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Avascular necrosis (osteonecrosis)

Medically reviewed by Last updated on May 17, 2022.


Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. The process usually takes months to years.

A broken bone or dislocated joint can stop the blood flow to a section of bone. Avascular necrosis is also associated with long-term use of high-dose steroid medications and too much alcohol.

Anyone can be affected. But the condition is most common in people between the ages of 30 and 50.


Some people have no symptoms in the early stages of avascular necrosis. As the condition worsens, affected joints might hurt only when putting weight on them. Eventually, you might feel the pain even when you're lying down.

Pain can be mild or severe. It usually develops gradually. Pain associated with avascular necrosis of the hip might center on the groin, thigh or buttock. Besides the hip, the shoulder, knee, hand and foot can be affected.

Some people develop avascular necrosis on both sides, such as in both hips or in both knees.

When to see a doctor

See your health care provider for ongoing pain in any joint. Seek immediate medical attention for a possible broken bone or dislocated joint.


Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

Sometimes the cause of avascular necrosis not brought on by trauma isn't fully understood. Genetics combined with overuse of alcohol, certain medications and other diseases likely play a role.

Risk factors

Risk factors for developing avascular necrosis include:

Medical conditions associated with avascular necrosis include:


Untreated, avascular necrosis worsens. Eventually, the bone can collapse. Avascular necrosis also causes bone to lose its smooth shape, possibly leading to severe arthritis.


To reduce the risk of avascular necrosis and improve general health:


During a physical exam, a health care provider will press around your joints, checking for tenderness. They might also move the joints through different positions to see if the range of motion is lessened.

Imaging tests

Many conditions can cause joint pain. Imaging tests can help pinpoint the source of pain. Tests may include:


The goal is to prevent further bone loss.


In the early stages of avascular necrosis, certain medications may help ease symptoms:


Your health care provider might recommend:

Surgical and other procedures

Because most people don't develop symptoms until avascular necrosis is advanced, your health care provider might recommend surgery. The options include:

Preparing for your appointment

Your health care provider might refer you to a doctor who specializes in disorders of the joints (rheumatologist) or to an orthopedic surgeon.

What you can do

Make a list of:

Ask a relative or friend to accompany you, if possible, to help you remember the information you receive.

Some questions to ask your provider about avascular necrosis include:

Don't hesitate to ask other questions.

What to expect from your doctor

Your provider is likely to ask you questions, including:

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