Osteonecrosis. Medical search. Frequent questions

Dysbaric osteonecrosis or DON is a form of avascular necrosis where there is death of a portion of the bone that is thought to be caused by nitrogen (N2) embolism (blockage of the blood vessels by a bubble of nitrogen coming out of solution) in divers. (wikipedia.org)
For patient education information, see Avascular Necrosis (Aseptic Necrosis or Osteonecrosis) . (medscape.com)
[ 4 ] Fat cell hypertrophy with resultant pressure increase within the femoral head, leading to vascular collapse and then necrosis, has been proposed as a mechanism for steroid-induced osteonecrosis. (medscape.com)
Clinical manifestations and diagnosis of osteonecrosis (avascular necrosis of bone). (mayoclinic.org)
Osteonecrosis is a bone disorder resulting from insufficient blood flow to a part of the skeleton and is characterized by resulting death of bone cells (necrosis). (glutenfreeworks.com)
Osteonecrosis = aseptic necrosis, avascular necrosis, ischemic necrosis and osteochondritis dessicans. (slideserve.com)
Hip necrosis, also called osteonecrosis or avascular necrosis, is a painful condition in which lack of proper blood flow to the head of the femur results in osteocytes and the bone marrow dying. (mendmyhip.com)
Osteonecrosis is a disease characterized by a derangement of osseous circulation that leads to necrosis of osseous tissue. (medscape.com)
You may hear osteonecrosis referred to as avascular necrosis, asceptic necrosis and ischemic necrosis. (dallasboneandjoint.com)

Traumatic osteonecrosis is a direct result of disruption of the blood supply to the femoral head. (medscape.com)
Management of early stages of osteonecrosis aims to prevent the collapse of the femoral head by attempts at restoring the vascularity of femoral head. (nih.gov)
Forty patients (60 hips) with stage I, II or III (ARCO system) osteonecrosis of femoral head were treated by either core decompression and isolated mononuclear cells (group A) or core decompression and unprocessed bone marrow injection (group B). The patients were followed up clinically and radiologically for a minimum of 2 years. (nih.gov)
It is well established that antiretrovirals (ARVs) affect markers of bone turnover, but less is known about their effect on risk of fractures and femoral osteonecrosis. (croiconference.org)
EuroSIDA participants were prospectively followed from baseline (Jan 2004) until last visit or death to assess fractures and femoral osteonecrosis. (croiconference.org)
Interleukin-6 (IL-6) is a pleiotropic cytokine and associated with the pathogenesis of femoral head deformity in patients with ischemic osteonecrosis of the femoral head. (nii.ac.jp)
If the blood supply is not steady enough to keep the femoral head healthy, osteonecrosis can set in. (mendmyhip.com)
Trauma to the hip joint (i.e. fracture or dislocation) can interrupt the flow of blood to the femoral head, leading to osteonecrosis. (mendmyhip.com)
The first is hip decompression where they drill holes in the area of the hip osteonecrosis to help relieve the pressure on the femoral head. (mendmyhip.com)
Cellular therapy based on mesenchymal stem cells (MSCs) is a promising novel therapeutic strategy for the osteonecrosis of the femoral head (ONFH), which is gradually becoming popular, particularly for early-stage ONFH. (biomedcentral.com)
Osteonecrosis of the femoral head (ONFH) is a progressive and refractory disease that is common in orthopedics. (biomedcentral.com)
Osteonecrosis of the knee is most commonly seen in the femoral condyle, usually on the inner side of the knee (the medial femoral condyle). (michaelswankmd.com)

