ABNORMALITIES IN THE BONE-MARROW OF THE ILIAC CREST IN PATIENTS WHO HAVE OSTEONECROSIS SECONDARY TO CORTICOSTEROID-THERAPY OR ALCOHOL-ABUSE

The bone-marrow activity in the iliac crest of eleven patients who had idiopathic osteonecrosis of the hip and thirty patients who had osteo necrosis of the hip that was related to corticosteroid therapy (fourte en patients) or to alcohol abuse (sixteen patients) was compared with that in two groups of control subjects who did not have osteonecrosis (thirty-three healthy bone-marrow donors and thirty-four patients who had been managed with bone-marrow grafting for a non-union), Cultures of granulocyte-macrophage progenitor cells and fibroblast colony-formi ng units were performed to assess the activity of hematopoietic stem c ells and stromal cells, The activity of stem cells in both the hematop oietic and the stromal compartment of the bone marrow was decreased in the patients who were receiving corticosteroids or who abused alcohol , as compared with that in the two groups of control subjects. The pat ients who had idiopathic osteonecrosis also had a decrease in bone-mar row activity compared with the control subjects. CLINICAL RELEVANCE: O ur findings suggest that patients who are receiving corticosteroid the rapy or who abuse alcohol have decreased activity of bone-marrow cells , Whether this decrease is related to the osteonecrosis could not be d etermined, as our study did not include control subjects who had a his tory of alcohol abuse or who were receiving corticosteroids but did no t have osteonecrosis. However, it is possible that the reduced bone-ma rrow activity was related to the osteonecrosis, as patients who had id iopathic osteonecrosis also had decreased bone-marrow activity, The st udy of pathological alterations in the bone marrow outside the necroti c zone may provide important insights into the pathophysiology of oste onecrosis.