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Causes
By Mayo Clinic staffMost cases of avascular necrosis follow trauma to the bone — for instance, a broken bone (fracture) or dislocated joint. The trauma can damage the blood vessels that deliver blood to the bone, leaving the bone without a source of oxygen and nutrients. As a result, the bone cells die, weakening the bone.
Other common causes of avascular necrosis include:
- Corticosteroids. It isn't clear how these anti-inflammatory medications, such as prednisone, cause avascular necrosis. People who take high doses of corticosteroids for long periods of time — for instance, people with chronic illnesses such as rheumatoid arthritis and lupus — are more likely to experience avascular necrosis. Avascular necrosis is rare in people who take lower doses of corticosteroids for a short time. Corticosteroid injections — for instance, into an inflamed or arthritic joint — don't cause avascular necrosis.
- Heavy drinking. People who drink large amounts of alcohol may be more likely to experience avascular necrosis than do those who drink less. Several alcoholic drinks a day for several years can cause fatty deposits to form in your blood vessels. This can restrict the flow of blood to your bones. The more alcoholic drinks you consume on a daily basis, the higher your risk of avascular necrosis.
Less common causes of avascular necrosis include:
- Sickle cell anemia
- Gaucher's disease
- Lupus
- Decompression disease, also called the bends
- Cancer treatments, including chemotherapy and radiation therapy
Biphosphonates and osteonecrosis of the jaw
A small number of cases of osteonecrosis of the jaw have been reported in people taking bisphosphonates for osteoporosis. These cases have primarily occurred after trauma to the jaw, such as a tooth extraction, or cancer treatment. Risk appears to be higher in people who have received bisphosphonates intravenously. While there is currently no clear evidence that you should stop taking bisphosphonates before dental surgery, let your dentist know what medications you're taking and discuss your concerns.