In 2003, oral surgeons first noticed that some patients receiving bisphosphonates were developing osteonecrosis of the jaw-a condition rarely seen before then. (cancer.gov)
2011. Bisphosphonates and osteonecrosis of the jaw. (medsafe.govt.nz)
2006. Osteonecrosis of the jaw and bisphosphonates-putting the risk in perspective. (medsafe.govt.nz)
2009. Bisphosphonates and time to osteonecrosis development. (medsafe.govt.nz)
As reported previously, there is increasing attention being paid to the association between the use of oral bisphosphonates and osteonecrosis of the jaw (ONJ) , the serious side effect which is commonly called jawbone death, bone decay, or jaw rot. (drug-injury.com)
Two recent medical journal articles provide information about how osteonecrosis of the jaw (ONJ) may be caused by Fosamax and other bisphosphonates as well as identify some of the predisposing, or risk, factors for developing ONJ. (drug-injury.com)
If there is a relationship between bisphosphonates and osteonecrosis of the jaw, what might explain it? (drug-injury.com)
The mechanism of bisphosphonates-induced osteonecrosis is unclear. (drug-injury.com)
In addition, the constant microtrauma from jaw movement and lack of adequate bone remodeling in the presence of bisphosphonates may contribute to the genesis of osteonecrosis of the jaw (ONJ). (drug-injury.com)
People who do not have cancer or who have not taken bisphosphonates or denosumab can develop osteonecrosis of the jaw, but it is extremely rare. (merckmanuals.com)
We report the first case of bilateral osteonecrosis of the external auditory canal associated with denosumab and bisphosphonates with successful conservative management. (bmj.com)
Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. (unicamp.br)
Yarom N, Lazarovici TS, Whitefield S, Weissman T, Wasserzug O, Yahalom R. Rapid onset of osteonecrosis of the jaw in patients switching from bisphosphonates to denosumab. (unicamp.br)
Current long-term medical therapy for HCM focuses on inhibiting bone resorption with bisphosphonates or denosumab, which have the rare complication of osteonecrosis of the jaw. (endocrine.org)
In one study, when asked to identify side effects of bisphosphonate therapy, only a minority of patients receiving IV or oral bisphosphonates were aware of the potential risk of developing osteonecrosis of the jaw. (rxmagazine.org)
Patients from across the three groups all had limited knowledge of the association between bisphosphonates and osteonecrosis of the jaw, and when patients possessed some knowledge, this typically came from the patient information leaflets supplied with medication or from the internet. (rxmagazine.org)

This systematic review was performed to assess the potential influence of medication-induced salivary changes on the development of medication-related osteonecrosis of the jaw (MRONJ). (frontiersin.org)
Medication-related osteonecrosis of the jaw (MRONJ) is an adverse drug reaction, described as an exposed necrotic bone or a bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region, that persists for more than 8 weeks in patients without a history of radiotherapy or disease metastasis to the jaws ( 1 , 2 ). (frontiersin.org)
Medication-related osteonecrosis of the jaw (MRONJ) is a rare and potentially debilitating condition that involves exposure of the bone of the jaws. (merckmanuals.com)
Aim: This study aimed to systematically review existing literature regarding the association between dental procedures-such as tooth extractions and periodontal therapy-and occurrence of medication-related osteonecrosis of the jaw (MRONJ) in individuals using bone-modifying drugs. (unicamp.br)
American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw - 2014 update. (unicamp.br)
Medication-related osteonecrosis of the jaw (MRONJ) is a specific type of ONJ caused by antiresorptive drugs. (strulloralsurgery.com)
Medication related osteonecrosis of the jaw (MRONJ) is a rare adverse effect of anti-resorptive or anti-angiogenic drug therapy that can cause significant morbidity. (rxmagazine.org)

Bisphosphonate-Associated Osteonecrosis of the Jaw" is a descriptor in the National Library of Medicine's controlled vocabulary thesaurus, MeSH (Medical Subject Headings) . (childrensmercy.org)
This graph shows the total number of publications written about "Bisphosphonate-Associated Osteonecrosis of the Jaw" by people in this website by year, and whether "Bisphosphonate-Associated Osteonecrosis of the Jaw" was a major or minor topic of these publications. (childrensmercy.org)
Below are the most recent publications written about "Bisphosphonate-Associated Osteonecrosis of the Jaw" by people in Profiles. (childrensmercy.org)

Current smokers were about twice as likely to develop osteonecrosis of the jaw as former or never smokers. (cancer.gov)
In addition, patients who received more total doses of zoledronic acid within the first year of treatment (or longer) were more likely to develop osteonecrosis of the jaw than those who received fewer doses. (cancer.gov)

