Osteonecrosis: A More Appropriate Term Than Avascular Necrosis - Pathophysiologic Rationale.

Abstract

Non-traumatic osteonecrosis has traditionally been attributed to vascular insufficiency, causing deprivation of oxygen and nutrients to the bone and subsequent bone death. The terminology used to describe this condition has varied widely, reflecting a lack of consensus regarding its underlying mechanisms. A thorough review of the literature reveals that the ultimate pathophysiologic event in the development of non-traumatic osteonecrosis is disrupted bone homeostasis, which may be induced by vascular insufficiency or caused by vascular-independent mechanisms. The continued use of the term "avascular necrosis" or "ischemic necrosis" presents major drawbacks, as it disproportionately emphasizes vascular insufficiency, directing diagnostic and therapeutic strategies primarily toward restoring blood flow. This narrow focus risks overlooking other equally or more relevant underlying mechanisms. In this manuscript, we critically evaluate the use of various terms for osteonecrosis, particularly "avascular necrosis" and "ischemic necrosis," and reinforce a previous shift towards adopting "osteonecrosis" as the preferred term. By advocating for the adoption of the term "osteonecrosis," we promote a more inclusive understanding of the multifactorial nature of the condition. This linguistic shift could also drive the development of innovative therapies that address not only vascular insufficiency but also the other underlying mechanisms contributing to bone necrosis.