Lupus and osteonecrosis

Several weeks ago, I published a post (“The Stages of Osteonecrosis”) that unintentionally misled. I was told that I had inferred that lupus caused osteonecrosis; a rare, debilitating, bone disease. Lupus does NOT cause osteonecrosis.

However, while lupus does NOT directly cause osteonecrosis (ON), often referred to as avascular necrosis (AVN); treatments for lupus and a side effects of lupus INDIRECTLY contribute to the development of osteonecrosis.

To what treatment am I referring?  I spoke of the treatment of lupus with steroids; usually, very successfully so. But, the effectiveness of steroids doesn’t come without a price. A percentage of lupus patients who are treated with steroids, develop osteonecrosis. Not because of their lupus, but because of the steroid treatment. This is also true when asthmatic patients are treated with steroids. A fair percentage of them develop ON because the treatment for asthma attacks is often with steroids.

Steroids (PrednisoneTM, Solu-medrolTM) and their cousins, while life-saving in most instances, have been shown to cause of osteonecrosis. It is theorized that steroids can interfere with fat metabolism causing the formation of fatty clots. It is these clots that obstruct blood flow to the bone, causing bone infarcts or ON. 

To what side effect was I referring? Some lupus patients develop the clotting disorder, Antiphospholipid Syndrome. People with APS have an increased risk of a blood clot.  This is one reason that lupus patients are at higher-risk during their pregnancies. A clot in the umbilical cord can result in miscarriage.

Again, lupus itself doesn’t cause these clots which can result in ON/AVN, but antiphospholipid syndrome is a result of lupus and IT causes the clots. The person with antiphospholipid syndrome often needs anti-coagulation therapy for life. 

I apologize to those readers who may have been confused. I don’t claim to speak all facts correctly, and thank you to the reader who informed me that he was confused.

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One Reply to “Lupus and osteonecrosis”

  1. All of us who take steroids can forget the distinction you clarify. Although the lupus is not to blame, it might as well be! It is hard to imagine a life of treating lupus without steroids having a place right there along side the lupus.

    I truly enjoy your blog!

    Lupus Adventurer

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