{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:11:39Z","timestamp":1790824299868,"version":"4.1.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2016,7,11]],"date-time":"2016-07-11T00:00:00Z","timestamp":1468195200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2016,7,11]],"date-time":"2016-07-11T00:00:00Z","timestamp":1468195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Our objective was to study the incidence, etiology and diagnosis of multifocal osteonecrosis (MFON) and its treatment options to facilitate an earlier diagnosis and to optimize treatment. A radiological investigation was performed in osteonecrosis patients with a high risk of MFON for a more accurate diagnosis between January 2010 and June 2015. For patients with osteonecrosis of both the hip and knee joints or for patients with a history of corticosteroid use or alcohol abuse who had osteonecrosis of one or more joints in the shoulder, ankle, wrist or elbow, magnetic resonance imaging (MRI) was also performed on other joints, regardless of whether these joints were symptomatic. Furthermore, we performed a radiological screening of 102 patients who had a negative diagnosis of MFON but were at a high risk; among them, another 31 MFON cases were successfully identified (30.4%). Thus, the incidence of MFON during the study period increased from 3.1% to 5.2%. Patients diagnosed with osteonecrosis and who are at a high risk of MFON should have their other joints radiologically examined when necessary. This will reduce missed diagnosis of MFON and facilitate an earlier diagnosis and treatment to achieve an optimal outcome.<\/jats:p>","DOI":"10.1038\/srep29576","type":"journal-article","created":{"date-parts":[[2016,7,12]],"date-time":"2016-07-12T14:20:37Z","timestamp":1468333237000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["The pathogenesis of multifocal osteonecrosis"],"prefix":"10.1038","volume":"6","author":[{"given":"Wei","family":"Sun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhencai","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuqiang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bailiang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zirong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2016,7,11]]},"reference":[{"key":"BFsrep29576_CR1","doi-asserted-by":"crossref","unstructured":"Symptomatic multifocal osteonecrosis. A multicenter study. Collaborative Osteonecrosis Group. Clin Orthop Relat Res 369, 312\u2013326 (1999).","DOI":"10.1097\/00003086-199912000-00033"},{"key":"BFsrep29576_CR2","first-page":"1968","volume":"25","author":"DM LaPorte","year":"1998","unstructured":"LaPorte, D. M., Mont, M. A., Mohan, V., Jones, L. C. & Hungerford, D. S. Multifocal osteonecrosis. J Rheumatol 25, 1968\u20131974 (1998).","journal-title":"J Rheumatol"},{"key":"BFsrep29576_CR3","first-page":"1048","volume":"43","author":"ZR Li","year":"2005","unstructured":"Li, Z. R. et al.Clinical research of correlation between osteonecrosis and steroid. Chinese Journal of Surger 43, 1048\u20131053 (2005).","journal-title":"Chinese Journal of Surger"},{"key":"BFsrep29576_CR4","doi-asserted-by":"publisher","first-page":"32","DOI":"10.2174\/1874325000903010032","volume":"3","author":"CH Flouzat-Lachaniete","year":"2009","unstructured":"Flouzat-Lachaniete, C. H. et al. Multifocal joint osteonecrosis in sickle cell disease. Open Orthop J. 3, 32\u201335 (2009).","journal-title":"Open Orthop J."},{"key":"BFsrep29576_CR5","doi-asserted-by":"publisher","first-page":"2220","DOI":"10.2106\/JBJS.G.00616","volume":"90","author":"CJ Glueck","year":"2008","unstructured":"Glueck, C. J., Freiberg, R. A., Boppana, S. & Wang, P. Thrombophilia, hypofibrinolysis, the eNOS T-786 C polymorphism,and multifocalosteonecrosis. J Bone Joint Surg Am 90, 2220\u20132229 (2008).","journal-title":"J Bone Joint Surg Am"},{"key":"BFsrep29576_CR6","doi-asserted-by":"crossref","unstructured":"Fajardo-Hermosillo, L. D., L\u00f3pez-L\u00f3pez, L., Nadal, A. & Vil\u00e1, L. M. Multifocal osteonecrosis in systemic lupus erythematosus: case report and review of the literature. BMJ Case Rep pii: bcr2013008980 (2013).","DOI":"10.1136\/bcr-2013-008980"},{"key":"BFsrep29576_CR7","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1093\/rheumatology\/41.10.1200","volume":"41","author":"RH Mullan","year":"2002","unstructured":"Mullan, R. H. & Ryan, P. F. Multiple site osteonecrosis in HIV infection. Rheumatology (Oxford) 41, 1200\u20131202 (2002).","journal-title":"Rheumatology (Oxford)"},{"key":"BFsrep29576_CR8","doi-asserted-by":"publisher","first-page":"3262","DOI":"10.1200\/JCO.2000.18.18.3262","volume":"18","author":"LA Mattano Jr","year":"2000","unstructured":"Mattano, L. A., Jr, Sather, H. N., Trigg, M. E. & Vil\u00e1, L. M. Osteonecrosis as a complication of treating acute lymphoblastic leukemia in children: a report from the Children\u2019s Cancer Group. J Clin Oncol 18, 3262\u20133672 (2000).","journal-title":"J Clin Oncol"},{"key":"BFsrep29576_CR9","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1007\/s12306-008-0047-2","volume":"92","author":"G Solarino","year":"2008","unstructured":"Solarino, G., Scialpi, L., Bruno, M. & De Cillis, B. On a case of multifocal osteonecrosis in a patient suffering from acute lymphoblastic leukemia. Chir Organi Mov. 92, 119\u2013122 (2008).","journal-title":"Chir Organi Mov."