Experience of Avascular Necrosis of Hip Joint due to Unjustified Use of Steroid: A Case Series Study

Abstract

The use of steroids, whether in herbal or synthetic form, for purposes such as weight gain, appetite enhancement, and pain relief is a prevalent practice in Bangladesh. Lacking adherence to pharmacological guidelines, such as those outlined by the American College of Rheumatology (ACR) poses a significant health risk. Steroid-induced osteonecrosis is one in many adverse effects that consuming OTC steroid causes. AVN is characterized by the death of bone tissue due to the prolonged use or high-dose administration of corticosteroids. Commonly affected areas include the hip joints, knees, and shoulders. However, this seemingly innocuous trend has prompted concern, particularly at the Dhaka Specialized Pain Management and Research Centre, where a notable pattern has emerged. From July 2022 to June 2023, a total of six reported cases highlighted a worrisome trend of individuals encountering health issues due to the misuse or prolonged use of over-the-counter (OTC) steroids. The majority of the reported cases were male, predominantly in their 2nd to 3rd decade of life. The common thread among these cases was the history of oral steroid ingestion, either in the form of herbal or synthetic compounds. The patients presented with complaints of pain in the hip and groin area, particularly during walking. Diagnostic imaging, including X-ray and MRI of the hip joints, consistently revealed a classical picture of Avascular Necrosis (AVN), underlining the potential association between steroid use and this debilitating condition. The cases reported at the Dhaka Specialized Pain Management and Research Centre serve as a stark reminder of the potential consequences, such as AVN, that can arise from the uninformed or unsupervised use of steroids.