skip to main content

Glucocorticoid-Induced AVN — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateClinical PharmacologyGlucocorticoid-Induced AVNRACP Adult Medicine

A 45-year-old man on long-term prednisolone 20 mg daily for autoimmune hepatitis develops avascular necrosis of the femoral head. He has hip pain and reduced mobility. MRI shows bilateral femoral head changes. What is the most important risk factor for glucocorticoid-induced AVN?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Age >50 years

Glucocorticoid-induced avascular necrosis (osteonecrosis) is dose-dependent, with risk increasing significantly at prednisolone doses >20 mg/day. Total cumulative dose and peak dose are more important than duration alone. It most commonly affects the femoral head bilaterally. MRI is the most sensitive imaging modality. Management includes orthopaedic referral, analgesics, protected weight-bearing, and consideration of core decompression or joint replacement depending on stage.

Reference: eTG – 2025 – Rheumatology; AMH – 2025 – Corticosteroid Adverse Effects