Decreased serum 4-Hydroxynonenal level as a biomarker for the progression of steroid-induced osteonecrosis of the femoral head

Abstract Background: 4-hydroxynonenal (4-HNE) is a common marker of oxidative stress. this study aim to study the potential role of 4-HNE in the progression of steroid-induced osteonecrosis of the femoral head (SIONFH). Method: Between April 2021 and December 2021, 64 subjects were enrolled in this cross-sectional case-control study. 36 patients were grouped based on the Association Research Circulation Osseous (ARCO) classification. Bone HE staining, micro-ct, immunohistochemistry, and level of plasma 4-HNE were evaluated. Immunohistochemistry presented that 4-HNE was detected in the trabecular bone, osteocytes, and bone marrow. Results: Plasma 4-HNE levels were significantly higher in SIONFH patients in the early stage of disease stages (Stage II) , and the 4-HNE level was higher in the SIONFH group than those in the normal control group (P<0.001). The 4-HNE level was negatively associated with ARCO stages (r =- 0.6875, P<0.001). Conclusion:The level of 4-HNE is negatively associated with ARCO stages. The reduced 4-HNE may be a critical biomarker of the progression of SIONFH.