Osteonecrosis — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 13 of 2020

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting osteonecrosis or death from osteonecrosis with the circumstances of a person's relevant service:

1. (1)
   experiencing blunt or penetrating trauma, including surgery, to the affected bone within the two years before the clinical onset of osteonecrosis;
2. (2)
   having a fracture, dislocation of a joint or subluxation of a joint of the affected bone within the two years before the clinical onset of osteonecrosis;
3. (3)
   smoking at least 15 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of osteonecrosis, and where smoking has ceased, the clinical onset of osteonecrosis has occurred within five years of cessation;

   Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.

4. (4)
   consuming an average of at least 160 grams of alcohol per week, for at least six months within the one year before the clinical onset of osteonecrosis;

   Note: Alcohol consumption is calculated utilising the Australian Standard of ten grams of alcohol per standard alcoholic drink.

5. (5)
   having a solid organ malignancy at the time of the clinical onset of osteonecrosis;
6. (6)
   having an autoimmune disorder from the specified list of autoimmune disorders at the time of the clinical onset of osteonecrosis;

   Note: specified list of autoimmune disorders is defined in the Schedule 1- Dictionary.

7. (7)
   having a haematological disease from the specified list of haematological diseases at the time of the clinical onset of osteonecrosis;

   Note: specified list of haematological diseases is defined in the Schedule 1- Dictionary.

8. (8)
   having a hypercoagulable state as specified at the time of the clinical onset of osteonecrosis;

   Note: hypercoagulable state as specified is defined in the Schedule 1- Dictionary.

9. (9)
   having chronic renal failure at least one year before the clinical onset of osteonecrosis;

   Note: chronic renal failure is defined in the Schedule 1 - Dictionary.

10. (10)
    having dyslipidaemia at the time of the clinical onset of osteonecrosis;

    Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.

11. (11)
    having Cushing syndrome at the time of the clinical onset of osteonecrosis;
12. (12)
    having acute or chronic pancreatitis at the time of the clinical onset of osteonecrosis;
13. (13)
    having infection with human immunodeficiency virus at the time of the clinical onset of osteonecrosis;
14. (14)
    having a localised bacterial, viral or fungal infection at the affected site at the time of the clinical onset of osteonecrosis;
15. (15)
    having osteomyelitis at the affected site at the time of the clinical onset of osteonecrosis;
16. (16)
    having glucocorticoid therapy as specified, before the clinical onset of osteonecrosis, and where the glucocorticoid therapy as specified has ceased or decreased, the last dose of the therapy was received within the five years before the clinical onset of osteonecrosis;

    Note: glucocorticoid therapy as specified is defined in the Schedule 1 - Dictionary.

17. (17)
    taking bevacizumab, denosumab or testosterone within the 30 days before the clinical onset of osteonecrosis;
18. (18)
    having a solid organ transplant, stem cell transplant or bone marrow transplant before the clinical onset of osteonecrosis;
19. (19)
    undergoing a course of therapeutic radiation for cancer, where the affected site was in the field of radiation, before the clinical onset of osteonecrosis;
20. (20)
    having internal deposition of radium-224, radium-226, or radium-228 before the clinical onset of osteonecrosis;
21. (21)
    having decompression sickness within the five years before the clinical onset of osteonecrosis;
22. (22)
    experiencing hyperbaric exposure as specified, within the five years before the clinical onset of osteonecrosis;

    Note: hyperbaric exposure as specified is defined in the Schedule 1- Dictionary.

23. (23)
    being pregnant at the time of the clinical onset of osteonecrosis;
24. (24)
    undergoing childbirth within the one year before the clinical onset of osteonecrosis;
25. (25)
    for osteonecrosis of the jaw only: (a) having diabetes mellitus at the time of the clinical onset of osteonecrosis; (b) having periodontitis, periodontal abscess or dental pulp and apical disease within the three months before the clinical onset of osteonecrosis; (c) having syphilitic palatine gumma at the time of the clinical onset of osteonecrosis; (d) having acute herpes zoster involving the trigeminal nerve within the six months before the clinical onset of osteonecrosis; (e) having substance use disorder, involving cocaine, at the time of the clinical onset of osteonecrosis; (f) having anaemia at the time of the clinical onset of osteonecrosis; (g) being treated with an osteoclast inhibitor for at least six months before the clinical onset of osteonecrosis, where the last dose of the drug was taken within the two years before the clinical onset of osteonecrosis; (h) being treated with an antiangiogenic agent for at least six months before the clinical onset of osteonecrosis, where the last dose of the drug was taken within the two years before the clinical onset of osteonecrosis; or (i) taking desomorphine (krokodil) within the 30 days before the clinical onset of osteonecrosis;

    Note: osteoclast inhibitor is defined in the Schedule 1 - Dictionary.

    Note: antiangiogenic agent is defined in the Schedule 1 - Dictionary.

26. (26)
    inability to obtain appropriate clinical management for osteonecrosis;

Aggravation-only factors: the factors in subsection 8(26) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.