Letter to the Editor
Prevalence of Risk Factors for the Development of Avascular Hip Necrosis in a Third-level Hospital
Prevalencia de los factores de riesgo para el desarrollo de necrosis avascular de cadera en un hospital de tercer nivel
Elena Cristina de Sautu de Borbón
, Montserrat Morales Conejo, Juan Manuel Guerra Vales
Corresponding author
Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
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A number of proposals have been made, including ischemia, direct cell toxicity and changes in the differentiation of mesenchymal stem cells.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the impact of this disease, which has an insidious onset and shows no clear symptoms or signs, it is necessary to be aware of those RF that promote it in order to maintain our vigilance in these patients. That will enable early diagnosis and the establishment of the necessary preventive measures and the proper treatment strategies.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">On this basis, the objective of our study was to estimate the prevalence of the different RF for AHN in patients admitted to Hospital Universitario 12 de Octubre in Madrid, Spain. We included, from January 2010 to December 2015, a total of 129 patients with a diagnosis of AHN. The mean age<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation was 58.35<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.33 years; 56.6% were men. The diagnostic criteria to define the presence of AHN were mainly obtained from the results of imaging studies. The study was approved by the clinical research ethic committee of our hospital.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The most prevalent RF were tobacco use (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>57; 44.2%) and dyslipidemia (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46; 35.7%), which we consider to be associated. Among the RF with the greatest etiological burden for the development of AHN, the most prevalent were corticosteroid therapy (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>37; 28.7%), alcoholism (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26; 20.2%) and previous traumatic injury (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>20; 15.5%). Of the 18 patients (13.9%) with autoimmune and/or inflammatory disease, 3 (16.7%) had systemic lupus erythematosus. The 3 were being treated with corticosteroids and 2 of the 3 were positive for antiphospholipid antibodies. In this respect, Gontero et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> found no differences in the total accumulated dose, daily dose and duration of steroid therapy or the presence of antiphospholipid antibodies.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 17 patients (13.2%), no RF was identified (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). However, there were patients with several RF, with an accumulation of up to 6 in 1.6%. The most prevalent finding was 2 and 3 RF associated with 32 cases (24.8%) and with 27 cases (20.9%), respectively.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The sample was divided into 2 groups to study the differences between the younger and older patients, randomly setting 50 years as the cutoff point. We found that there was an absence of known RF in the individuals over 50 years of age, resulting in a statistically significant difference (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.006).</p><p id="par0040" class="elsevierStylePara elsevierViewall">As other authors have indicated, this disease has a gradual onset, without specific symptoms or signs, meaning that the diagnosis is established late.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Malizos et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> mention that, given the numerous associated factors that have recently been described, it is now less common to classify osteonecrosis as idiopathic. The results of our study concur in terms of our findings in the group of patients aged 50 years or less (2.2%). The prevalence of idiopathic AHN in patients over the age of 50 years in our series (19.3%) is similar to that reported by other authors (20%–25%).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,8,10</span></a> It is certain that, although this study is retrospective, it has its limitations. For example, missing information because these RF are not recorded in the medical records, contributing to the number of patients without associated factors. In our series, the most prevalent of the RF associated with AHN were tobacco use, dyslipidemia, corticosteroid therapy and alcoholism. Knowledge and detection of the RF associated with this disease will aid in taking preventive measures to delay its development and improve the prognosis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: de Sautu de Borbón EC, Morales Conejo M, Guerra Vales JM. Prevalencia de los factores de riesgo para el desarrollo de necrosis avascular de cadera en un hospital de tercer nivel. Reumatol Clin. 2018;14:122–123.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br>(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>129) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">≤50 years<br>(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>46) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">>50 years<br>(n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>83) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tobacco use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (44.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (52.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (39.