Which drug therapy is associated with an increased risk of ischemic bone necrosis?

Prednisone is a corticosteroid that can significantly impact bone health and is notably associated with an increased risk of ischemic bone necrosis, also known as osteonecrosis. This risk is particularly heightened when these steroids are used at high doses or for extended periods. The mechanism behind this involves the impairment of blood flow to the bone, which can lead to the death of bone tissue due to lack of oxygen and nutrients.

Corticosteroids like prednisone can alter the balance between bone formation and resorption, disrupt the normal metabolic processes of bone cells, and cause changes in the microvascular system that supplies bones. These effects can culminate in compromised blood supply, resulting in ischemia and subsequent necrosis of the bone.

In contrast, other drugs listed, such as ibuprofen and ketorolac, are nonsteroidal anti-inflammatory drugs (NSAIDs) that primarily address pain and inflammation and do not carry the same risk for bone necrosis. Acetaminophen is similarly focused on pain relief and does not have an association with ischemic bone necrosis. Overall, understanding the implications of steroid therapy is crucial for managing patients at risk for musculoskeletal complications.