OSTEONECROSIS (AVASCULAR NECROSIS) is a topic covered in the Harrison's Manual of Medicine.

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Caused by death of cellular elements of bone, believed to be due to impairment in blood supply. Frequent associations include glucocorticoid treatment, connective tissue disease, trauma, sickle cell disease, embolization, alcohol use, and HIV disease. Commonly involved sites include femoral and humeral heads, femoral condyles, and proximal tibia. Hip disease is bilateral in >50% of cases. Clinical presentation is usually the abrupt onset of articular pain. Early changes are not visible on plain radiograph and are best seen by MRI; later stages demonstrate bone collapse (“crescent sign”), flattening of articular surface with joint space loss. Osteonecrosis of the jaw is a rare occurrence associated with cancer treatments (including radiation), infection, glucocorticoids, or bone antiresorptive therapies.

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