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Osteonecrosis
Reviewed by Medicinsk Expert•Last updated: 2026-10-22•Bones Joints Muscles

Osteonecrosis

Osteonecrosis is a condition where reduced blood flow causes bone tissue to die and break down faster than the body can replace it.

Overview

Osteonecrosis is a disease caused by reduced blood flow to bones in the joints. In people with healthy bones, new bone is always replacing old bone. In osteonecrosis, the lack of blood causes the bone to break down faster than the body can make enough new bone. The bone starts to die and may break down.

You can have osteonecrosis in one or several bones. It is most common in the upper leg. Other common sites are your upper arm and your knees, shoulders and ankles. The disease can affect men and women of any age, but it usually strikes in your thirties, forties or fifties.

Symptoms

At first, you might not have any symptoms. As the disease gets worse, you will probably have joint pain that becomes more severe. You may not be able to bend or move the affected joint very well.

Causes & Risk Factors

No one is sure what causes the disease. Risk factors include:

  • Long-term steroid treatment
  • Alcohol misuse
  • Joint injuries
  • Having certain diseases, including arthritis and cancer

Diagnosis & Treatment

Doctors use imaging tests and other tests to diagnose osteonecrosis. Treatments include medicines, using crutches, limiting activities that put weight on the affected joints, electrical stimulation and surgery.

Frequently Asked Questions

Standard X-rays often appear completely normal during the earliest stages of osteonecrosis when blood flow is first lost. An MRI can detect microscopic bone marrow edema and ischemic changes months before structural damage or bone collapse becomes visible on a plain radiograph.
Core decompression is the primary joint-preserving surgery for early-stage osteonecrosis. The surgeon drills one or more small channels into the dead bone to relieve intraosseous pressure, improve blood circulation, and sometimes insert bone grafts or stem cell concentrates to encourage bone regeneration.
Corticosteroids can alter lipid metabolism, causing microscopic fat globules to enlarge and obstruct the tiny blood vessels supplying the ends of bones. They also increase marrow pressure and suppress osteoblast activity, preventing the bone from repairing normal daily microtrauma.
In early pre-collapse stages, physicians often recommend partial weight-bearing or non-weight-bearing using crutches, a cane, or a walker. Reducing mechanical impact lowers the compressive forces across the vulnerable bone segment, buying time for surgical or natural revascularization to take place.
Source: MedlinePlus, National Library of Medicine

MedlinePlus brings together authoritative health information from the National Library of Medicine (NLM), the National Institutes of Health (NIH), and other government agencies and health-related organizations.

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