How is avascular necrosis (AVN) prevented?

Updated: Dec 05, 2020
  • Author: Sunny B Patel, MD; Chief Editor: Herbert S Diamond, MD  more...
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The following precautions can be taken to minimize the risk of developing avascular necrosis (AVN) and to improve outcomes in these patients:

  • Use the minimum effective dose of systemic corticosteroids; when possible, initiate use steroid-sparing agents
  • Early diagnosis and treatment are important; the earlier AVN is detected, the more treatment (and less invasive) options available to the patient
  • Provide patient education for high-risk patients

For patients undergoing pelvic radiotherapy, a variety of pharmacological interventions for preventing AVN have been studied, including supplemental calcium and/or vitamin D, bisphosphonates, selective estrogen receptor modulators, hormone replacement therapy (estrogen or testosterone), denosumab, and calcitonin. However, a Cochrane review concluded that the evidence relating to those interventions is of very low certainty. [45]

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