“For the majority of the patients, asymptomatic or symptomatic OsteoNecrosis of the humeral head related to corticosteroid treatment should be considered a progressive disease…”
My diagnosis of multiple myeloma led to induction chemotherapy, stem cell mobilization and an autologous stem cell transplant all in 1995. And of course, dexamethasone, a corticosteroid, was a component of every chemotherapy cocktail throughout my conventional oncologic treatments from diagnosis through diagnosis of end-stage cancer from 2/94-9/97.
In order to address my mantra “I wish I knew then what I know now” this post will define AVN, discuss the pros and cons of high-dose steroids in cancer therapy, discuss possible therapies shown to heal AVN and list several blog posts that I’ve written documenting my experiences with AVN.
For the record Corticosteroid-induced Avascular Necrosis is not a disease. It is a long-term side effect of corticosteroid therapy. This long-term side effect, whether shoulder, hip or knee, has been well documented and known about for years. Short, long-term and late stage side effect result from toxic therapies.
Benefit of high-dose steroid therapy?
A few years ago, I came upon a study that cited curcumin as a replacement for steroid therapy for those patients who were intolerant of steroids. When I read the study, it occurred to me that steroids were not needed for the management of multiple myeloma. I don’t know about all cancers.
Further, the side effects of steroids are well documented. Lower doses reduce the risk of side effects as well as reduce the severity of side effects that do occur.
Therapies to heal steroid-induced AVN?
According to the top link below, AVN is a progressive disease. I consider myself fortunate that I did not experience bone pain for the first 25 years following the discontinuation of dexamethasone. My guess is that AVN has been lurking in/on my shoulders but never reared it’s ugly head.
Because AVN is progressive, my goal is to prevent the bone from collapsing and stabilize the pain rather than heal the AVN.
According to the first study linked below, chances are pretty good that steroid-induced AVN started in my shoulder during the years immediately following my aggressive conventional chemotherapy in 1995. I am writing this blog post during the summer of 2021.
If you’d like to learn how my evidence-based, non-toxic therapies worked- holding off bone collapsing and managing bone pain, feel free to send me an email. I will reply ASAP.
“The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as traumatism, corticosteroid use…
Corticosteroids are a common cause of atraumatic humeral head necrosis, but the exact mechanism is unknown. Hernigou4 evaluated the natural history and the rate of disease progression with a long-term follow up. The outcomes of 215 shoulders (125 adult patients) with osteonecrosis related to corticosteroids were evaluated at early stages before collapse with radiographs and MRI. With an average 15 years of follow up (range 10 to 20), there was pain in 65% of asymptomatic shoulders and collapse had occurred in 50% of shoulders. In symptomatic shoulders, collapse has developed in most at the final follow up. The time between the diagnosis and collapse was an average lof 6 years. At the most recent follow up (average 15 years), 50% of shoulders had required surgical treatment. Stage, occurrence of pain, and continuation of peak doses of corticosteroids were risk factors for progression of osteonecrosis.
The role of steroid dose remains controversial. Suspected as early as 195721, whether this is a dose response, threshold, peak-dose, or idiosyncratic phenomenon is unclear. The high dose of steroids during the first several weeks seems to be more important than the total cumulative dose. In addition, patients may have a predisposition toward osteonecrosis, with a possible genetic susceptibility for the disease…”
“Results-We observed partial or total regression on MRI only in patients with asymptomatic Stage I ON. At last followup, pain had developed in 98 (74%) and collapse had occurred in 71 (54%) of the 132 previously asymptomatic shoulders. Of the 83 symptomatic shoulders, 68 (82%) had collapsed at the final followup. The time between diagnosis and collapse averaged 10 years for patients with symptomatic Stage I ON and 3 years for patients with symptomatic Stage II ON…
Spontaneous size reduction was observed only in asymptomatic patients and within 5 years after the beginning of steroid treatment. For the other patients, the initial size of the lesion, its location, and the continuation of peak doses of corticosteroid determined the risk of progression of the disease.
For the majority of the patients, asymptomatic or symptomatic ON of the humeral head related to corticosteroid treatment should be considered a progressive disease, with substantial clinical and radiographic progression of the disease within 15 years, even if treatment with corticosteroids has ceased…”