Who is at risk for necrosis? Understanding major causes and risk factors

September 30, 2025 •

4 min read

According to UPMC, over 20,000 Americans are affected by avascular necrosis—one of many types of tissue death—each year. Understanding who is at risk for necrosis is vital, as this irreversible condition is often linked to underlying chronic diseases, severe trauma, and certain lifestyle factors that compromise blood flow.

Quick Summary

Major risk factors for necrosis include diabetes, long-term steroid use, excessive alcohol consumption, and physical trauma. Chronic conditions impacting circulation, infections, and certain medical treatments also increase vulnerability to tissue death.

Key Points

Diabetes is a major risk: Poor blood sugar control damages blood vessels and nerves, leading to poor circulation and unnoticed injuries that can cause necrosis, especially in the feet.
Steroid use is a key cause: Long-term, high-dose corticosteroid use is a leading non-traumatic cause of avascular necrosis, impacting blood flow to bones.
Trauma can trigger necrosis: Physical injuries like fractures and joint dislocations can disrupt blood supply, leading to tissue and bone death.
Infections can spread rapidly: Necrotizing soft tissue infections, sometimes called "flesh-eating bacteria," are a medical emergency that cause rapid tissue death and require immediate intervention.
Lifestyle factors play a role: Chronic alcohol abuse and smoking are significant risk factors that damage blood vessels and impair circulation.
Immobility is a major threat: Bedridden or immobile patients are highly susceptible to pressure ulcers, which can lead to localized tissue necrosis.

Necrosis is the medical term for the premature, uncontrolled death of cells and tissue in a living body, often due to injury, infection, or a loss of blood supply. Unlike apoptosis, which is programmed cell death, necrosis is a chaotic process that can lead to significant tissue damage and inflammation. The risk of developing necrosis is not universal; several factors and underlying conditions significantly increase a person’s susceptibility.

Chronic diseases that increase risk

Chronic illnesses that affect circulation, immune function, and overall tissue health are significant risk factors for necrosis. Managing these conditions is a cornerstone of prevention.

Diabetes mellitus

Poorly managed diabetes is a major contributor to necrosis, particularly in the extremities. High blood sugar (hyperglycemia) can damage nerves (diabetic neuropathy) and blood vessels (peripheral vascular disease) over time. This impaired circulation and loss of protective sensation means that minor cuts or scrapes, especially on the feet, can go unnoticed and become infected. The resulting infection can progress rapidly to gangrene, a large-scale necrosis that often leads to amputation. Vigilant foot care is essential for diabetic individuals to prevent this complication.

Cardiovascular and blood disorders

Conditions that compromise blood flow are direct threats for causing ischemic necrosis, or tissue death from a lack of oxygen.

Peripheral Artery Disease (PAD): Narrows the arteries and reduces blood flow to the limbs, increasing the risk of gangrene.
Atherosclerosis: The build-up of fatty plaques inside arteries can lead to blood clots that block blood supply, causing ischemic necrosis.
Deep Vein Thrombosis (DVT): A blood clot in a deep vein, which can completely obstruct blood flow and cause tissue infarction (death) downstream if not treated.
Sickle Cell Anemia: This genetic blood disorder can cause crescent-shaped red blood cells that block small blood vessels, leading to repeated episodes of impaired blood flow and bone necrosis (avascular necrosis).
Hypercoagulable States: Conditions causing an abnormal tendency for blood clotting also increase the risk of blockages.

Autoimmune conditions and other diseases

Certain autoimmune disorders and systemic diseases also increase necrosis risk by causing inflammation or interfering with blood flow.

Systemic Lupus Erythematosus (Lupus): Can cause inflammation that damages blood vessels, leading to reduced blood flow.
Pancreatitis: Inflammation of the pancreas can lead to fat necrosis, where enzymes break down fatty tissue.
Gaucher Disease: An inherited metabolic disorder that can lessen blood flow to bone.
HIV/AIDS: Weakens the immune system, increasing susceptibility to severe infections that can cause necrosis.

Trauma, infection, and medical treatments

Physical injuries and medical interventions can directly trigger necrosis.

Trauma and infection

Significant trauma, such as fractures, joint dislocations, or crush injuries, can severely damage nearby blood vessels and cut off the blood supply to tissue and bone. Furthermore, deep tissue infections, like necrotizing soft tissue infections (NSTIs), can be initiated by seemingly minor cuts. The bacteria release toxins that rapidly destroy tissue, necessitating immediate and aggressive medical intervention to prevent widespread necrosis.

