The epidemiology of femoral head osteonecrosis in Bangladesh: a population-based study of etiological prevalence and risk factors

Abstract

Background: Femoral head osteonecrosis (FHO) is a debilitating condition leading to progressive hip joint destruction. Epidemiological data in Bangladesh are limited. This study aimed to describe the demographic profile, etiology, sex distribution, affected side, and residence patterns among patients with FHO.

Methods: A cross-sectional study was conducted on 122 patients diagnosed with FHO. Data were collected on age, sex, occupation, residence, etiology, and affected side. Descriptive statistics were used for frequency and percentage distributions. Associations between categorical variables, including sex and residence with etiology, were analyzed using Fisher’s exact test.

Results: The study population comprised 72 males (59%) and 50 females (41%). The most affected age group was 18–29 years (42.6%). Rural patients accounted for 65.6% of the cohort. Idiopathic FHO was the predominant etiology (41%), followed by steroid-induced cases (27.9%) and trauma (13.1%). Ankylosing spondylitis, alcohol intake, sequelae of Perthes disease, and thalassemia were less common. Right hip involvement occurred in 44.3% of patients, left in 18%, and bilateral in 37.7%. Sex distribution showed idiopathic FHO was more frequent in males (41.7%), while steroid-induced cases were higher in females (44%), with a statistically significant association (p < 0.001). Residence did not show a significant association with etiology (p = 0.288).

Conclusions: Idiopathic and steroid-induced osteonecrosis are the leading causes of FHO in Bangladesh, with males more frequently affected and a high proportion of rural cases. The findings highlight the need for targeted awareness, early diagnosis, and management strategies, particularly in young adults and rural populations.