A rare cause of osteonecrosis

  • Paolo Agostinis | paolo.agostinis@ass3.sanita.fvg.it UO Medicina Interna, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.
  • Maurizio Vergendo UO Radiologia, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.
  • Nicola Bizzaro Laboratorio di Patologia Clinica, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.
  • Claudio Avellini Istituto di Anatomia Patologica, Azienda Ospedaliero-Universitaria di Udine, Italy.
  • Nadia Durigon UO Medicina Interna, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.
  • Paola Bardus UO Medicina Interna, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.
  • Alfio Englaro UO Medicina Interna, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.
  • Cristina Quaglio UO Medicina Interna, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.
  • Vito Di Piazza UO Medicina Interna, Ospedale Sant’Antonio Abate, Tolmezzo (UD), Italy.



Hereditary hemochromatosis (HH) is an autosomal recessive disorder caused by mutations in the HFE gene, which increase intestinal iron absorption. The prevalence of C282Y homozygosity, which causes the disorder, is 0.5% in Caucasian populations. The clinical manifestations are related to excess iron in the tissues, especially the liver, heart, pancreas, pituitary, and skin. They include fatigue, loss of libido or impotence in males, liver disease, skin pigmentation, diabetes mellitus, cardiac enlargement—with or without heart failure, and conduction defects. The classic triad of cirrhosis, diabetes mellitus, and skin pigmentation (“bronze diabetes”) results from a combination of iron deposits and melanin. It occurs late in the disease, when the total body iron content is more than five times the normal value, about 20 grams. Left untreated, approximately half of all patients with HH eventually develop arthralgia or arthropathy. Chondrocalcinosis, chronic pseudo-osteoarthritis, and osteoporosis are the major rheumatic manifestations of HH. The cause of the arthropathy is still unknown. Iron deposits within joints may trigger a number of pathologic events, such as free radical generation and crystal deposition, which stimulate immune complex formation and inflammation.

Materials and methods

We describe the case of a 48-year-old male suffering from chronic bilateral ankle pain.


The work-up revealed osteonecrosis of ankle. The patient also presented high plasma ferritin levels and homozygosity for the C282Y mutation. Other than HH, which was confirmed by liver biopsy, the patient had no other risk factors for osteonecrosis.


HH represents a rare cause of osteonecrosis, and there are no prior reports of aseptic osteonecrosis of the ankle in a patient with this disease. The pathogenetic mechanism remains unknown.


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Case Reports
Hereditary hemochromatosis, Arthropathy, Osteonecrosis
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How to Cite
Agostinis, P., Vergendo, M., Bizzaro, N., Avellini, C., Durigon, N., Bardus, P., Englaro, A., Quaglio, C., & Di Piazza, V. (2012). A rare cause of osteonecrosis. Italian Journal of Medicine, 6(1), 52-56. https://doi.org/10.4081/itjm.2012.52