High-Dose Corticosteroid Use and Risk of Hip Osteonecrosis: Meta-Analysis and Systematic Literature Review

Michael A. Mont, Robert Pivec, Samik Banerjee, Kimona Issa, Randa K. Elmallah, Lynne C Jones

Research output: Contribution to journalArticle


The effect of varying corticosteroid regimens on hip osteonecrosis incidence remains unclear. We performed a meta-analysis and systematic literature review to determine osteonecrosis occurrences in patients taking corticosteroids at varying mean and cumulative doses and treatment durations, and whether medical diagnoses affected osteonecrosis incidence. Fifty-seven studies (23,561 patients) were reviewed. Regression analysis determined significance between corticosteroid usage and osteonecrosis incidence. Osteonecrosis incidence was 6.7% with corticosteroid treatment of >2 g (prednisone-equivalent). Systemic lupus erythematosus patients had positive correlations between dose and osteonecrosis incidence. Each 10 mg/d increase was associated with a 3.6% increase in osteonecrosis rate, and >20 mg/d resulted in a higher osteonecrosis incidence. Clinicians must be wary of osteonecrosis in patients on high corticosteroid regimens, particularly in systematic lupus erythematosus.

Original languageEnglish (US)
Pages (from-to)1506-1512.e5
JournalJournal of Arthroplasty
Issue number9
Publication statusPublished - Sep 1 2015



  • Corticosteroid
  • Hip
  • Meta-analysis
  • Osteonecrosis
  • Risk factors

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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