Lipid-Lowering Agents and Their Effects on Osteonecrosis: Pros and Cons

Osteonecrosis is a debilitating disease with many causes. It has been linked to processes that affect vascular perfusion to the bone. Systemic steroid use is a significant risk factor for the development of osteonecrosis. It is postulated that prolonged steroid use produces a hyperlipidemic state in patients and puts them at risk for osteonecrosis. The idea is that steroid use increases the fat content within the bone (most commonly the femoral head), resulting in increased intracortical pressure that may lead to sinusoidal collapse and osteonecrosis. Statins are lipid-lowering agents that dramatically reduce lipid levels in blood and tissues. They are widely used to prevent cardiovascular disease and have been shown to reduce the adverse effects of steroids on lipid metabolism as will be outlined in this chapter. As a result, the effect of lipid-lowering agents on the development and progression of osteonecrosis has been an interesting area of research.