Bone damage from steroid treatment in MSers

#MSBlog: A previous post, from last year, that explains what avascular necrosis of the hip is!

Epub ahead of print: Sahraian et al. Avascular necrosis of the femoral head in multiple sclerosis: report of five patients. Neurol Sci. 2011 Dec 31. 

Osteonecrosis (death of bone due to blockage of blood vessels) of the femoral head (top of thigh bone) is a severe complication of steroid use, which may lead to more disability in MSers because of delayed diagnosis. The exact dose and risk period of steroids which cause the necrosis are not clearly known. The aim of the study was to enhance the attention of clinicians to leg pain in MSers with regard to steroid therapy.

This is a report five MSers with femoral head necrosis who had RRMS and received different doses of methyl prednisolone. The cases consisted of 3 females and 2 males. The duration of disease varied between 1 and 3 years. The least interval between the last pulse of prednisolone and diagnosis of avascular necrosis was 6 months. 2 of them received one pulse of 5 g of methyl prednisolone. All 5 patients had delayed diagnosis because the signs and symptoms were attributed to MS, which indicate the necessity of further focusing attention to early evaluations.

“This is one of the reasons why I try an avoid using steroids for treating relapses; avascular necrosis (AVN) is a serious complication and when it involves the femoral head it usually requires a joint replacement. MSrs need to know that the final outcome from a relapse (recovery or non-recovery) is the same whether or not the relapse is treated with steroids. All  that steroid treatment does is hasten the recovery period; you only recovery about 2 weeks earlier, on average, if you receive steroid therapy. In addition to AVN steroids are associated with a large number of other side effects.”

“If you have a relapse please ask yourself if you really need those steroids? Preventing AVN is better than treating it!”

Additional reading: AVN

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • I never knew steroids can cause such serious damage.
    What about relapses with optic neuritis? I believe methyl prednisolone is needed to prevent permanent vision damage.

  • Re: " What about relapses with optic neuritis? I believe methyl prednisolone is needed to prevent permanent vision damage."

    Not correct; there is no evidence in optic neuritis that steroids protects the nerves. All steroids do is hasten the recovery and help relieve the pain that can be quite severe in with acute optic neuritis.

    • Works for me! The only time I take steroids is when my relapse includes optic neuritis. Three times in 15 years. I can't afford to risk it, as steroids do dramatically cut the duration of the relapse and within days my eyes are back to normal. I work full time -writing and design. So I really need my eyes. I'm not saying the steroids 'protected' the optic nerves but it certainly shortened the duration of the relapse, otherwise I wouldn't have been able to do my job. Other than for optic neuritis, I avoid steroids like the plague.

  • Great!:( To ensure I was protected while the Copaxone built up efficacy in my body, my neuro had me do three IV steroid infusions (1000mg for three days, no taper) in the space of 5 months. What testing should I request to check for AVN?

  • Re: " What testing should I request to check for AVN?"

    No testing; if you were going to develop AVN you will know by now. I am assuming you have no hip pain. Although you may not have any symptoms early on as the AVN progresses, however, you would experience joint pain. At first, the pain typically occurs only when putting weight on the affected joint. Later, it will occur at rest as well. If the bone surrounding the joint surface collapses, pain may develop suddenly or increase dramatically. Pain may be severe enough to limit the range of motion in the affected joint. The period of time between the first symptoms and loss of joint function is different for each person; it typically ranges from several months to more than a year.

  • I would feel so nervous not having steriods for ON – my vision went black for months and only had any real improvement when I was given IV steriods for a spine lesion and suspected NMO (though now its thought I have MS). I can see if I have spine lesions best to avoid steroids but I just dont think I could for ON – I think I would take a chance on AVN to save my sight even though I guess what you would say is it was a coincidence my sight improved?

  • Is it only femoral head joints or any joints? I have had 2 mega dose steroids in 18 months and year on between 15mg and 20 mgs daily for over a year – now off completely – but have recent joint pains in fingers wrists and ankles.

    • The femoral head is the most common site, but it can occur in other bones. Generalised joint pains when you come of steroids is called pseudo-rheumatism and is quite common.

