Abstract
Avascular necrosis of bone or Osteonecrosis incidence has been increasing in a larger number of surviving ALL patients, especially in adolescents and young adults [1]. Osteonecrosis and decreased bone mineral density(BMD) are well-known side effects of corticosteroids and avascular necrosis has been reported as one of the leading causes of treatment related morbidity in ALL survivors [2]. Symptomatic avascular necrosis has been reported to occur in up to 20% of children and adolescents with ALL [3]. We are reporting two cases of ALL patients who have been treated with steroid and chemotherapy and developed avascular necrosis of bilateral femoral heads.
Highlights
Corticosteroids, such as prednisone and dexamethasone, comprise a core component of ALL treatment in induction, consolidation, and maintenance regimens[2]
Significant common toxicities include increased appetite, immunosuppression, myopathy, centripetal obesity, increased risk of thrombosis, osteoporosis, peptic ulceration, pancreatitis, avascular necrosis of bone, psychiatric disorders, cataracts, hypertension, precipitation of diabetes, growth failure, amenorrhea, impaired wound healing, and atrophy of subcutaneous tissue[3].Avascular osteonecrosis is caused by focal bone necrosis, resulting in painful and debilitating bone complications distinct from bone marrow density (BMD) loss 4
Pathogenesis of avascular necrosis is poorly understood and is thought to involve local vascular damage leading to ischemia due to intravascular thrombi, impaired repair due to metabolic factors, extravascular lipid deposition, and impaired blood flow to medullary cavity due to increase in intraosseous lipocyte size[5]
Summary
Corticosteroids, such as prednisone and dexamethasone, comprise a core component of ALL treatment in induction, consolidation, and maintenance regimens[2]. Corticosteroids have some effect on almost every organ and tissue in the body. Significant common toxicities include increased appetite, immunosuppression, myopathy, centripetal obesity, increased risk of thrombosis, osteoporosis, peptic ulceration, pancreatitis, avascular necrosis of bone, psychiatric disorders, cataracts, hypertension, precipitation of diabetes, growth failure, amenorrhea, impaired wound healing, and atrophy of subcutaneous tissue[3].Avascular osteonecrosis is caused by focal bone necrosis, resulting in painful and debilitating bone complications distinct from bone marrow density (BMD) loss 4
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