Extract
There appear to be quite a number of case studies that presume a link
between osteonecrosis and steroids. Unfortunately, no high-level prospective
studies that make the link solid are available. I agree that osteonecrosis is
such a devastating affliction that, until certainty exists as to the true
cause(s), then caution regarding the use of any dose of steroids should be
considered. I believe that Asano et
al.2 may offer an
answer in respect to a specific genotype related to the metabolism of
corticosteroids. It would certainly be interesting to determine whether the
fifteen individuals who were afflicted with osteonecrosis in the 2001
report1 had
"at risk" genotypes and therefore may have been at greater risk of
steroid side effects. Not only is this an interesting topic, but it is a very
important one.