OSTEONECROSIS OF THE HUMERAL HEAD IN SICKLE-CELL DISEASE

The prevalence and incidence of osteonecrosis (ON) of the humeral head in sickle cell disease was determined by a study of 2524 patients who were entered into a prospective study and followed for an average of 5.6 years. At entry, 5.6% had roentgenographic evidence of ON in one o r both shoulders. There was little difference in age-adjusted prevalen ce among genotypes, but there were striking differences in age-specifi c rates. Observed at ages ranging from five to 24 years, 3.25% of sick le cell anemia (S/S) patients, but only 1.1% of sickle cell disease (S /C) patients, had ON. No S/beta+ thalassemia patients younger than 25 years of age had ON on entry. The highest age-adjusted incidence rate was found in S/S patients with concomitant alpha-thalassemia (4.85 per hundred patient-years), followed by S/beta0 thalassemia (4.84 per hun dred patient-years), S/beta+ thalassemia (2.61 per hundred patient-yea rs), S/S without alpha-thalassemia (2.54 per hundred patient-years), a nd S/C (1.66 per hundred patient-years). Only 20.9% of patients report ed pain or had limited range of movement at the time of diagnosis. Sic kle cell disease is a frequent cause of ON of the humeral head, especi ally in children and young adults.