Survivors of COVID-19 may be at risk of developing spontaneous osteonecrosis of the jaw, according to a case series published June 14 in BMC Infectious Diseases . (drbicuspid.com)
Although spontaneous osteonecrosis is reported in a minority of cases, the majority of patients give a history of some prior dental or oral surgical manipulation. (drug-injury.com)
Osteonecrosis of the knee has been divided into two separate entities: spontaneous osteonecrosis of the knee (SPONK) and secondary osteonecrosis. (medscape.com)
[ 3 ] The osteonecrosis that Ahlback described now is referred to as spontaneous osteonecrosis of the knee (SPONK). (medscape.com)
The etiologies of both spontaneous osteonecrosis of the knee (SPONK) and secondary osteonecrosis are poorly understood. (medscape.com)
Clinical presentation of spontaneous osteonecrosis of the knee (SPONK) and secondary osteonecrosis is summarized in the following table. (medscape.com)

Symptoms of osteonecrosis of the jaw can include localized pain in the jaw and/or maxillofacial region, a feeling of numbness or altered sensation, the loosening of teeth, soft tissue infections, and the exposure of bone within the oral cavity. (yourlegalguide.com)
In part two of this series, sub-titled 'What Patients Should Know About The Signs And Symptoms As Well As Diagnostic Staging' , we get from these same two medical journal articles some important information about the early signs and symptoms of osteonecrosis of the jaw (ONJ) as well as the extent, or staging, of ONJ upon diagnosis. (drug-injury.com)
What are the symptoms of osteonecrosis? (msdmanuals.com)
A patient suffering from hip osteonecrosis will typically exhibit one or more of the following symptoms. (mendmyhip.com)
Patients with early stage osteonecrosis may not have any symptoms. (dallasboneandjoint.com)
Osteonecrosis progresses differently in each person affected by it, however the time between feeling the first symptoms of joint pain and losing joint function is usually anywhere from a few months to over a year. (dallasboneandjoint.com)
Becoming aware of osteonecrosis of the jaw's early symptoms and signs allows for speedy intervention and, consequently, more effective treatment. (strulloralsurgery.com)
There are four stages of development of osteonecrosis of the knee which can be distinguished by symptoms and X-rays. (michaelswankmd.com)

Long-term use of medications to increase bone density might contribute to developing osteonecrosis of the jaw. (mayoclinic.org)

There are two surgical treatments for the early stages of osteonecrosis. (mendmyhip.com)

Osteonecrosis can be caused by disease or by severe trauma, such as a fracture or dislocation , that affects the blood supply to the bone. (medlineplus.gov)
CT scan showing osteonecrosis of the lower jaw with an arrow pointing to a fracture. (cancer.gov)
There are approximately 10,000 to 20,000 new cases of osteonecrosis diagnosed each year in the United States, most of which occur as a result of some type of bone injury such as a fracture or dislocation. (yourlegalguide.com)
After adjustment, higher risk of fractures was associated with older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV-coinfection, prior osteonecrosis, prior fracture, recent non-AIDS cancer and recent cardiovascular disease (last 12 months) (Figure). (croiconference.org)
Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture and prior AIDS (Figure). (croiconference.org)
Osteonecrosis of the medial aspect of the talus (talus fracture 12 y ago). (ankleplatform.com)

Because of the serious nature of certain Fosamax side effects and the development of osteonecrosis of the jaw, Merck & Co. has already found itself the target of a number of personal injury lawsuits filed by people victimized by the bisphosphonate drug. (yourlegalguide.com)
As for the ONJ risk factors, Dr. Bilezikian states: 'Predisposing factors for the development of osteonecrosis of the jaw appear to be dental disease, dental surgery (e.g., tooth extraction), oral trauma, periodontitis, and poor dental hygiene. (drug-injury.com)

Osteonecrosis of the jaw Complications after a dental procedure that include swelling and pain, dry socket, osteomyelitis, bleeding, and osteonecrosis of the jaw comprise another set of urgent dental problems that require. (merckmanuals.com)