  • Wow, The Great Professor of G is actually speaking out against a drug for multiple sclerosis? Do my eyes deceive me?

    I bet early in his career he talked up steroids as much as he does alemtuzumab, but now he's had a change of heart. What are the chances he will be writing a post of this nature about alemtuzumab in 12 years time?

    Surely if you can avoid taking any medicine for MS then that is the most responsible plan of action, is it not? Somebody just commented on this blog about how the drugs they were put on made them sexually psychotic. That's a scary confession, enough to suggest drugs for MS are messing sufferers up in ways that are dangerously ignored by neurologists.

    Until you can demonstrate that remyelination and restoration in the CNS is achievable, you're committing serious malpractice by pushing toxic drugs in the name of good medicine. Until then all MSers should hope for the best but plan for the worst. Drugs don't fix MS, neither does CCSVI. A good attitude and healthy lifestyle goes much further than both.

    • Live well. The rest will be whatever it's meant to be. Accept with simplicity everything that comes your way. To absorb life's body blows is to be truly alive. MS is your destiny. If you can accept that then you will never be disappointed or frustrated by what is happening to you, nor will you be exploited by elements that do not have your best interest at heart, primarily because whatever happens to you will have zero impact on them personally. You are just one of many. The only one who cares about you is you, therefore live well.

    • This sort of platitudes is utterly irresponsible. This attitude reminds of the 19th century practice when priests condemned 'modern' medicine as evil and advocated acceptance and prayer instead. High mortality was the consequence. Nothing against positive attitude but MS is too complex & serious a disease to listen to some self-proclaimed gurus who basically are either ignorant or uncaring.

    • Hmm, has the rate of MS actually declined since the 19th century? Is the rate of disability brought about by MS decreased in the DMT eara? Are MSers today likely to give up work within a decade of diagnosis as a result of ill health caused by MS? I think your answers will be an adequate exemplar as to why your polemic is ill-informed at best, desperate at worst.

      One of the reasons why we are living longer in the 21st century is better living standards, yet that does not negate the actuality that untreatable illnesses are at their highest rate ever. Living longer and living a quality life are not the same thing. I think it is the greedy pharmaceutical companies and their minion neurologists that are ignorant and uncaring, not I. After all, it is now public knowledge that some doctors at Barts and the London have been engaging in corporate crime and paying themselves for work they had not even done, not that I am accusing any of the people that run this blog of exercising such crimes. (

      I am very fond of Gibran's masterwork. I'll take the compliment gladly.

    • Mouse Doc and myself are employed by Queen Mary University of London; we are not employed by Barts Health (NHS). This saga has nothing to do with us!

  • If anyone reads Wheelchair Kamikaze's blog about life with progressive MS, he has talked about AVN because he lives with it.

    • I am sure there are many more of you with this complication. It is not that uncommon. You need to think twice about having steroids. All that steroids do is speed-up the rate of recovery from a relapse; the final outcome is the same. I only use steroids for disabling attacks; disabling however is a difficult thing to define, which is why I usually leave it up to the MSer concerned to make the call.

    • Are there any stats about how common AVN is in MSers? It sounds from the post like not a lot is known about the risk rate.

    • I have AVN in both hips and I"m 29 yrd due to steriods courses (MS), 4 days ago my right eye got damaged because of optic neuritis and my doctors are recommanding (how not?) seriods.

      dunno what to do, from the one hand my sight might improve without steriods ( 92 % of patients that do'nt use steriods are getin their sight back) but the drs are saying I might not get it back withoud a steriod course from the othe hand if Ill take more steriods my left hip which have only level 1-2 (R hip is in level 4) might get wose or even spread to the shoulders..

      I guess the doctors just want to know how the steriods will impact me since ms can hit again in the future and steriods are the ONLY treatmen for ms relapses in the medicion of the 21 cent..

      any suggestions ?

    • Have you tried swimming? my neurologist told me 20 years ago go swimming or take pain killers for the rest of your life. I did and it helped. Public swimming pools have a disabled session. They are not well advertised so you need to make a phone call. They have hoists. My pool had a disabled shower room accessible by radar key, however, I managed to persuade the manager to install a seat in the main shower area too. I am unable to do any exercise other than swimming.

By Prof G



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