Medications and medical procedures

Several medical treatments are known to increase the risk of necrosis.

Corticosteroid Use: Long-term, high-dose use of corticosteroids (e.g., prednisone) is a common cause of avascular necrosis, potentially by increasing lipid levels that block small blood vessels.
Radiation Therapy: Radiation treatments for cancer can weaken bone and harm blood vessels in the treated area, leading to radiation necrosis.
Chemotherapy: Can suppress the immune system, making individuals more vulnerable to infections that cause necrosis.
Organ Transplants: Particularly kidney transplants, are associated with an increased risk of avascular necrosis.

Lifestyle and other factors

Certain lifestyle choices and demographic factors can also play a role in necrosis risk.

Substance use and obesity

Excessive Alcohol Use: Chronic, heavy alcohol consumption is a major risk factor for avascular necrosis, as it can cause fatty deposits to form in blood vessels, impeding blood flow.
Smoking: Nicotine in cigarette smoke narrows blood vessels, reducing blood flow to tissues throughout the body.
Obesity: Linked to increased inflammation and vascular problems that can contribute to necrosis, especially in infections and pressure ulcers.

Immobility and age

Older adults and those with limited mobility, such as bedridden or paralyzed patients, are at a high risk for developing pressure ulcers (bedsores). Constant pressure on bony areas like the sacrum or heels can impede blood flow, leading to tissue death and the formation of deep wounds.

Comparing types of necrosis


Feature	Avascular Necrosis (Osteonecrosis)	Necrotizing Soft Tissue Infection (NSTI)
Affected Tissue	Bone tissue	Soft tissue (skin, muscle, fascia)
Primary Cause	Interruption of blood supply to bone	Severe bacterial infection
Common Locations	Hip, knee, shoulder	Extremities, abdomen, groin
Key Risk Factors	Long-term steroid use, alcohol abuse, trauma, blood disorders	Open wounds, diabetes, obesity, weakened immune system
Progression	Can take months to years for bone collapse	Can spread rapidly, sometimes in hours
Appearance	May have no early symptoms; later, joint pain and limited motion	Initial pain disproportionate to wound size; rapid skin discoloration (purple, black), blisters
Treatment	Pain management, physical therapy, surgery (joint replacement)	Immediate surgery (debridement), powerful IV antibiotics

Conclusion

Necrosis is a severe medical condition with a diverse range of risk factors that can lead to irreversible tissue death. Understanding these risks is the first step toward effective prevention and management. Individuals with chronic conditions like diabetes, those on long-term steroid therapy, and those who abuse alcohol or smoke are particularly vulnerable. Vigilant self-care, including proper wound management and regular health check-ups, is crucial. If you fall into a high-risk group or experience symptoms of tissue damage, seeking immediate medical attention is essential for a timely diagnosis and appropriate treatment.

For more information on general health topics, visit reputable health resources like the Centers for Disease Control and Prevention.

Frequently Asked Questions

Necrosis is primarily caused by a severe injury to cells, such as an inadequate supply of blood (ischemia), infection, or physical trauma. This leads to the uncontrolled breakdown of cells and the death of tissue.

Yes, high cholesterol (hyperlipidemia) can increase your risk, particularly for avascular necrosis. The accumulation of fatty deposits can block small blood vessels, restricting blood flow to the bone and causing tissue death.

Diabetes leads to necrosis by causing chronic hyperglycemia, which damages nerves and blood vessels. This results in poor circulation and loss of sensation (neuropathy), making wounds prone to infection and poor healing, which can progress to necrosis.

Yes, long-term, high-dose use of corticosteroid medications like prednisone is a well-known risk factor for avascular necrosis (bone tissue death), likely due to their effects on fat metabolism and circulation.

Yes, obesity is a risk factor linked to reduced circulation and an increased state of inflammation. This can contribute to conditions like necrotizing soft tissue infections and complicate the healing of pressure ulcers.

No, by definition, necrosis is the irreversible death of tissue. Once confirmed, the necrotic tissue must be removed to prevent further complications like infection spread.

Heavy, long-term alcohol use can increase the risk of avascular necrosis by causing fatty deposits to form in blood vessels that supply the bones. It has been linked to the death of bone tissue, especially in the hip.