Genetic Polymorphism for Steroid-induced Osteonecrosis of the Femoral Head: A Meta-analysis

OBJECTIVE To investigate whether polymorphisms in target genes were associated with the risk of steroid-induced osteonecrosis of the femoral head(SONFH) through a meta-analysis. METHODS Searched for eligible published literature from data base like PubMed, Embase, The Cochrane Library, Clinical Trial, CBM, Wanfang Data, Vip Data and CNKI and calculated pooled odds ratio(OR) and 95% confidence interval(CI) using a fixed- or random-effects model. RESULTS Thirty-seven articles with 41 genes described the relationship between polymorphisms and SONFH were found. Meta-analyses were carried out for those SNPs with three or more eligible studies, which included four SNPs located in three genes (PAI-1, MTHFR, ABCB1). The meta-analysis revealed that the risk of SONFH increased in PAI-1 5G allele carriers after using steroid but with no statistical differenceOR=0.95, 95%CI(0.54, 1.67), P=0.85. Statistical differenceOR=0.69, 95%CI(0.50, 0.95), P=0.02 were observed between wild type and mutant type of MTHFR. The risk of SONFH in MTHFR 677T carriers is higher. The risk of SONFH also increased higher in ABCB1 3435C carriers with significant statistical differenceOR=1.40, 95%CI(1.11,1.76), P=0.005, while the polymorphisms of ABCB1 G2677T/A were not associated with the obvious risk of SONFHOR=1.32, 95%CI(0.76, 2.28), P=0.32. CONCLUSION The MTHFR C677T and ABCB1 C3435T polymorphisms may be significant risk factors for SONFH.