ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2026-2-173-183ssmu-6546Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESРоль дислипидемии и ожирения в патогенезе асептического некроза головки бедренной костиThe role of dyslipidemia and obesity in the pathogenesis of osteonecrosis of the femoral headhttps://orcid.org/0000-0003-2010-3296ПорядинГ. В.PoryadinG. V.

Порядин Геннадий Васильевич – д-р мед. наук, профессор, член-корр. РАН, профессор кафедры патофизиологии и клинической патофизиологии

Россия, 117997, г. Москва, ул. Островитянова, 1 

1 Ostrovityanov St., 117997 Moscow, Russian Federation 

poryadin_gv@rsmu.ruhttps://orcid.org/0000-0003-1433-0337ЗахватовА. Н.ZakhvatovA. N.

Захватов Алексей Николаевич – д-р мед. наук, профессор кафедры общей хирургии им. Н.И. Атясова

Россия, 430005, г. Саранск, ул. Большевистская, 68

68 Bolshevistskaya St., 430005 Saransk, Russian Federation

zachvatan78@mail.ruhttps://orcid.org/0000-0002-6399-3703ЯснецовВ. В.YasnetsovV. V.

Яснецов Виктор Владимирович – д-р мед. наук, вед. науч. сотрудник, зав. лабораторией экспериментальной и клинической фармакологии,  зам. заведующего отделом космической  радиобиологии и фармакологии

Россия, 123007, г. Москва, Хорошёвское шоссе, 76а 

76a Khoroshyovskoe Highway, 123007 Moscow, Russian Federation

vicyas@yandex.ruhttps://orcid.org/0000-0001-6831-3116МосинаЛ. М.MosinaL. M.

Мосина Лариса Михайловна – д-р мед. наук, профессор кафедры госпитальной терапии 

Россия, 430005, г. Саранск, ул. Большевистская, 68 

68 Bolshevistskaya St., 430005 Saransk, Russian Federation

larisamosina97@yandex.ruhttps://orcid.org/0000-0002-8519-3408ХайдарД. А.KhaydarD. A.

Хайдар Далила Али – ассистент, кафедра общей и клинической стоматологи

Россия, 117198, г. Москва, ул. Миклухо-Маклая, 6 

6 Miklouho-Maclay St., 117198 Moscow, Russian Federation

dhaidarA@mail.ruhttps://orcid.org/0000-0001-7132-4887ЗахаркинИ. А.ZakharkinI. A.

Захаркин Илья Александрович – ст. преподаватель, кафедра стоматологии

Россия, 430005, г. Саранск, ул. Большевистская, 68 

68 Bolshevistskaya St., 430005 Saransk, Russian Federation

zakharkinas@mail.ruhttps://orcid.org/0000-0001-9745-9739ТарасоваТ. В.TarasovaT. V.

Тарасова Татьяна Викторовна – д-р биол. наук, профессор кафедры психологии

Россия, 430005, г. Саранск, ул. Большевистская, 68 

68 Bolshevistskaya St., 430005 Saransk, Russian Federation

9023060@mail.ruhttps://orcid.org/0009-0007-5151-123XШаевА. А.ShaevA. A.

Шаев Алексей Александрович 

Россия, 430005, г. Саранск, ул. Большевистская, 68 

68 Bolshevistskaya St., 430005 Saransk, Russian Federation

schaev.leha2017@yandex.ruРоссийский национальный исследовательский медицинский университет (РНИМУ) им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationНациональный исследовательский Мордовский государственный университет (МГУ) им. Н.П. ОгарёваРоссияNational Research Ogarev Mordovia State UniversityRussian FederationГосударственный научный центр РФ «Институт медико-биологических проблем Российской академии наук» (ГНЦ РФ – ИМБП РАН)РоссияInstitute of Biomedical Problems of the Russian Academy of SciencesRussian FederationРоссийский университет дружбы народов (РУДН) им. П. ЛумумбыРоссияRUDN UniversityRussian Federation202623072026252173183Copyright © Порядин Г.В., Захватов А.Н., Яснецов В.В., Мосина Л.М., Хайдар Д.А., Захаркин И.А., Тарасова Т.В., Шаев А.А., 20262026Порядин Г.В., Захватов А.Н., Яснецов В.В., Мосина Л.М., Хайдар Д.А., Захаркин И.А., Тарасова Т.В., Шаев А.А.Poryadin G.V., Zakhvatov A.N., Yasnetsov V.V., Mosina L.M., Khaydar D.A., Zakharkin I.A., Tarasova T.V., Shaev A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/6546

Представлен обзор современных данных о роли ожирения, индуцированного им хронического системного воспаления и нарушений липидного обмена в патогенезе асептического некроза головки бедренной кости (АНГБК) для обоснования новых подходов к профилактике и лечению. Проведен анализ современных фундаментальных и клинических исследований, посвященных взаимосвязи метаболических нарушений, хронического воспаления и остеонекроза. Рассмотрены работы, изучающие молекулярные механизмы дисфункции жировой ткани, липотоксичности, окислительного стресса и их влияния на гомеостаз костной ткани.Установлено, что ожирение выступает системным фактором риска развития АНГБК, действуя не только как источник механической нагрузки, но и как инициатор патогенетического каскада. Дисфункциональное состояние жировой ткани приводит к развитию хронического вялотекущего системного воспаления и окислительного стресса. В совокупности эти факторы провоцируют развитие эндотелиальной дисфункции, ухудшают перфузию костной ткани головки бедренной кости и вызывают явления липотоксичности в костном мозге. Следствием этого на локальном уровне становится угнетение остеогенеза, одновременное усиление резорбции кости и апоптоз остеоцитов.Инициируемые ожирением системные метаболические и воспалительные сбои формируют основу для нарушения костного ремоделирования, ишемии и некроза субхондральной кости головки бедренной кости. Следовательно, коррекция массы тела и сопутствующих метаболических расстройств должна рассматриваться как неотъемлемая часть комплексной стратегии лечения и вторичной профилактики прогрессирования АНГБК. Такой подход может улучшить результаты органосохраняющих вмешательств и отсрочить необходимость эндопротезирования у молодых пациентов.

The review focuses on current concepts of the role of obesity, the chronic systemic inflammation it induces, and lipid metabolism disorders in the pathogenesis of osteonecrosis of the femoral head (ONFH) in order to substantiate new approaches to its prevention and treatment. This review analyzes modern fundamental and clinical studies focusing on the relationship between metabolic disorders, chronic inflammation, and osteonecrosis. Specifically, we examine research investigating the molecular mechanisms of adipose tissue dysfunction, lipotoxicity, oxidative stress, and their impact on bone tissue homeostasis.The analysis established that obesity acts as a systemic risk factor for ONFH development, functioning not merely as a source of mechanical load but also as an initiator of a pathogenic cascade. Dysfunctional adipose tissue leads to chronic low-grade systemic inflammation and oxidative stress. Together, these factors provoke endothelial dysfunction, impair perfusion of the femoral head bone tissue, and induce lipotoxicity in the bone marrow. Consequently, at the local level, this cascade suppresses osteogenesis, simultaneously enhances bone resorption, and triggers osteocyte apoptosis.Systemic metabolic and inflammatory disruptions initiated by obesity underlie impaired bone remodeling, ischemia, and necrosis of the femoral head subchondral bone. Therefore, the correction of body weight and associated metabolic disorders should be considered an integral part of a comprehensive strategy for treating ONFH and preventing its progression. This integrated approach may improve the outcomes of joint-preserving interventions and delay the need for total hip arthroplasty in young patients.

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The authors declare that there are no conflicts of interest present.