted for more than 2 years. Her severe knee, shoulder, and ankle pain was treated with 1 dose zolendronic acid. Despite a prolonged acute phase reaction, the patient's symptoms improved with near total resolution of pain. Oxford University Press 2022-11-29 /pmc/articles/PMC10578391/ /pubmed/37908238 http://dx.doi.org/10.1210/jcemcr/luac006 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Case Report Subbu, Karthik Renner, Jordan B Rubin, Janet E Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate |
title | Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate |
title_full | Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate |
title_fullStr | Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate |
title_full_unstemmed | Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate |
title_short | Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate |
title_sort | extensive osteonecrosis after glucocorticoids: clinical response to bisphosphonate |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10578391/ https://www.ncbi.nlm.nih.gov/pubmed/37908238 http://dx.doi.org/10.1210/jcemcr/luac006 |
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