{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:56:46Z","timestamp":1779098206568,"version":"3.51.4"},"reference-count":47,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,7,22]],"date-time":"2019-07-22T00:00:00Z","timestamp":1563753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81672157"],"award-info":[{"award-number":["81672157"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Early diagnosis and prevention of glucocorticoid (GC)\u2010induced osteonecrosis of the femoral head (ONFH) continues to be a challenging problem for clinicians and researchers. However, the role of circulating biomarkers for GC\u2010induced ONFH, which may reveal individual susceptibility and facilitate earlier diagnosis, remains to be determined. The aim of this study was to identify potential biomarkers that may predict early GC\u2010induced ONFH. A total of 123 patients scheduled for initial systemic GC therapy were enrolled in this prospective nested case\u2013control study. The serum concentrations of 13 potential biomarkers were measured in seven patients with GC\u2010induced ONFH, diagnosed instantly after short\u2010term use of GCs and in 20 controls who did not develop osteonecrosis despite similar GC therapy. Biomarkers were measured both before and after taking GCs to identify any differences in marker levels and the changes during GC therapy between two groups. Type I collagen cross\u2010linked C\u2010telopeptide (\u03b2\u2010CTX; <jats:italic>p<\/jats:italic>\u2009=\u20090.000) was significantly lower, high\u2010density lipoprotein cholesterol (<jats:italic>p<\/jats:italic>\u2009=\u20090.092) and apolipoprotein (apo)\u2010B\/apo\u2010A1 (<jats:italic>p<\/jats:italic>\u2009=\u20090.085) tended to be lower and higher, respectively, before GC treatment in osteonecrosis group. After GC therapy, \u03b2\u2010CTX (<jats:italic>p<\/jats:italic>\u2009=\u20090.014) was significantly lower and amino terminal telopeptide of procollagen type I (PINP; <jats:italic>p<\/jats:italic>\u2009=\u20090.068) tended to be lower in the osteonecrosis group. As secondary outcomes, we observed remarkable changes in nine potential biomarkers following short\u2010term GC therapy in both groups. In conclusion, we found that \u03b2\u2010CTX, could potentially be used to predict GC\u2010induced ONFH before GC therapy. Lower \u03b2\u2010CTX and PINP are promising biomarkers for the early diagnosis of GC\u2010induced ONFH. These findings need to be confirmed in large\u2010scale prospective studies. \u00a9 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. 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