Dysbaric osteonecrosis lesions are typically bilateral and usually occur at both ends of the femur and at the proximal end of the humerus. (wikipedia.org)
Dysbaric osteonecrosis is a significant occupational hazard, occurring in 50% of commercial Japanese divers, 65% of Hawaiian diving fishermen and 16% of commercial and caisson divers in the UK. (wikipedia.org)
Dysbarism-related osteonecrosis: proceedings of a symposium on dysbaric osteonecrosis. (cdc.gov)
Clinical manifestations of DCS include (but are not limited to) joint pain ("bends"), lytic lesions of bones (dysbaric osteonecrosis), cutaneous disorders (cutis marmorata), spinal cord and brain disorders (stroke, paralysis, paresthesias, bladder dysfunction, etc.), and cardiopulmonary disorders (shortness of breath ["chokes"]), arterial gas embolism). (cdc.gov)

Osteonecrosis: etiology, diagnosis, and treatment. (slideserve.com)
Although the etiology of secondary osteonecrosis is unknown, several risk factors are associated with the disease. (medscape.com)

Advanced osteonecrosis can lead to osteoarthritis and permanent decreased mobility. (medlineplus.gov)
Osteonecrosis of the knee is commonly mistaken for osteochondritis dissecans, primary osteoarthritis, meniscal tears, bone bruises, transient osteopenia of the knee, and pes anserine bursitis. (medscape.com)

This is especially true of the hip joint, as osteonecrosis most commonly appears at the end of the femur (the long bone that extends from the knee to the hip joint). (dallasboneandjoint.com)

Ahlback et al first reported on osteonecrosis of the knee in 1968. (medscape.com)
The knee is the second most common site for osteonecrosis, but it is affected much less often than the hip. (medscape.com)
The true incidence of the disease is unknown, but osteonecrosis of the knee is believed to account for approximately 10% of cases of osteonecrosis. (medscape.com)
The exact cause of the osteonecrosis of the knee is unknown. (michaelswankmd.com)
Certain conditions and treatments that are associated with osteonecrosis of the knee are obesity, sickle cell anemia, lupus, kidney transplants, and steroid therapy. (michaelswankmd.com)
Osteonecrosis in the knee results in sudden onset of pain inside the knee that is activated with a specific activity or minor injury. (michaelswankmd.com)
Osteonecrosis may also cause swelling of the knee and sensitivity to touch and pressure, and can result in limited motion due to pain and swelling. (michaelswankmd.com)

Though many patients recover from COVID-19, clinicians should be aware of the potential complications, including osteonecrosis in the maxillofacial region, they can experience after recovery, the authors wrote. (drbicuspid.com)

Between January and August 2021, 12 patients prescribed corticosteroids as treatment for COVID-19 developed spontaneous maxillary osteonecrosis. (drbicuspid.com)

We present a case of non-surgically managed bilateral osteonecrosis of the external auditory canal with a history of long-term medical therapy for osteoporosis. (bmj.com)
We investigated awareness in dental hygienists of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with osteoporosis and cancer and assessed the situation in systemic history investigations to broaden the scope of the dental hygienists ' BRONJ awareness as a basis for contributing to preventing this disease . (bvsalud.org)

The jaws are particularly sensitive to osteonecrosis due to high bone turnover resulting from daily activity and the presence of teeth 1 . (medsafe.govt.nz)

The mechanism by which corticosteroids contribute to osteonecrosis also is unclear. (medscape.com)

Osteonecrosis of the mandible associated with bevacizumab therapy. (unicamp.br)

Unfortunately, patients who are affected with osteonecrosis are young, usually in the third to sixth decades of life. (medscape.com)
Prostheses with novel bearing surfaces (ie, metal-on-metal, ceramic-on-ceramic) are being investigated, to increase the success rate for total hip replacements in patients with osteonecrosis. (medscape.com)
The NCI-funded study, run by the SWOG Cancer Research Network, also found that poor dental health and smoking were risk factors for developing osteonecrosis of the jaw in these patients. (cancer.gov)
And patients can also play a role in reducing the risk of osteonecrosis of the jaw, Dr. Minasian said. (cancer.gov)
To assess the risk of osteonecrosis of the jaw in people with cancer, the SWOG study team, which included dental specialists as well as cancer researchers, enrolled 3,491 patients who were planning to receive zoledronic acid for metastatic bone cancer. (cancer.gov)
After 3 years, about 2.8% of patients (90 people) had confirmed osteonecrosis of the jaw, which was defined as having an area of exposed bone in the jaw that had been present for at least 8 weeks. (cancer.gov)
2011. Epidemiology and risk factors for osteonecrosis of the jaw in cancer patients. (medsafe.govt.nz)
A variant clinical picture, which may be present in patients with post-COVID-19-related osteonecrosis of the jaw. (drbicuspid.com)
5% of patients with SLE will develop osteonecrosis. (slideserve.com)
Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. (unicamp.br)
The risk of developing an osteonecrosis associated with the regeneration / implant placement in patients with benign bone diseases is scarce, but it exists and it should not be underestimated. (uv.es)
Apart from the inherent difficulty of the treatment of patients with biphosphonate-associated maxillomandibular osteonecrosis, its results are unpredictable. (bvsalud.org)
Besides age, patients with certain systemic conditions, including diabetes and anemia, are more prone to osteonecrosis. (strulloralsurgery.com)

