Research Progress Related to Osteonecrosis

Investigators supported by the National Institutes of Health and other research centers across the country are working to understand what causes osteonecrosis, which may lead to new treatment strategies. Many efforts are aimed at comparing the efficacy of current and new therapies, which require clinical trials.

Following are examples of other types of studies that are ongoing:

• Researchers are actively searching for pharmaceutical alternatives to surgical procedures, which are currently the mainstay of treatment. One study is testing whether low doses of aspirin, which has anti-blood clotting properties, can increase blood flow to an affected bone and slow disease progression.
• The underlying causes of osteonecrosis are not known, but genetics may play a role. Some studies are aimed at uncovering genetic factors that confer a higher risk of the disease. If found, these genetic factors could help physicians identify high-risk individuals that need to be closely monitored for signs of the disease.
• Research on osteoarthritis has shown that stem cells called mesenchymal stem cells are drawn to arthritic knee joints. Scientists are investigating whether these cells collect at osteonecrotic sites as well, and if their concentration correlates with disease severity. If so, physicians may be able to use mesenchymal stem cell levels to help inform disease staging and treatment decisions.
• Osteoporosis drugs called bisphosphonates tend to accumulate in the jaw bones, and in rare cases this can lead to osteonecrosis of the jaw. Investigators have discovered that certain types of oral bacteria are drawn to these osteonecrotic sites, suggesting that they may play a part in damaging the bone. By exploring the relationship between bisphosphonates and these bacteria, the researchers hope to find ways to prevent bone death without losing the treatment benefit.
• Scientists are testing various approaches involving bone marrow stem cells to regenerate healthy bone. Some studies are examining the benefit of transplanting the stem cells directly into channels generated by core decompression procedures. Another approach is focused on testing the efficacy of bioengineered stem cell-based composite materials in restoring bone lost to the disease.