[Beacon Staff]

Steroids, avascular necrosis / osteonecrosis & statins

by Beacon Staff on Tue Aug 05, 2014 10:52 pm

Most myeloma patients have heard of osteonecrosis of the jaw (ONJ), which is a potential side effect of treatment with "bone building" drugs such as Zometa (zoledronic acide) and Aredia (pamidronate). ONJ occurs when blood flow to portions of the jaw is interrupted, causing parts of the jawbone to die.

The same thing can happen in other bones in the body and, when it does, the phenomenon is generally known as either avascular necrosis or osteonecrosis.

There is research suggesting that long-term treatment with steroids may increase the chances of a myeloma patient developing avascular necrosis. (See the first reference below.) However, our reading of the literature is that there is not yet a consensus regarding such a connection.

That said, avascular necrosis does seem to occur in some myeloma patients who have been treated for extended periods with steroids. Beacon columnist Pat Killingsworth, for example, has experienced this problem, as he mentioned in his most recent column.

As was pointed out in a comment on Pat's column, there is also research suggesting that taking statins -- drugs like Lipitor (atorvastatin) and Zocor (simvastatin) that are usually taken to reduce cholesterol levels -- may reduce the risk of avascular necrosis due to steroid treatment. We've included in the references at the end of this posting a few studies that have investigated this issue.

Has your oncologist or myeloma specialists ever mentioned to you that taking steroids for an extended period of time may lead to avascular necrosis / osteonecrosis?

Likewise, have any of your physicians ever mentioned the possibility of taking statins to reduce the risk of avascular necrosis due to long-term steroid treatment?

Have you heard of other myeloma patients taking statins for this reason?

We ask these questions partly to see whether these issues are discussed with myeloma patients, and partly just to make certain forum participants are aware of the subject and related research.

We should add, once again, that a definitive connection between long-term steroid use and avascular necrosis does not seem to have been firmly established. As we said, it's our understanding that the connection is still a bit controversial.

Thanks!

References:

"Impact of oral corticosteroid use for idiopathic osteonecrosis of the femoral head: a nationwide multicenter case-control study in Japan", M Sakaguchi et al, J Orthop Sci. 2010 Mar;15(2):185-91

"Statin therapy decreases the risk of osteonecrosis in patients receiving steroids," JW Pritchett, Clin Orthop Relat Res. 2001 May;(386):173-8.

"Does statin usage reduce the risk of corticosteroid-related osteonecrosis in renal transplant population?", M Ajmal et al, Orthop Clin North Am. 2009 Apr;40(2):235-9.

[asaryden]

Re: Steroids, avascular necrosis / osteonecrosis & statins

by asaryden on Wed Aug 06, 2014 5:06 am

I was diagnosed with avascular necrosis of the femur head a few months ago as well as with osteoarthritis. I had an allogeneic transplant 2 years ago and I´ve been on steroids for a year, so any of these or a combination may be the cause. My doctor has not talked to me about this side effect but I´ve read about it. No talk about statins either.

I´m scheduled for a replacement of one hip later this month. If this turns out ok the other one will also be replaced.