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Rheumatology Advance Access originally published online on January 25, 2006
Rheumatology 2006 45(7):855-858; doi:10.1093/rheumatology/kel013
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Risk factors for dysbaric osteonecrosis

K. Miyanishi, Y. Kamo, H. Ihara, T. Naka, M. Hirakawa and Y. Sugioka

Department of Orthopaedic Surgery, Kyushu Rosai Hospital, Kitakyushu, Japan.

Correspondence to: Keita Miyanishi, MD, PhD, Department of Orthopaedic Surgery, Kyushu Rosai Hospital, 1–3–1, Kuzuharatakamatsu, Kokuraminami-ku, Kitakyushu, 800-0296 Japan. E-mail: keitamiya{at}jcom.home.ne.jp

Objectives. Dysbaric osteonecrosis (DON) is a complication of ineffective decompression following exposure to high-pressure environments. This study was designed to determine risk factors for the occurrence of DON in divers.

Methods. Fifty-six male divers received skeletal examinations by radiography to assess the occurrence of DON. A questionnaire was used to obtain clinical and diving information, including diving experience and maximum diving depth. Blood samples were collected to analyse the levels of plasminogen activator inhibitor (PAI)-1, cholesterol, triglyceride, low-density lipoprotein, very low-density lipoprotein, high-density lipoprotein, apolipoprotein A1 and apolipoprotein B.

Results. Lesions of DON were detected in 31 of the 56 (55%) divers. Multivariate logistic regression analysis showed that high levels of PAI-1, a coagulation marker (odds ratio 4.281; P=0.0296) and great maximum diving depth (odds ratio 5.627; P=0.0231) were independent predictors of DON.

Conclusions. This study has shown the presence of coagulation abnormality in divers with DON. This result suggests that a pharmacological approach incorporating the use of an anticoagulant may represent a potential strategy for the prevention of DON.

KEY WORDS: Dysbaric osteonecrosis, Plasminogen activator inhibitor, Coagulation


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