Osteonecrosis can also occur without trauma or disease. (medlineplus.gov)

Osteonecrosis is now a commonly recognized disorder with significant morbidity. (medscape.com)
Osteonecrosis is a type of bone disease that is commonly associated with large joints like the hips, knees, ankles or shoulders. (yourlegalguide.com)

Many cases of osteonecrosis do not have a known cause, so prevention may not be possible. (medlineplus.gov)
This is one of the first studies to systematically evaluate dental health and the risk for developing osteonecrosis of the jaw with zoledronic acid," said Lori Minasian, M.D., deputy director of NCI's Division of Cancer Prevention , who helped facilitate the study but was not a study investigator. (cancer.gov)
With the increasing rate of COVID-19, the general dentists and oral and maxillofacial surgeons must be best prepared and positioned for the early identification and prevention of PC-RONJ (post-COVID-19-related osteonecrosis of the jaw) to avoid permanent deformity," wrote the authors, led by Yehia El-Mahallawy of Alexandria University in Egypt. (drbicuspid.com)

The following PICO clinical question was applied: Does the treatment with agents associated with drug osteonecrosis influence the success of regenerative and implant treatments? (uv.es)

Osteonecrosis in tunnel and caisson workers. (cdc.gov)

Oral infection is considered to play a critical role in the pathogenesis of bisphosphonate-related osteonecrosis of the jaw (BRONJ), and antibiotic therapy has become a mainstay of BRONJ therapy. (nih.gov)
The pathogenesis of osteonecrosis. (cdc.gov)

The risk of zoledronic acid causing osteonecrosis of the jaw in people with cancer in their bones, the study found, is about 1% after a year of being on the drug, 2% after 2 years, and 3% after 3 years. (cancer.gov)
Osteonecrosis is a disease caused by reduced blood flow to bones in the joints. (howmed.net)
You can have osteonecrosis in one or several bones. (howmed.net)

Necrotising otitis externa, cholesteatoma and malignancy were considered but with histology, microbiological and CT assessment, bilateral osteonecrosis of the external auditory canal was diagnosed. (bmj.com)

When osteonecrosis occurs in the shoulder joint, it is usually due to long-term treatment with steroids, a history of trauma to the shoulder, or the person has sickle cell disease or any abnormal blood clotting conditions. (medlineplus.gov)

Each year between 10,000 and 20,000 men and women develop osteonecrosis. (dallasboneandjoint.com)

How can doctors tell if I have osteonecrosis? (msdmanuals.com)
Doctors may suspect osteonecrosis if you broke a bone but keep having pain after the bone should have healed. (msdmanuals.com)
How do doctors treat osteonecrosis? (msdmanuals.com)
Doctors use imaging tests and other tests to diagnose osteonecrosis. (howmed.net)

The study results, published December 17 in JAMA Oncology , also showed that people who received the same dose of zoledronic acid more frequently had a greater risk of developing osteonecrosis of the jaw. (cancer.gov)
A new study provides new evidence linking the bone drug Fosamax to an increased risk of jaw bone death, involving a rare condition known as osteonecrosis of the jaw. (aboutlawsuits.com)
Fosamax users run the risk of developing a serious case of osteonecrosis of the jaw and suffering through the extreme pain associated with the death of jawbone tissue. (yourlegalguide.com)
Persons who had ever used didanosine, indinavir, saquinavir, lopinavir/r, or TDF had higher risk of osteonecrosis, but this association was no longer observed in models adjusted for confounders (not shown). (croiconference.org)
In HIV infection, host factors, HIV-specific variables and co-morbidities contribute to risk of fractures and osteonecrosis. (croiconference.org)
There was no association between the use of any of the ARVs and risk of osteonecrosis. (croiconference.org)
2-4 An increased risk of developing osteonecrosis is associated with intravenous administration or when treatment is sustained over 3-5 years. (bmj.com)