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.198 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (35.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (43.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (31.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.184 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corticosteroid therapy/hypercortisolism<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (28.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (37%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (24.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.155 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (20.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (28.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (15.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Traumatic injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (15.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (8.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (19.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.133 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Autoimmune/inflammatory disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (13.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (17.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (12.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.434 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (10.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (6.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.377 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liver cirrhosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (10.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (13%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (8.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.543 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transplantation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (8.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (8.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (8.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (7.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (10.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.327 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chemotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (13%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (3.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.068 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thrombophilia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (6.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (4.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (8.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.186 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pro-embolic phenomenon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.538 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Myeloproliferative syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (13.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (19.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1703952.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">A case of adrenocorticotropic hormone-dependent Cushing syndrome.</p> <p class="elsevierStyleNotepara" id="npar0010">HIV, human immunodeficiency virus.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Risk Factors for Avascular Hip Necrosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "<span class="elsevierStyleBold">References</span>" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiological and clinical analysis of osteonecrosis of the femoral head in Chinese patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "X.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 2 | 9 |
| 2024 October | 47 | 23 | 70 |
| 2024 September | 55 | 14 | 69 |
| 2024 August | 59 | 42 | 101 |
| 2024 July | 78 | 30 | 108 |
| 2024 June | 58 | 32 | 90 |
| 2024 May | 68 | 26 | 94 |
| 2024 April | 70 | 27 | 97 |
| 2024 March | 68 | 28 | 96 |
| 2024 February | 68 | 27 | 95 |
| 2024 January | 38 | 19 | 57 |
| 2023 December | 48 | 37 | 85 |
| 2023 November | 51 | 21 | 72 |
| 2023 October | 70 | 24 | 94 |
| 2023 September | 70 | 39 | 109 |
| 2023 August | 55 | 16 | 71 |
| 2023 July | 59 | 41 | 100 |
| 2023 June | 56 | 25 | 81 |
| 2023 May | 64 | 24 | 88 |
| 2023 April | 26 | 10 | 36 |
| 2023 March | 58 | 22 | 80 |
| 2023 February | 51 | 23 | 74 |
| 2023 January | 33 | 17 | 50 |
| 2022 December | 53 | 38 | 91 |
| 2022 November | 57 | 47 | 104 |
| 2022 October | 53 | 28 | 81 |
| 2022 September | 33 | 41 | 74 |
| 2022 August | 40 | 28 | 68 |
| 2022 July | 36 | 38 | 74 |
| 2022 June | 37 | 30 | 67 |
| 2022 May | 39 | 38 | 77 |
| 2022 April | 30 | 42 | 72 |
| 2022 March | 38 | 41 | 79 |
| 2022 February | 36 | 25 | 61 |
| 2022 January | 44 | 33 | 77 |
| 2021 December | 27 | 41 | 68 |
| 2021 November | 29 | 44 | 73 |
| 2021 October | 62 | 47 | 109 |
| 2021 September | 33 | 36 | 69 |
| 2021 August | 26 | 27 | 53 |
| 2021 July | 30 | 26 | 56 |
| 2021 June | 34 | 27 | 61 |
| 2021 May | 42 | 38 | 80 |
| 2021 April | 105 | 78 | 183 |
| 2021 March | 36 | 19 | 55 |
| 2021 February | 17 | 17 | 34 |
| 2021 January | 21 | 22 | 43 |
| 2020 December | 32 | 13 | 45 |
| 2020 November | 27 | 22 | 49 |
| 2020 October | 13 | 15 | 28 |
| 2020 September | 35 | 23 | 58 |
| 2020 August | 30 | 14 | 44 |
| 2020 July | 22 | 14 | 36 |
| 2020 June | 43 | 15 | 58 |
| 2020 May | 17 | 16 | 33 |
| 2020 April | 19 | 14 | 33 |
| 2020 March | 18 | 7 | 25 |
| 2020 February | 2 | 0 | 2 |
| 2018 October | 0 | 1 | 1 |
| 2018 April | 0 | 1 | 1 |
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