ALCOHOL ABUSE AS AN UNDERESTIMATED CAUSE OF NON-TRAUMATIC OSTEONECROSIS OF THE FEMORAL HEAD (DESCRIPTION OF CLINICAL CASES)

Abstract

Osteonecrosis of the femoral head is a severe degenerative-dystrophic disease, which is characterized by the destruction of the bone substance in the head in the most vulnerable (loaded) parts. Due to a rapid progression in the absence of proper surgical treatment, osteonecrosis of the femoral head, as a rule, results in disability. There is a wide range of causes that cause the development of osteonecrosis. According to the authors, alcohol abuse should be attributed to the underestimated causal factors of this pathology. The article presents two clinical observations which convincingly demonstrate the role of alcohol abuse as a cause of osteonecrosis. In a 44-year-old man prolonged alcohol abuse led to a progressive (within a year) advance of osteonecrosis in the heads of both femurs, and in a 26-year-old woman, along with a short-term intake of glucocorticoids, it contributed to the formation of multifocal non-traumatic osteonecrosis with damage to the pelvic, right knee, shoulder joints. The authors explain underestimated role of alcohol abuse as a causal factor of osteonecrosis as follows. Firstly, patients, as a rule, try not to display their addiction, and therefore, unlike other predictors of developing femoral bone osteonecrosis (injuries, serious somatic diseases, taking glucocorticoids), this fact is not reflected in medical documentation. Secondly, patients with idiopathic forms of osteonecrosis often do not have an "assigned" doctor who could dynamically follow up the patient and, consequently, monitor more carefully his condition and risk factors for osteonecrosis. When consulting such a patient, a subspecialist, as a rule, sets himself the task first of all to exclude "his disease", which makes the patient vulnerable in terms of finding out the causes of osteonecrosis. These clinical cases demonstrate the need to take into account alcohol abuse as a significant causal factor in the development of osteonecrosis.