Why More Young Adults Are Getting Diagnosed with AVN

A Quiet Crisis Amongst the Young

Raj was only 32 when a dull ache in his hip started keeping him awake at night. A software engineer and a new father, he shrugged it off as the price of working long hours on his laptop. But within a few months, the pain grew sharper no longer limited to late nights, it haunted him during daily walks in the park with his toddler. X-rays first showed nothing unusual. It was only after a specialized MRI that he received a diagnosis that didn’t seem to fit someone his age: avascular necrosis (AVN) of the femoral head.

AVN, also known as osteonecrosis, is the painful death of bone tissue due to a loss of blood supply. Traditionally seen in older adults or those with major trauma, doctors worldwide are now documenting a worrying surge in AVN among young adults in their 20s and 30s a demographic once thought largely immune to this disease.

The Numbers Tell a New Story

Recent hospital data underscores this trend. Hospitals that once saw just a handful of AVN cases in young adults each year are now treating several such patients every single month. For example, in one orthopedic center, over 21% of hip replacement surgeries for AVN in the first quarter of 2024 were done on patients under 40 an unprecedented proportion in recent history.

This rise is alarming because AVN, if not caught early, can lead to permanent disability often resulting in the need for a total joint replacement and an altered quality of life, years if not decades before such surgeries used to be necessary.

Unpacking the Causes: Why Is AVN Rising in the Young?

The sudden surge in AVN cases among the young cannot be traced to a single cause, but several converging factors have come into play:

• Post-COVID Phenomenon: Pandemics often leave unforeseen footprints. After COVID-19, many young adults treated with high-dose corticosteroids (a common protocol for severe infection) began appearing in clinics with unexplained hip pain later found to be AVN. Some studies report a tenfold jump in AVN diagnoses in young adults post-pandemic. This may be related both to direct effects of the virus (blood clotting abnormalities) and the medications used in treatment.

• Steroid Use: Even outside of COVID-19, chronic use of corticosteroids for conditions like asthma or autoimmune disorders has been strongly linked to AVN. Steroids can inadvertently decrease blood supply to bones, setting off the disease process.

• Alcohol Abuse: Young adults who regularly consume large amounts of alcohol are at increased risk. Alcohol leads to fatty blockages in blood vessels, starving bones of oxygen and nutrients.

• Unrecognized Trauma: Sports injuries, falls, or even repetitive micro-trauma from high-impact workouts (popular among the fitness-conscious youth), can damage small blood vessels in the hip, sometimes without any outward sign until the bone starts to die.

• Chronic Illnesses and Medical Conditions: Diseases like sickle cell anemia, lupus, HIV, and certain blood disorders some of which have become more common or better recognized in the young can all disrupt blood flow to the hip.

Hidden Suffering, Delayed Diagnosis

What makes AVN especially insidious is its stealthy early course. The initial symptoms are vague: mild joint aches, stiffness, or discomfort easily dismissed as “overexertion” or “bad posture.” By the time pain becomes severe or movement is restricted, the disease is often in advanced stages.

This diagnostic delay is compounded by the relative rarity of the condition in the young in previous decades few think to suspect AVN in active, otherwise healthy patients in their 20s or 30s. As a result, a simple MRI can reveal a problem that’s already significantly progressed, leaving limited options aside from surgical intervention.

Human Stories, Human Costs

Behind the statistics are lives deeply altered. Raj, an avid trekker, faced the devastating choice of an early hip replacement a surgery his grandfather underwent, but never one he expected at 32. Young athletes suddenly sidelined, enthusiastic parents learning to cope with chronic pain all are grappling with a diagnosis few have even heard of.

Hope and the Road Ahead

The rise in AVN among young adults is a wake-up call. Early recognition and prevention are crucial. Here’s what experts recommend:

• Seek Help Early: Don’t ignore persistent joint pain, especially after COVID, steroid use, or significant injuries.

• Limit Steroids and Alcohol: Use steroids only when absolutely necessary, and under medical supervision. Moderating alcohol can meaningfully reduce your risk.

• Protect Joints: Use protective gear for sports, and avoid repetitive, excessive strain on the hips.

• Stay Informed: If you have a condition like sickle cell anemia, lupus, or are taking immunosuppressive drugs, ask your doctor about your AVN risk.

For those diagnosed early, new treatments may delay or avoid the need for replacement for some, even helping the body heal itself with lifestyle modification and minimally invasive therapies.

AVN doesn’t have to spell the end of an active life, but recognizing and destigmatizing this “older person’s disease” in the young is the first, crucial step. With widespread awareness, timely medical intervention, and a bit of courage, many young adults can hope not just for relief but for a full, active future ahead.