Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Aseptic necrosis is a bone condition that results from poor blood supply to an area of bone, causing localized bone death.
Aseptic necrosis can be caused by trauma, damage to the blood vessels that supply bone its oxygen, poor blood circulation to the bone, abnormally thick blood (hypercoagulable state), atherosclerosis, or inflammation of the blood vessel walls (vasculitis).
The treatment of aseptic necrosis is critically dependent on the stage of the condition.
What is aseptic necrosis?
Aseptic necrosis is a bone condition that results from poor blood supply to an area of bone, causing localized bone death. This is a serious condition because the dead areas of bone do not function normally, are weakened, and can collapse. Aseptic necrosis is also referred to as avascular necrosis or osteonecrosis.
Aseptic necrosis can be caused by trauma and damage to the blood vessels that supply bone its oxygen. Other causes of poor blood circulation to the bone include a blockage by air or fat (embolism) that obstructs the blood flow through the blood vessels, abnormally thick blood (hypercoagulable state), atherosclerosis (hardening of the arteries), or inflammation of the blood vessel walls (vasculitis). Steroid medications (cortisone, such as prednisone [Deltasone, Liquid Pred] and methylprednisolone [Medrol, Depo-Medrol]) are the most common medications to cause aseptic necrosis. Typical bones affected by steroids include the femur bone of the hip, the humerus bone of the shoulder, and the tibia bone of the knee, sometimes in combinations and frequently affecting both sides of the body (bilateral). Aseptic necrosis of the jawbone has been associated with the use of medications (bisphosphonates) used to treat high blood calcium levels from cancer.
Conditions that are risk factors associated with aseptic necrosis include alcoholism, cortisone medications, Cushing's syndrome, radiation exposure, smoking cigarettes, sickle cell disease, pancreatitis, hyperlipidemia, Caisson's disease (dysbarism), Gaucher disease, and systemic lupus erythematosus. Aseptic necrosis of the jawbone has been rarely reported in association with the use of bisphosphonate medication, particularly intravenously including zoledronate (Zometa) and pamidronate (Aredia).