Work

Senescence-driven osteonecrosis of the femoral head in the elderly—a distinct pathophysiological entity

Year: 2025

Type: article

Abstract: This article conceptualizes "Senescence-Driven Osteonecrosis of the Femoral Head" in elderly patients as a distinct pathophysiological entity, differing from classic osteonecrosis of the femoral head (ONFH) by its primary age-related etiological factors. It hypothesizes that this condition arises from a convergence of vascular fragility, impaired bone mechanoadaptation, and systemic inflammaging. Epidemiological patterns reveal under-recognition and diagnostic delays, with presentations often mimicking osteoarthritis. The manuscript examines endothelial cell senescence, microvascular dysfunction, increased bone marrow adiposity-reducing perfusion and osteogenic capacity-and chronic inflammation in the aging femoral head. Emerging omics and biomechanical evidence, including subchondral insufficiency fractures, highlight molecular and structural differences contributing to collapse. Conventional joint-preserving treatments often fail in older individuals, prompting exploration of novel therapies like senolytics, vasculoprotective agents, and early mechanical support. This work advocates for a new framework integrating geriatric comorbidities and senescence biology for tailored diagnosis, prevention, and treatment of this debilitating condition.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2025.1653037

Authors: Tong-jie Yang, Tian-xin Chen, Yu Zhang, Ye Luo, Peng-peng Wen

Institutions: Wangjing Hospital of China Academy of Chinese Medical Sciences, China Academy of Chinese Medical Sciences, Xiamen University, Zhongshan Hospital of Xiamen University, First Affiliated Hospital of Wenzhou Medical University

Language: English

Topic: Bone and Joint Diseases

Subfield: Orthopedics and Sports Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801