Multifocal Glucocorticoid-Associated Osteonecrosis: Clinical Characteristics and Systemic Molecular Features.

Authors

Kosuke Arita, Tomohiro Shimizu, Hotaka Ishizu, Yusuke Ohashi, Kentaro Homan, Daisuke Takahashi, Akihiro Ishizu, Norimasa Iwasaki

Published in

Biomedicines. Volume 14. Issue 7. Jun 27, 2026. Epub Jun 27, 2026.

Abstract

Background: Multifocal osteonecrosis involving three or more anatomical sites is an uncommon but severe manifestation of glucocorticoid-associated osteonecrosis and may be associated with systemic clinical backgrounds. This study investigated the clinical characteristics and exploratory serum proteomic profiles of multifocal osteonecrosis using clinical and proteomic analyses. Methods: We analyzed 107 patients who underwent surgery for osteonecrosis of the femoral head between 2019 and 2024. Whole-body MRI was used to detect multifocal lesions. Patients were classified into glucocorticoid-related osteonecrosis of the femoral head (GO) and multifocal glucocorticoid-related osteonecrosis (MGO). Clinical variables were compared, and multivariate logistic regression identified clinical factors associated with multifocal osteonecrosis. Serum proteomic profiling using nanoLC-MS/MS was performed as an exploratory analysis to compare protein expression among GO, MGO, and osteoarthritis controls. Results: Multifocal osteonecrosis was identified in 31 patients (29.0%). Patients with MGO were younger (42.6 vs. 50.9 years, p = 0.021) and had higher glucocorticoid doses (59.5 vs. 48.5 mg, p = 0.005). Hematologic diseases (OR 14.51, 95% CI 3.42-86.69, p < 0.001) and skin manifestations (OR 3.17, 95% CI 1.05-10.44, p = 0.046) were independently associated with multifocal osteonecrosis. Exploratory proteomic analysis showed protein expression patterns related to fibrinolysis, coagulation, inflammation, and vascular homeostasis in MGO. Conclusions: Multifocal osteonecrosis was associated with systemic clinical backgrounds and showed exploratory vascular- or coagulation-related proteomic patterns within glucocorticoid-associated osteonecrosis.

PMID:
42511938
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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