Bone Death from Poor Blood Supply: Understanding Avascular Necrosis

When Bone Loses Its Blood Supply

Bone is living tissue that requires a continuous blood supply. When this supply is disrupted — by any of several mechanisms — the bone tissue dies. Without intervention, the joint surface collapses, causing severe pain and permanent disability. The hip is most commonly affected, but the knee, shoulder, and ankle can also be involved.

Causes Most Relevant to Nigeria

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• Sickle cell disease — the most common cause in Nigeria; sickled red cells block small vessels in bone, causing ischaemia and necrosis. Hip AVN is a major source of disability in Nigerian sickle cell patients
• Corticosteroid use — steroid-induced AVN is increasingly common given widespread steroid use in Nigeria; risk is dose and duration dependent
• Alcohol excess — regular heavy alcohol use causes fat emboli that block bone blood supply
• Trauma — hip fracture or dislocation disrupts the blood supply to the femoral head
• Decompression sickness — nitrogen bubbles in divers cause bone ischaemia

Early Diagnosis Changes Outcomes

MRI is the most sensitive investigation for early AVN — identifying bone ischaemia before X-ray changes appear. Caught early, treatment options include core decompression (surgical) and conservative management. Caught late, total joint replacement is often the only option. FXMed facilitates early MRI referral for at-risk patients presenting with hip or joint pain.

Functional Support

• Bisphosphonates — may slow progression of early AVN by reducing bone resorption
• Vitamin D and calcium optimisation — support bone health in remaining tissue
• Steroid minimisation — working with prescribing physicians to use the lowest effective dose and shortest possible duration
• Alcohol reduction support — addressed through our Lifestyle & Longevity programme

Don't Wait for Joint Collapse

If you have unexplained hip or joint pain with any of the above risk factors, book an urgent consultation with FXMed. Early investigation is the difference between preservation and replacement.