Elucidation of the Mechanism of Steroid-Related Osteonecrosis of the Femoral Head and Prevention of Its Occurrence

Idiopathic osteonecrosis of the femoral head leads to hip pain, gait disturbances, and rapid destruction of the hip joint. This disease is triggered by steroids, alcohol, and narrowly defined idiopathic conditions. Among these, steroid-related osteonecrosis, is considered a serious problem because of the effectiveness of steroids in various diseases and its widespread use in clinical practice. Although various studies have been conducted on the pathogenesis and prevention of this disease, no effective methods have been established. Therefore, the disease has been classified as intractable by the Ministry of Health, Labour, and Welfare. Although lipid metabolism disorders and abnormal coagulation/fibrinolysis systems have been proposed as mechanisms of pathogenesis, we focused on oxidative stress in our study. In addition, the possibility of inhibiting the occurrence of osteonecrosis by statins, drugs that improve lipid metabolism, and antioxidants has been reported in animal models as a method of preventing this disease. This review describes the characteristics of this disease, including its clinical features, and discuss its mechanisms and preventive measures, focusing on the oxidative stress theory, based on our research findings.