Osteonecrosis is a disease of the bones. It’s when blood flow to a bone is slowed or cut off. The cells in the bone start to die from a lack of blood. Over time, the bone breaks down. You may develop arthritis and have pain and trouble moving.
Osteonecrosis is most often found in the hip, knee, or shoulder. But it can affect any bone in the body, even the jaw.
What causes osteonecrosis?
There are many possible causes of osteonecrosis. These are:
Certain health problems, such as lupus, sickle-cell disease, or leukemia
Trauma, such as a broken bone
Radiation treatment for cancer
High doses of some steroids
Osteonecrosis of the jaw is often caused by taking bisphosphonates. These medicines treat cancer and osteoporosis. Taking good care of your teeth can help prevent it.
Symptoms of osteonecrosis
The main symptom is pain in the affected bone. Once you feel pain, the bone has already started to decay. At first, you may feel the pain only when you move the bone. In time, it may hurt even when you are resting. The pain may make it hard to move. If you have osteonecrosis in your hip, you may start to limp. If it’s in the jaw, you may have tooth loss, infection, pain, and swelling.
Treatment for osteonecrosis
Treatment works best when it is started during the early stages of the disease. But often osteonecrosis is found late, after you already feel pain. So treatment focuses on slowing down bone loss and lessening pain. It may include:
Limits on movement. If you have osteonecrosis in a lower limb, you may feel better if you don’t put weight on the bone. You may need crutches or bed rest.
Pain relievers. These medicines may ease pain and help keep you active.
Other medicines. Depending upon the cause of your osteonecrosis, medicines such as statins or blood thinners may slow bone loss. Or you may have to stop taking a certain medicine if it is the cause of the disease. People with osteonecrosis of the jaw may need to stop using bisphosphonates. They may instead take antibiotics and use a medicated mouthwash.
Surgery. Removing parts of the bone or replacing it with a graft may restore blood flow and lessen pain. In some cases, you may need joint replacement surgery.
Possible complications of osteonecrosis
Complications depend on what part of the bone is affected, how large an area is involved, and how well the bone rebuilds itself. Some common complications include:
Loss of movement
When to call your healthcare provider
Call your healthcare provider right away if you have any of these:
Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
Redness, swelling, or fluid leaking from a surgical incision or wound that gets worse
Pain that gets worse
Symptoms that don’t get better, or get worse
November 18, 2017
Eisenhower C, et al. Bisphosphonate-Related Osteonecrosis of the Jaw. In: Ferri F, ed. Ferri's Clinical Advisor 2017. Philadelphia: Elsevier; 2017:e2-174., Medication-related osteonecrosis of the jaw in patients with cancer. UpToDate., Osteonecrosis (Avascular Necrosis of Bone). UpToDate., Ruggiero S, et al. Medication-Related Osteonecrosis of the Jaw—2014 Update. American Association of Oral and Maxillofacial Surgeons. 2014:26.
Fraser, Marianne, MSN, RN,Joseph, Thomas N, MD