Osteonecrosis múltiple. Patogénesis, características clínicas y tratamiento

Osteonecrosis (ON) is a highly disabling disease that mainly affects patients in the third to fifth decades of life. Multiple osteonecrosis (MO) is defined by the presence of ON in three or more different bones. MO is unusual, representing less than 3% of patients diagnosed with ON. This process is associated mainly with a previous history of high-dose corticosteroid therapy and systemic disorders such as systemic lupus erythematosus, solid organ transplantation, and hematological diseases. Some patients also have an associated hypercoagulation disorder. MO involves mainly the proximal and distal femur, talus, and distal tibia, but almost any bone can be affected. An early diagnosis is essential to prevent bone collapse and joint damage. Although therapeutic strategies are not well established, treatment is based on conservative measures with limited weight bearing and pain relief and in selected cases surgical intervention is needed. Finally, a prothrombotic disorder should be ruled out in these patients.