{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:54:23Z","timestamp":1790949263371,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T00:00:00Z","timestamp":1668729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The osteoclastic bone resorption inhibitors might have positive effect in preventing femoral head collapse in patients with osteonecrosis of the femoral head (ONFH). However, as a novel osteoclastic inhibitor, whether denosumab can prevent collapse in steroid\u2010induced ONFH remains unknown. This study aims to evaluate the treatment effect of denosumab and the potential protective mechanism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study. A total of 161 patients with steroid\u2010induced ONFH who underwent denosumab treatment were reviewed, and 209 untreated patients were selected as controls. Their clinical characteristics and radiological exam results were obtained. Patients were treated with 60 mg denosumab every 6\u2009months for 2\u2009years. The primary outcome was the incidence of femoral head collapse at 2\u2009years after the initial diagnosis of ONFH. Secondary outcomes included the Harris hip score, progression of osteosclerosis, increase in necrotic area, bone marrow oedema relief, and bone mineral density increase in the femoral head. The Mann\u2013Whitney U test and chi\u2010square tests were performed to identify the differences between the continuous and categorical variables, respectively. A multivariate logistic regression model was built to identify the factors associated with the treatment effect of denosumab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of femoral head collapse was 42.24% (68\/161) in the denosumab group and 54.07% (113\/209) in the control group (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u20095.094, <jats:italic>p<\/jats:italic>\u00a0=\u20090.024; relative risk\u00a0=\u00a00.787, 95% CI\u00a0=\u00a00.627\u20130.973). The excellent\u2010good rates of the Harris hip score were 63.98% (103\/161) in the denosumab group and 44.98% (94\/209) in the control group (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a013.186, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The incidence of osteosclerosis progression in the denosumab group was 55.28% (89\/161), which was significantly higher than that in the control group (43.54%, 91\/209, <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a05.016, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.025). Meanwhile, a significant increase in bone mineral density was identified in 29.19% (47\/161) and 7.18% (15\/209) of patients in the denosumab and control groups, respectively (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a031.600, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The osteoclastic cytoplasm expression of LC3\u2010II was more positive in the control group than in the denosumab group (immunohistochemistry scoring: 3.58\u2009\u00b1\u20092.27 <jats:italic>vs<\/jats:italic> 6.33\u2009\u00b1\u20092.64, <jats:italic>Z<\/jats:italic>\u00a0=\u2009\u22122.684, <jats:italic>p<\/jats:italic>\u00a0=\u20090.007). A total of three independent factors were considered to be associated with the positive treatment effect of denosumab, the time of first denosumab administration (OR\u00a0=\u00a02.010, 95% CI\u00a0=\u00a01.272\u20133.177), osteosclerosis (OR\u00a0=\u00a01.583, 95% CI\u00a0=\u00a01.024\u20132.445), and the necrotic area before denosumab administration (medium necrotic area: OR\u00a0=\u00a02.084, 95% CI\u00a0=\u00a01.245\u20133.487; large necrotic area: OR\u00a0=\u00a02.211, 95% CI\u00a0=\u00a01.255\u20133.893).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current study demonstrated that denosumab had a positive effect on preventing femoral head collapse in patients with steroid ONFH. This effect might be closely associated with the inhibition of osteoclasts and their autophagy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13584","type":"journal-article","created":{"date-parts":[[2022,11,18]],"date-time":"2022-11-18T08:15:03Z","timestamp":1668759303000},"page":"256-265","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Denosumab Can Prevent Collapse in Patients with Early\u2010Stage Steroid\u2010Induced Osteonecrosis of the Femoral Head by Inhibiting Osteoclasts and Autophagy"],"prefix":"10.1111","volume":"15","author":[{"given":"Bo","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Osteonecrosis and Hip Surgery the Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Pathology the Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofei","family":"Xiu","sequence":"additional","affiliation":[{"name":"Department of Pathology the Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Osteonecrosis and Hip Surgery the Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3757-1109","authenticated-orcid":false,"given":"Zeming","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Osteonecrosis and Hip Surgery the Third Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingshi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Osteonecrosis and 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