Corticosteroid-associated osteonecrosis in children

Corticosteroids are potent anti-inflammatory drugs used to treat various adult and pediatric medical conditions. More than 30 million Americans receive corticosteroids as part of their treatment protocols for acute and chronic illnesses [1, 2]. Use of systemic corticosteroids in children has been most thoroughly studied in patients treated for acute lymphocytic leukemia (ALL), systemic lupus erythematosus (SLE), and renal transplant. In the case of ALL, the addition of corticosteroids to antileukemic protocols has been shown to improve the remission rate [3]. Current treatment protocols characterized by chemotherapy intensified by higher-dose corticosteroids are thought to be partly responsible for improved outcomes in ALL with cure rates ranging from 70 to 90 % [3–7]. In pediatric SLE, long-term survival has improved dramatically as corticosteroids have become the mainstay of treatment [8]. Depending on the specific disease and severity, the length of treatment ranges from days to years to a lifetime of use. As with many medications, chronic use may result in adverse side effects. Such effects of corticosteroids have been described in multiple organ systems including the musculoskeletal system [9]. The specific effect of hypercortisolism on bone was first recognized as a feature of Cushing’s disease. Since that time, the cause-effect relationship between corticosteroid treatment and bone disease such as osteoporosis, fractures, and osteonecrosis has become more clearly established [10–12].