Letters to the Editor   |    
A. Salerno replies:
Angelo Salerno, Dip App Sc, Grad Dip, Mpod (Pod Surg)1
1 130 Stephen Terrace, Gilberton, SA 5081, Australia, e-mail: footmed@bigpond.net.au
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These letters originally appeared, in slightly different form, on jbjs.org. They are still available on the web site in conjunction with the article to which they refer.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 May 01;89(5):1134-1134
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


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.
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