In osteonecrosis, the lesion can extend to the subchondral plate and result in collapse of the necrotic segment. (medscape.com)

If a case of osteonecrosis of the jaw goes undetected or untreated, it can potentially lead to the death of bone tissue and irreversible joint collapse within the jaw. (yourlegalguide.com)
Osteonecrosis is the death of bone cells. (msdmanuals.com)

If your provider knows the cause of your osteonecrosis, part of the treatment will be aimed at the underlying condition. (medlineplus.gov)
Nonsurgical treatment can often slow the progression of osteonecrosis, but most people will need surgery. (medlineplus.gov)
There is no specific treatment for osteonecrosis. (msdmanuals.com)
It will also help you better understand what to expect when osteonecrosis has an impact on your joints and requires medical treatment. (dallasboneandjoint.com)
For people diagnosed with osteonecrosis, treatment and medical management of the disease may continue throughout their lifetime. (dallasboneandjoint.com)
Osteonecrosis of the Jaw (ONJ) can be managed effectively with proper treatment. (strulloralsurgery.com)

These are believed to be the first reported cases of jaw osteonecrosis following SARS-CoV-2 infection. (drbicuspid.com)
95%CI 6.6-7.7) and 89 incident cases of osteonecrosis (1.0;0.8-1.3). (croiconference.org)
In recent years, the number of cases of drug-related osteonecrosis of the jaw has steadily increased due to the introduction of new immunological drugs. (oraljournal.com)

Also called osteonecrosis, it can lead to tiny breaks in the bone and cause the bone to collapse. (mayoclinic.org)

Following various periods of COVID-19 disease and its management, each patient showed a mutual clinical picture and spontaneous, unprovoked maxillary osteonecrosis. (drbicuspid.com)

Osteonecrosis is bone death caused by poor blood supply. (medlineplus.gov)

Osteonecrosis (ON), a debilitating disease frequently involving multiple joints, has been recognised in recent years as a severe complication of acute lymphocytic leukaemia (ALL) therapy in adolescents and young adults. (annals.edu.sg)
Steroid-induced osteonecrosis affects multiple joints and can be seen in younger patient groups. (michaelswankmd.com)

If osteonecrosis is not treated, the joint deteriorates, leading to severe arthritis. (medlineplus.gov)
1 Orthopaedic surgeons have found that in as many as ten percent of all people requiring hip replacement, osteonecrosis has led to their joint damage. (dallasboneandjoint.com)

Osteonecrosis occurs when part of the bone does not get blood flow and dies. (medlineplus.gov)
Osteonecrosis is a condition in which death of a section of bone occurs because of lack of blood supply to it. (michaelswankmd.com)

Anatomy13

Organisms1

Diseases13

Chemicals and Drugs10

Analytical, Diagnostic and Therapeutic Techniques and Equipment21

Psychiatry and Psychology1

Phenomena and Processes5

Health Care4

Necrosis9

Femoral12

Bisphosphonates16

Medication-related osteonecrosis of7

Bisphosphonate-Associated Osteonecrosis of3

Develop osteonecrosis of2

Spontaneous osteonecrosis6

Symptoms8

Contribute to developing os1

Early stages of osteonecrosis1

Fracture6

Development of osteonecrosis2

Osteomyelitis1

Dysbaric osteonecrosis4

Etiology2

Osteoarthritis2

Femur1

Knee7

Complications1

20211

Osteoporosis2

Jaws1

Corticosteroids1

Mandible1

Patients13

Occur1

Commonly2

Prevention3

Treatments1

Caisson1

Pathogenesis2

Bones3

Bilateral1

Sickle1

20,0001

Doctors4

Risk7

Lesion1

Death of bone2

Treatment6

Cases3

Collapse1

Clinical1

Bone death1

Multiple joints2

Joint2

Occurs2