Ozan Beytemur1, Mustafa Fatih Dasci1, Asiye Gök Yurttaş2, Busra Yaprak Bayrak3, Ender Alagöz1

1Department of Orthopedics and Traumatology, University of Health Science, Bağcılar Training and Research Hospital, Istanbul, Türkiye
2Department of Biochemistry, Istanbul Health and Technology University Faculty of Pharmacy, Istanbul, Türkiye
3Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye

Keywords: Lipopolysaccharide, methylprednisolone, osteonecrosis of femoral head, vitamin C, vitamin E.


Objectives: This study aimed to determine whether vitamin C (VC) and vitamin E (VE) can effectively protect the femoral head and reduce the risk of developing osteonecrosis in rats that have been treated with steroids.

Materials and methods: The study was conducted on 30 young adult male Sprague-Dawley rats (mean weight: 356±18 g; range, 330 to 375 g), which were randomly assigned to one of five groups. The control group received saline solution, while the other groups were given lipopolysaccharide/methylprednisolone (LPS/MPS) to induce osteonecrosis. Three groups in which osteonecrosis was induced were also intraperitoneally administered either VC, VE, or both once a day for four weeks. Intracardiac blood samples were taken at the end of the fourth week for biochemical examination, and the rats were then sacrificed under general anesthesia. After sacrification, right femurs were removed for histopathological, immunohistochemical, and radiologic examinations.

Results: The results showed that the mean trabecular number increased significantly in the VC+VE group. There was a substantial decrease observed in the mean trabecular separation within the LPS/MPS group compared to the control group, although trabecular separation decreased in all three vitamin groups compared to the LPS/MPS group. The surface area/bone volume was significantly increased in the VC+VE group compared to the LPS/MPS group. Histological, immunohistochemical, and radiological examinations showed that the administration of VC and VE significantly reduced oxidative stress, inflammation, and microvascular dysfunction in rats with steroid-induced femoral head osteonecrosis.

Conclusion: This study suggests that VC, VE, and particularly VC+VE have a protective effect on the femoral head in rats with steroid-induced femoral head osteonecrosis. These findings may lead to new treatment options for patients.

Citation: Beytemur O, Dasci MF, Gök Yurttaş A, Yaprak Bayrak B, Alagöz E. The protective role of vitamins C and E in steroidinduced femoral head osteonecrosis: An experimental study in rats. Jt Dis Relat Surg 2024;35(1):72-84. doi: 10.52312/jdrs.2023.1405.

Ethics Committee Approval

The study protocol was approved by the Istanbul Bağcılar Training and Research Hospital Animal Experiments Local Ethics Committee (date: 31.07.2018, no: 2018-90). All animal experiments were conducted in compliance with the “Guide for the Care and Use of Laboratory Animals” published by the US National Institutes of Health (revised, 1985).

Author Contributions

Writing, editing, analysis: O.B.; Writing, data collection, statistics, proofreading: M.F.D.; Data collection, analysis, proofreading: A.G.Y.; Data collection, proofreading, editing: B.Y.B.; Supervision, proofreading, editing: E.A.; All authors contributed to the study conception and design. All authors read and approved the final manuscript.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.


We would like to thank the Istanbul Bağcılar Experimental Research and Skill Development Center for their kind contributions and support. We also appreciate the assistance of Göker Külüslü from the Istanbul Technical University Biomedical Engineering Department for his help during the micro-CT scan analyses.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.