The Journal of Bone and Joint Surgery, Vol 65, Issue 9 1319-1327, Copyright © 1983 by Journal of Bone and Joint Surgery, Inc
Bone histology in adults with aseptic necrosis. Histomorphometric evaluation of iliac biopsies in seventy-seven patients
ME Arlot, M Bonjean, PM Chavassieux and PJ Meunier
We studied the bone histology by histomorphometric methods in transiliac
bone-biopsy specimens from seventy-seven adult patients with aseptic
osteonecrosis and normal kidney function. The trabecular bone volume,
trabecular osteoid volume, trabecular osteoid surfaces, thickness index of
osteoid seams, total resorption surfaces, calcification rate,
tetracycline-labeled surfaces, and bone-formation rate at the basic
multicellular unit level and at the tissue level were determined.
Histological evidence of osteomalacia was found in nine patients, of whom
four were alcoholics. In the remaining sixty-eight patients--fifteen
treated with corticosteroids, twenty-nine alcoholics, and twenty-four who
did not have any detectable etiological factor--a common histomorphometric
profile was found. This consisted morphologically of a reduction in
trabecular bone volume and in the thickness of osteoid seams, and
dynamically of a reduction in calcification rate and in total labeled
surfaces. All of these changes suggested a marked decrease in osteoblastic
appositional rate and in bone-formation rate at the cell and tissue levels.
This could induce a healing defect of microfractures and thus facilitate
subchondral fractures. Clinical Relevance: This histological study
indicated that non-apparent bone disease--either osteoporosis or
osteomalacia--may underlie aseptic osteonecrosis in almost all patients,
and be found even when blood and urinary biochemical parameters, usually
reflecting bone-remodeling, are normal. An iliac-crest bone biopsy with
static and dynamic histomorphometric study is the appropriate method for
detecting these abnormalities. These results are of importance for
understanding the pathophysiological mechanisms underlying osteonecrosis as
well as its prevention and treatment.
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