Femoral Head Osteonecrosis is associated with thrombosis, fatty acid and cholesterol biosynthesis: A potential role for anti-thrombotics and statins as disease modifying agents

Femoral Head Osteonecrosis (FHO) is a progressive, debilitating disease that affects the middle-aged population. Though the disease is managed using bisphosphonates or surgical procedures like core decompression, arthroplasty, osteochondral transplantation, it eventually leads to total hip replacement. Previous studies have shown an association of genetic, lifestyle, and environmental factors in FHO. Many risk factors result in elevated levels of homocysteine, coagulation, fat embolism, increased osteoclastogenesis as well as decreased osteoblastogenesis and its function. Transcriptomics, proteomics, and metabolomic as well as integrated systems analysis has helped to elucidate the molecular signatures associated with the disease, potential biomarkers, and therapeutic targets in the disease. Elevated homocysteine leads to increased biosynthesis of lipids and cholesterol which are associated with the disease. Herein we show that transcriptomic analysis of GEO datasets of cartilage from the GEO database shows platelet aggregation, adipogenesis, and cholesterol biosynthesis. Based on analysis of our data and those published in the literature, we propose that anti-thrombotic agents and statins concomitant with vitamin B6, B12, and Folate might help in the better management of FHO.