Osteonecrosis: A More Appropriate Term than Avascular Necrosis–Pathophysiologic Rationale

Background: Nontraumatic osteonecrosis has historically been attributed to vascular insufficiency, leading to oxygen and nutrient deprivation and subsequent bone death. However, terminology used to describe this condition remains inconsistent and often fails to capture its complex pathogenesis. Terms such as “avascular necrosis” and “ischemic necrosis” may inappropriately emphasize vascular mechanisms, potentially limiting diagnostic and therapeutic approaches. Methods: We performed a comprehensive review of the literature to examine the evolution of terminology for nontraumatic osteonecrosis and to evaluate the breadth of underlying pathophysiologic mechanisms. Particular attention was given to the clinical and conceptual implications of commonly used terms. Results: Evidence indicates that disrupted bone homeostasis represents the final common pathway in the development of nontraumatic osteonecrosis, which may result from vascular or vascular-independent mechanisms. Continued use of terms that focus solely on vascular insufficiency may bias clinical management toward revascularization strategies, overlooking other contributory factors. Conclusions: The term “osteonecrosis” more accurately reflects the multifactorial nature of this condition. Broader adoption of this terminology may foster a more comprehensive understanding of disease mechanisms and stimulate the development of innovative, multimodal treatment strategies.