Osteonecrosis: Causes, Symptoms, and Treatment
Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Osteonecrosis?
An orthopedic surgeon, a doctor who treats bone and joint disease, usually treats osteonecrosis. A rheumatologist, a doctor who treats arthritis and related diseases, can provide nonsurgical care. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is osteonecrosis?
In osteonecrosis, blood flow to part of a bone is disrupted. This results in death of bone tissue. The bone can eventually break down, and the joint can collapse.
Osteonecrosis is also called avascular necrosis, aseptic necrosis, or ischemic necrosis of bone. It can happen to any bone, but it most often develops in the ends of long bones, such as the thigh bone (femur) and the upper arm bone (humerus).
Symptoms
There may be no symptoms at first. The main symptom is pain. The hip joint is most often affected, and the pain is usually felt in the groin or, less commonly, in the buttock area. Most people first have pain when they put weight on the joint, but eventually the joint may hurt even at rest.
Over time, the joint may stiffen and lose its range of motion. If the end of the bone collapses, the pain may suddenly get worse.
Causes and who gets it
Osteonecrosis happens when the blood supply to part of a bone is disrupted. The bone tissue then lacks nutrients and oxygen. No one is sure exactly what causes it. Some people who get it have no known risk factors. People of any age can get it, but it is most common in people in their 30s and 40s. Risk factors may include:
- An injury, such as a broken or dislocated bone or a joint injury, which may damage nearby blood vessels.
- Corticosteroid medicines, which reduce inflammation, when used for long periods at high doses. The risk is low with short-term use at lower doses.
- Excessive alcohol use. Excessive tobacco use is also a risk factor.
- Certain medical conditions, such as sickle cell disease, leukemia, HIV infection, pancreatitis, rheumatoid arthritis, and lupus.
- Chemotherapy, radiation treatment, and organ transplantation.
How doctors diagnose it
Your doctor may take your medical history, do a physical exam, and order imaging tests to see which bones are affected. Early diagnosis increases the chance that treatment will be successful. X-rays are usually ordered first. They can also help rule out other causes of joint pain, such as a fracture or arthritis. But an x-ray is not sensitive enough to detect bone changes in the early stages, so you may need more tests. An MRI, a scan that takes detailed pictures inside the body, can detect early signs before they show on an x-ray. It may even pick up signs before you have symptoms.
Treatment
The goal of treatment is to preserve joint function for as long as possible. If the disease is caught early, the damaged area is small, and the bone does not bear weight, the bone may heal on its own. In most cases, though, treatment involves surgery.
Nonsurgical approaches may include:
- Anti-inflammatory medicines to reduce pain and swelling.
- Physical therapy to ease joint stiffness and increase range of motion.
- A cane or crutches, if the bone bears weight.
Nonsurgical approaches may help manage symptoms, but generally they do not cure the disease or slow its progression. Most people with osteonecrosis eventually need surgery as the disease worsens. Core decompression, the most common surgery, drills one or more narrow shafts through the bone to lower the pressure inside it. It is often combined with bone grafting. If the bone has broken down too much, the joint is replaced with an artificial one.
When to see a doctor
See a doctor about joint pain, because early diagnosis increases the chance that treatment will be successful. Pain that suddenly gets much worse can mean the end of the bone has collapsed, so contact your doctor promptly. If you think you may have a medical emergency, such as a serious injury, call 911.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. A direct primary care doctor can examine the painful joint, review your medicines, and refer you to an orthopedic surgeon when needed.
Common questions
Can osteonecrosis heal on its own?
Sometimes, if it is caught early. In most cases, though, treatment involves surgery.
Does osteonecrosis need surgery?
Most often, yes. Most people with osteonecrosis eventually need surgery as the disease worsens.
Can steroid medicines cause osteonecrosis?
Yes, they can. Corticosteroids raise the risk when used for long periods at high doses. The risk is low when they are used short term at lower doses. Ask your doctor before changing any medicine.
Is osteonecrosis the same as avascular necrosis?
Yes. Avascular necrosis is another name for osteonecrosis.
Which joint does osteonecrosis affect most?
The hip joint is most commonly affected.
Sources
- NIAMS - Osteonecrosis (Avascular Necrosis) Symptoms & Causes
- NIAMS - Osteonecrosis: Diagnosis, Treatment, and Steps to Take
- MedlinePlus - Osteonecrosis
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
