Idiopathic osteonecrosis, hypofibrinolysis, high plasminogen activator inhibitor, high lipoprotein(a), and therapy with Stanozolol.

Am J Hematol. 1995 Apr;48(4):213-20.

Idiopathic osteonecrosis, hypofibrinolysis, high plasminogen activator inhibitor,
high lipoprotein(a), and therapy with Stanozolol.

Glueck CJ, Freiberg R, Glueck HI, Tracy T, Stroop D, Wang Y.

Cholesterol Center Jewish Hospital, Cincinnati, OH 45229, USA.

In five patients with idiopathic osteonecrosis (ON) of the hip, four having
hypofibrinolysis mediated by high plasminogen activator inhibitor (PAI-Fx), and
one with high Lp(a), our specific aim was to determine whether therapy (Rx) with
the anabolic-androgenic steroid, Stanozolol (6 mg/day), would normalize PAI-Fx
and Lp(a) and thus potentially ameliorate ON. Prior to Rx, none of the four
patients with high PAI-Fx could normally elevate tissue plasminogen activator
(tPA-Fx) after 10 min venous occlusion at 100 mm Hg. After 12-18 weeks on Rx,
PAI-Fx and stimulated tPA-Fx normalized in all four patients. Prior to Rx, mean
(SD) stimulated tPA-Fx was low, 0.4 +/- 0.3 IU/ml (lower limit of normal 2.28
IU/ml). On Rx, stimulated tPA-Fx normalized, rising to 2.83 +/- 1.9 IU/ml, P =
.004. Prior to Rx, mean (SD) basal PAI-Fx was high, 99 +/- 68 (upper limit of
normal 26.9 U/ml), and fell on Rx to 22.5 +/- 22, P = .004. In two of the five
patients normalization of hypofibrinolysis or high Lp(a) was accompanied by major
symptomatic improvement. Prior to Rx, and 2 years after onset of unilateral hip
pain, one of the four patients with high PAI-Fx and low stimulated tPA-Fx could
walk only one block painfully. After 8 weeks on Stanozolol Rx, and continuing
through 54 weeks on Rx, he walked 2 miles per day without pain, despite
radiographic progression of ON. In three of the four patients with high PAI and
with osteonecrosis present 0.3, 2, and 6 years prior to Stanozolol Rx, there was
no clinical improvement after 14-156 weeks of Rx despite normalization of
stimulated tPA-Fx and PAI-Fx. The fifth patient, 1 month after onset of disabling
hip pain, had normal PAI-Fx but high Lp(a) (27 mg/dl), and MRI evidence of bone
marrow edema ("transient osteoporosis").(ABSTRACT TRUNCATED AT 250 WORDS)