Beware of hormone-induced femoral head necrosis

Author: Li Tao, deputy chief physician, Nanfang Hospital, Southern Medical University

Reviewer: Wang Jian, Chief Physician, Nanfang Hospital, Southern Medical University

In the development of modern medicine, the use of hormones is undoubtedly a double-edged sword. It plays an important role in saving lives and treating diseases, but it may also bring some potential risks. Among them, femoral head necrosis, a disease that sounds worrying, is inextricably linked to hormones.

1. Will excessive use of hormones lead to femoral head necrosis?

1. Necessity of hormone use: The hormones mentioned here refer to glucocorticoids. Sometimes in clinical practice, in order to rescue critically ill patients, medical staff will use a large amount of hormones after weighing the pros and cons. For example, "hormone shock therapy" is used for some critically ill patients with viral pneumonia. Although this therapy can save the lives of many patients, patients may be left with sequelae - steroid-induced femoral head necrosis. In addition, hormones are also needed in the treatment of patients with systemic lupus erythematosus, leukemia, nephritis, etc.

2. Hormones do not necessarily lead to femoral head necrosis: Some people say: "I only know that people who use hormones will gain weight. It turns out that hormones are so terrible!" Some people say: "I have asthma and have been taking oral/nasal hormones for a long time. Will this cause femoral head necrosis?" Some people say: "My father has suffered from rheumatoid arthritis for many years and must use hormones to control the disease. What can I do?"

Short-term excessive doses or long-term high-dose use of hormones does have the risk of causing femoral head necrosis. It has been reported that when patients take a total dose equivalent to more than 200 mg of prednisone, the incidence of femoral head necrosis increases significantly. At the same time, it can be seen clinically that many patients with rheumatoid arthritis do not suffer from femoral head necrosis even if they use hormones for a long time; some patients use hormones for a long time, but the dosage is relatively small, and it will not cause femoral head necrosis; some patients use a relatively large dose of hormones, and femoral head necrosis occurs in a short period of time; some patients use a relatively small dose of hormones, but also suffer from femoral head necrosis.

3. Possible reasons for hormone-induced femoral head necrosis: Long-term accumulation of hormones in the body will increase blood viscosity, cause fat to deposit in the liver, and cause hyperlipidemia and fat embolism at the end of blood vessels. Embolism will block bone micro-vessels, and then cause ischemic necrosis of the bone. In addition, hormones can cause osteoporosis, making bones prone to collapse, which makes the femoral head "worse".

Figure 1 Copyright image, no permission to reprint

From this, we can see that the duration of hormone use, dosage and personal physique will affect the occurrence of hormone-induced femoral head necrosis, which requires a comprehensive assessment. Although we don't have to be afraid of hormones, we must use hormones rigorously, scientifically and in accordance with the doctor's advice.

2. How to use hormones correctly to avoid femoral head necrosis?

Short-term or long-term use of high-dose hormones has the risk of femoral head necrosis. So what should we do? In order to treat the disease, can we only watch the femoral head "suffer"? Of course not, we need to use hormones correctly.

1. Hormones or drugs containing hormones must be used under the guidance of doctors in regular hospitals. Do not trust so-called "folk remedies" or "secret recipes handed down from ancestors". These drugs may contain hormones. Although they can temporarily relieve symptoms after use, they may cause greater hidden dangers due to incorrect dosage and usage of hormones.

Figure 2 Copyright image, no permission to reprint

2. When using hormones on patients, doctors should be alert to the possibility of femoral head necrosis. Early diagnosis, early treatment and early prevention are required. If the condition permits, stop using hormones in a timely manner.

3. What should I pay attention to when receiving hormone treatment?

1. Go to the hospital regularly for MRI checkups (generally recommended every 3 to 6 months) to detect femoral head necrosis at an early stage, especially within 2 years of starting hormone use.

2. If you experience pain, discomfort or weakness in your hip joint, seek medical attention immediately.

3. Press the midpoint of the groin by yourself. If you feel pain, discomfort or soreness, seek medical attention immediately.

4. If you experience hip pain when sitting cross-legged, seek medical attention immediately.

5. Avoid trauma to the hip joint to reduce the occurrence of femoral head necrosis.

6. Avoid walking for long periods of time while carrying heavy loads. If you need to travel long distances, it is recommended to use a vehicle to reduce the load.

7. Avoid strenuous exercise such as running and jumping.

8. Quit smoking and drinking. Hormones, combined with the influence of multiple factors such as smoking and drinking, have a greater impact on the blood supply to the femoral head, which can increase the risk of femoral head necrosis.

9. Losing weight can reduce the load on the femoral head and reduce the probability of femoral head necrosis.