{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T14:59:30Z","timestamp":1783090770941,"version":"3.54.6"},"reference-count":20,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"9","license":[{"start":{"date-parts":[[2008,9,1]],"date-time":"2008-09-01T00:00:00Z","timestamp":1220227200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2008,9]]},"abstract":"<jats:p> Severe acute respiratory syndrome (SARS) is a newly described infectious disease caused by the SARS coronavirus which attacks the immune system and pulmonary epithelium. It is treated with regular high doses of corticosteroids. Our aim was to determine the relationship between the dosage of steroids and the number and distribution of osteonecrotic lesions in patients treated with steroids during the SARS epidemic in Beijing, China in 2003. <\/jats:p><jats:p> We identified 114 patients for inclusion in the study. Of these, 43 with osteonecrosis received a significantly higher cumulative and peak methylprednisolone-equivalent dose than 71 patients with no osteonecrosis identified by MRI. We confirmed that the number of osteonecrotic lesions was directly related to the dosage of steroids and that a very high dose, a peak dose of more than 200 mg or a cumulative methylprednisolone-equivalent dose of more than 4000 mg, is a significant risk factor for multifocal osteonecrosis with both epiphyseal and diaphyseal lesions. Patients with diaphyseal osteonecrosis received a significantly higher cumulative methylprednisolone-equivalent dose than those with epiphyseal osteonecrosis. Multifocal osteonecrosis should be suspected if a patient is diagnosed with osteonecrosis in the shaft of a long bone. <\/jats:p>","DOI":"10.1302\/0301-620x.90b9.20056","type":"journal-article","created":{"date-parts":[[2008,8,31]],"date-time":"2008-08-31T21:17:38Z","timestamp":1220217458000},"page":"1239-1243","source":"Crossref","is-referenced-by-count":48,"title":["Steroid-induced osteonecrosis"],"prefix":"10.1302","volume":"90-B","author":[{"given":"N.-F.","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Center of Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, People\u2019s Republic of China 100029."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z. R.","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Center of Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, People\u2019s Republic of China 100029."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.-Y.","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Center of Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, People\u2019s Republic of China 100029."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.-H.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Center of Osteonecrosis and Joint Preserving & Reconstruction, China-Japan Friendship Hospital, 2 Yinghua East Road, Chaoyang District, Beijing, People\u2019s Republic of China 100029."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Hernigou","sequence":"additional","affiliation":[{"name":"University Paris XII, 51 avenue du Marechal de Lattre de Tassigny, 94010 Creteil, France."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"R1","unstructured":"Jones LC, Hungerford DS. The pathogenesis of osteonecrosis. Instr Course Lect 2007;56:179\u201396."},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199912000-00033"},{"key":"R3","unstructured":"LaPorte DM, Mont MA, Mohan V, Jones LC, Hungerford DS. Multifocal osteonecrosis. J Rheumatol 1998;25:1968\u201374."},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1053\/j.sart.2007.06.002"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2007.061088"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1080\/00313020600696231"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2351040100"},{"key":"R8","unstructured":"Li Z-P, Sun W, Qu H, et al. Clinical research of correlation between osteonecrosis and steroid. Zhonghua Waike Za Zhi 2005;43:1048\u201353 (in Chinese)."},{"key":"R9","unstructured":"No authors listed. World Health Organisation. Case definitions for surveillance of severe acute respiratory Syndrome (SARS) http:\/\/www.who.int\/csr\/sars\/casedefinition\/en\/(date last accessed 24 December 2007)."},{"key":"R10","unstructured":"Gardeniers JWM. ARCO Committee on Terminology and Staging. ARCO Newsletter 1993;5:79\u201382. http:\/\/www.arco-intl.org\/Newsletters\/Gardeniers-1993-5-2\/Gardeniers-1993.htm (date last accessed 28 July 2008)."},{"key":"R11","unstructured":"Shen J, Liang BL, Zeng QS, et al. Investigation of proximal femoral marrow with magnetic resonance imaging in recovered patients with severe acute respiratory syndrome. Zhonghua Jie He He Hu Xi Za Zhi 2006;29:189\u201393 (in German)."},{"key":"R12","doi-asserted-by":"crossref","unstructured":"Mont MA, Hungerford DS. Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg [Am] 1995;77-A:459\u201374.","DOI":"10.2106\/00004623-199503000-00018"},{"key":"R13","doi-asserted-by":"crossref","unstructured":"Mont MA, Jones LC, Hungerford DS. Nontraumatic osteonecrosis of the femoral head: ten years later. J Bone Joint Surg [Am] 2006;88-A:1117\u201332.","DOI":"10.2106\/JBJS.E.01041"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.83B2.0830274"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"Sch\u00f6mig A, L\u00fcth B, Dietz R, Gross F. Changes in vascular smooth muscle sensitivity to vasoconstrictor agents induced by corticosteroids, adrenalectomy and differing salt intake in rats. Clin Sci Mol Med Suppl 1976;3:61\u20133.","DOI":"10.1042\/cs051061s"},{"key":"R16","doi-asserted-by":"crossref","unstructured":"Hirano K, Tsutsui H, Sugioka Y, Sueishi K. Histopathologic alterations of retinacular vessels and osteonecrosis. Clin Orthop 1997;342:192\u2013204.","DOI":"10.1097\/00003086-199709000-00027"},{"key":"R17","doi-asserted-by":"crossref","unstructured":"Driessens M, Vanhoutte PM. Vascular reactivity of the isolated tibia of the dog. 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