},{"key":"BFsrep29576_CR10","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1191\/0961203306lu2301cr","volume":"15","author":"J Mundo","year":"2006","unstructured":"Mundo, J. et al. Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome. Lupus 15, 304\u2013307 (2006).","journal-title":"Lupus"},{"key":"BFsrep29576_CR11","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.reuma.2012.01.008","volume":"8","author":"A Gonzalez Garcia","year":"2012","unstructured":"Gonzalez Garcia, A. et al. Multifocal osteonecrosis associated with human immunodefi ciency virus infection. Reumatol Clin 8, 361\u2013364 (2012).","journal-title":"Reumatol Clin"},{"key":"BFsrep29576_CR12","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1177\/1352458509358091","volume":"16","author":"V Sinclair","year":"2010","unstructured":"Sinclair, V. & Shepard, G. Symptomatic steroid-induced multifocal diaphyseal osteonecrosis in a patient with multiple sclerosis. Mult Scler 16, 370\u2013372 (2010).","journal-title":"Mult Scler"},{"key":"BFsrep29576_CR13","doi-asserted-by":"publisher","first-page":"3587","DOI":"10.1007\/s11999-012-2579-x","volume":"470","author":"PM Miettunen","year":"2012","unstructured":"Miettunen, P. M., Lafay-Cousin, L., Guilcher, G. M., Nettel-Aguirre, A. & Moorjani, V. Widespread osteonecrosis in children with leukemia revealed by whole-body MRI. Clin Orthop Relat Res 470, 3587\u20133595 (2012).","journal-title":"Clin Orthop Relat Res"},{"key":"BFsrep29576_CR14","doi-asserted-by":"crossref","unstructured":"Awais, M., Hafeez, S., Rehman, A. & Baloch, N. U. Vibration-induced multifocal carpal osteonecrosis in a 31-year-old man. Occup Environ Med. pii: oemed-2015-103100 (2015).","DOI":"10.1136\/oemed-2015-103100"},{"key":"BFsrep29576_CR15","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1055\/s-0034-1365933","volume":"52","author":"PC Grunert","year":"2014","unstructured":"Grunert, P. C. et al. A rare cause of peripheral arthralgia in inflammatory bowel disease: multifocal osteonecrosis. Z Gastroenterol 52, 285\u2013289 (2014).","journal-title":"Z Gastroenterol"},{"key":"BFsrep29576_CR16","first-page":"1117","volume":"88A","author":"MA Mont","year":"2006","unstructured":"Mont, M. A., Jones, L. C. & Hungerford, D. S. Non-traumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg (Am). 88A, 1117\u20131132 (2006).","journal-title":"J Bone Joint Surg (Am)."},{"key":"BFsrep29576_CR17","first-page":"1629","volume":"35","author":"MA Mont","year":"2008","unstructured":"Mont, M. A. et al. Bone scanning of limited value for diagnosis of symptomatic oligofocal and multifocal osteonecrosis. J Rheumatol 35, 1629\u20131634 (2008).","journal-title":"J Rheumatol"},{"key":"BFsrep29576_CR18","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1007\/s00247-010-1636-4","volume":"40","author":"TC Castro","year":"2010","unstructured":"Castro T. C., Lederman H., Terreri, M. T., Kaste, S. C. & Hilario, M. O. Detection of multifocal osteonecrosis in an adolescent with dermatomyositis using whole-body MRI. Pediatr Radiol 40, 1566\u20131568 (2010).","journal-title":"Pediatr Radiol"},{"key":"BFsrep29576_CR19","first-page":"4:3","volume":"6","author":"AH Zibis","year":"2015","unstructured":"Zibis A. H. et al. Fast sequences MR imaging at the investigation of painful skeletal sites in patients with hip osteonecrosis. Springerplus 6, 4:3 (2015).","journal-title":"Springerplus"},{"key":"BFsrep29576_CR20","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/j.1757-7861.2011.00127.x","volume":"3","author":"W Sun","year":"2011","unstructured":"Sun, W., Wang, B. L. & Li, Z. R. Chinese specialist consensus on diagnosis and treatment of osteonecrosis of the femoral head. Orthop Surg 3, 131\u2013137 (2011).","journal-title":"Orthop Surg"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/srep29576","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep29576.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/srep29576.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T19:50:43Z","timestamp":1672861843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/srep29576"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,11]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,9,30]]}},"alternative-id":["BFsrep29576"],"URL":"https:\/\/doi.org\/10.1038\/srep29576","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,11]]},"assertion":[{"value":"29 February 2016","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 June 2016","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2016","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing financial interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"29576"}}