Idiopathic and secondary osteonecrosis of the femoral head show different thrombophilic changes and normal or higher levels of platelet growth factors

Figures & data

Table 1. Profiles of 18 patients with idiopathic ON, 18 patients with corticosteroid-associated ON, and 44 healthy controls. For qualitative variables, the number of patients is reported

Variable	Idiopathic ON	Corticosteroid-associated ON	Healthy controls
Sex
male	15	12	33
female	3	6	11
Age (years)
mean (SD)	45 (12)	41 (10)	45 (10)
median (range)	41 (27–74)	42 (25–64)	44 (22–64)
Bilaterality	9	9	–
Smoking habit
no. of smokers	13	7	42
no. of non-smokers	3	6	1
no. of unknown	2	5	1

Table 2. Stages of osteonecrosis (ON) in 18 patients with idiopathic ON and 18 patients with corticosteroid-associated ON, according to the radiographic criteria of the Japanese Specific Disease Investigation Committee under the auspices of the Japanese Ministry of Health, Labour and Welfare (Sugano et al. 2002). The number of patients for each stage is reported. In 1 patient with idiopathic ON, the radiographs did not show any lesions and the clinical diagnosis was confirmed by magnetic resonance imaging

	Stage
	1	2	3A	3B	4
Idiopathic ON	0	2	7	5	3
Corticosteroid-associated ON	0	2	6	5	5

Table 3. Protein C and antithrombin III activity in 18 patients with idiopathic ON, 18 patients with corticosteroid-associated ON, and 44 healthy controls

	Protein C	Antithrombin III
	(%)	(%)
Idiopathic ON
mean (SD)	174 (50)	110 (22)
median	163	115
minimum–maximum range	95–273	72–145
Corticosteroid-associated ON
mean (SD)	138 (42) ^a	103 (17)
median	129	107
minimum–maximum range	85–243	68–125
Healthy controls
mean (SD)	167 (35)	102 (18)
median	160	98
minimum-–maximum range	99–237	80–146

^a p = 0.02 when compared with healthy controls.

Table 4. Plasma levels of D-dimer, plasminogen, and PAI-1 in 18 patients with idiopathic ON, 18 patients with corticosteroid-associated ON, and 44 healthy controls

	D-dimer	Plasminogen	PAI-1
	(ng/mL)	(%)	(ng/mL)
Idiopathic ON
mean (SD)	241 (132)	115 (18) ^b	4.6 (2.6)
median	173	118	4.7
range	86–553	72–149	1.2–10.5
Corticosteroid-associated ON
mean (SD)	384 (274) ^a	104 (15)	3.6 (1.9)
median	333	101	2.9
range	85–1000	84–129	1.5–7.1
Healthy controls
mean (SD)	173 (72)	104 (16)	3.4 (1.8)
median	164	101	3.2
range	65–338	65–129	0.6–8

^a p = 0.004 vs. healthy controls

^b p = 0.02 vs. healthy controls

Table 5. Coagulation and fibrinolysis in smokers (13 with idiopathic ON, 7 with corticosteroid-associated ON, and 42 healthy controls)

	Idiopathic ON	Corticosteroid-associated ON	Healthy controls
Protein C (%)
mean (SD)	178 (57)	152 (52)	165 (39)
median	163	148	158
range	95–273	97–243	99–237
Antithrombin III (%)
mean (SD)	107 (22)	104 (19)	103 (19)
median	107	112.7	99
range	72–134	68–117	80–146
D-dimer (ng/mL)
mean (SD)	227 (118) ^a	239 (131)	172 (73)
median	173	235	158
range	145–553	85–419	65–338
Plasminogen (%)
mean (SD)	116 (20)	108 (18)	104 (16)
median	118	105	102
range	72–149	84–129	65–129
PAI-1 (ng/mL)
mean (SD)	5.3 (2.5) ^b	3.8 (2.3)	3.4 (1.8)
median	4.8	2.6	3.2
range	1.8–10.5	2–7	0.6–8

^a p = 0.01 when compared with healthy controls;

^b p = 0.05 when compared with healthy controls.

Table 6. Platelet factor 4 (PF4) and growth factors in releasates, platelet lysates, platelet-poor plasma (PPP), and serum in 14 patients with osteonecrosis (ON) and in 10 controls (Ctr). Releasates and lysates were obtained from platelet concentrates, after adjustment of platelet number to 1 × 10⁶ / mL

Sample	PF4 (IU/mL)		TGF-β1 (ng/mL)		PDGF-BB (ng/mL)		VEGF-A (pg/mL)
	ON	Control	ON	Control	ON	Control	ON	Control
Releasates
mean (SD)	7,661 (2,648)	6,856 (2,171)	55 (76)	28 (35)	8.1 (3.5)	6.4 (2.6)	165 (83)	105 (88)
median	8,265	6,939	21	16	8.1	6.5	183	105
range	4,568–10,000	3,269–10,000	2–200	2–105	2.9–13.7	2.5–11.1	9–235	9–230
Lysates
mean (SD)	8,621 (3,231)	9,042 (1,670)	146 (85)	99 (68)	11.9 (7.4)	10.8 (6.3)	206 (180)	172 (134)
median	10,000	10,000	200	69	11.1	9.2	152	138
range	2,031–10,000	4,717–10,000	33–200	26–196	2.7–26.8	4–26	9–570	9–402
Serum
mean (SD)	7,405 (985) ^a	5,142 (1240)	38 (18)	26 (15)	4.2 (3.6) ^b	2.3 (0.5)	215 (210)	182 (134)
median	7,383	4,697	50	29	3.1	2.2	155	160
range	5,777–8,553	3,576–7,165	14.6–50	2.5–50	1.1–13.5	1.3–3.1	9–628	9–493

^a p = 0.005 when compared with controls; ^b p = 0.02 when compared with controls.

Sugano N, Atsumi T, Ohzono K, Kubo T, Hotokebuchi T, Takaoka K. The 2001 revised criteria for diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head. J Orthop Sci 2002; 7(5):601-5.

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