Osteonecrosis and Bone Regeneration: A Bibliometric Odyssey over 24 Years

Abstract

Background:

Osteonecrosis is a pathological condition characterized by disturbances in microcirculation, osteolysis, and subsequent bone collapse, leading to significant pain and motor impairments that severely affect the quality of life of affected individuals. The primary therapeutic goal in osteonecrosis is the restoration of bone integrity, typically through bone grafting or the use of tissue-engineered constructs. Despite the critical importance of these approaches, a systematic and comprehensive review of the field remains lacking. This study aims to provide a thorough bibliometric analysis of the current state and key research trends in bone regeneration for osteonecrosis.

Methods:

A systematic search of the Web of Science Core Collection, Scopus, and OpenAlex was conducted for studies published between 2001 and 2024, yielding a total of 1,548 publications related to “osteonecrosis and bone regeneration.” Bibliometric tools, including VOSviewer, CiteSpace, and the R package “bibliometrix,” were utilized for data analysis.

Results:

The analysis revealed a notable increase in the number of publications over the years, with China leading the global output at 38.6%, followed by the United States (16.4%) and Japan (5.2%). Shanghai Jiao Tong University and researcher Ling Qin were identified as key contributors to the field. The journal International Orthopaedics emerged as a highly active outlet, while Bone was recognized for its significant impact. Research efforts have primarily focused on bone grafts, tissue engineering, and mesenchymal stem cells, with emerging interest in the integration of exosomes, apoptosis, oxidative stress, and immunomodulation in regenerative therapy.

Conclusion:

This bibliometric review highlights the leading contributors to the field of osteonecrosis research and identifies key trends in bone regeneration strategies. The findings underscore the progressive advancements in the field and suggest promising avenues for future research.

Impact Statement

This study presents the first comprehensive bibliometric analysis of global research trends in bone regeneration for osteonecrosis over the past 24 years. By leveraging advanced computational tools—VOSviewer, CiteSpace, and bibliometrix—we systematically map the evolution of the field, identifying leading contributors, seminal publications, and emerging thematic clusters. Our analysis highlights a shifting focus toward stem cell-based therapies, oxidative stress, exosomes, and immunomodulation, with China, the United States, Germany, and Japan as major contributors. The study uncovers rapidly growing interest in apoptosis, extracellular vesicles, and glucocorticoid-induced osteonecrosis, providing a data-driven foundation for future research. This work not only synthesizes a fragmented body of literature but also identifies underexplored areas, offering valuable insights for guiding innovative therapeutic strategies and clinical translations in tissue engineering and regenerative medicine.