{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T19:30:04Z","timestamp":1771875004781,"version":"3.50.1"},"reference-count":27,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"3","license":[{"start":{"date-parts":[[2013,3,1]],"date-time":"2013-03-01T00:00:00Z","timestamp":1362096000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:p>The systemic use of steroids and habitual alcohol intake are two major causative factors in the development of idiopathic osteonecrosis of the femoral head (ONFH). To examine any interaction between oral corticosteroid use and alcohol intake on the risk of ONFH, we conducted a hospital-based case-control study of 71 cases with ONFH (mean age 45 years (20 to 79)) and 227 matched controls (mean age 47 years (18 to 79)). Alcohol intake was positively associated with ONFH among all subjects: the adjusted odds ratio (OR) of subjects with \u2265 3032 drink-years was 3.93 (95% confidence interval (CI) 1.18 to 13.1) compared with never-drinkers. When stratified by steroid use, the OR of such drinkers was 11.1 (95% CI 1.30 to 95.5) among those who had never used steroids, but 1.10 (95% CI 0.21 to 4.79) among those who had. When we assessed any interaction based on a two-by-two table of alcohol and steroid use, the OR of those non-drinkers who did use steroids was markedly elevated (OR 31.5) compared with users of neither. However, no further increase in OR was noted for the effect of using both (OR 31.6). We detected neither a multiplicative nor an additive interaction (p for multiplicative interaction 0.19; synergy index 0.95), suggesting that the added effect of alcohol may be trivial compared with the overwhelming effect of steroids in the development of ONFH.<\/jats:p><jats:p>Cite this article: Bone Joint J 2013;95-B:320\u20135.<\/jats:p>","DOI":"10.1302\/0301-620x.95b3.30856","type":"journal-article","created":{"date-parts":[[2013,2,28]],"date-time":"2013-02-28T17:47:06Z","timestamp":1362073626000},"page":"320-325","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":36,"title":["The effect of alcohol intake and the use of oral corticosteroids on the risk of idiopathic osteonecrosis of the femoral head"],"prefix":"10.1302","volume":"95-B","author":[{"given":"W.","family":"Fukushima","sequence":"first","affiliation":[{"name":"Osaka City University Faculty of Medicine, Department of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Kyushu University , Department of Orthopaedic Surgery, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Osaka City University Faculty of Medicine, Department of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Sakaguchi","sequence":"additional","affiliation":[{"name":"Osaka City University Faculty of Medicine, Department of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Kubo","sequence":"additional","affiliation":[{"name":"Kyoto Prefectural University of Medicine, Department of Orthopaedics, Graduate School of Medical Science, 465 Kajii-chou, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Kyushu University , Department of Orthopaedic Surgery, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Hirota","sequence":"additional","affiliation":[{"name":"Osaka City University Faculty of Medicine, Department of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1016\/S0049-0172(05)80026-5"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-199907000-00005"},{"key":"r3","first-page":"1117","volume":"88","author":"Mont MA","year":"2006","journal-title":"J Bone Joint Surg [Am]"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1292-x"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1191\/0961203306lu2311oa"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.48.2414"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker277"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.11.676"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200101000-00019"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.1080\/17453670810016641"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2351040100"},{"key":"r12","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/00003086-198809000-00021","volume":"234","author":"Matsuo K","year":"1988","journal-title":"Clin Orthop Relat Res"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a116706"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.2188\/jea.6.37"},{"key":"r15","doi-asserted-by":"publisher","DOI":"10.2739\/kurumemedj.50.121"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-009-1439-3"},{"key":"r17","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.81B4.0810590"},{"key":"r18","unstructured":"Rothman KJ.Epidemiology: an introduction. 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