While alcohol abuse is a possible etiologic factor in osteonecrosis in the femoral hea (ON), the relationship between alcoholic liver dysfunction and ON is uncertain. Among 336 patients with alcoholic liver dysfunction who had radiographic examination of the hip at two hospitals for alcohol abuse treatment in southern Japan, the records for 291 men and 1 woman (mean age, 47.8 years; range, 24 to 72 years) had adequate information available concerning daily and cumulative alcohol intake, duration of intake, serum concentrations of liver enzymes, and platelet count. These variables were investigated for any correlation between the 8 patients with radiographic evidence of ON and the 284 without. Liver biopsy was performed in 223 patients. Except for alanine aminotransferase, liver enzyme concentrations were significantly lower in patients with ON than in those without. Histologically, 2 patients with ON were diagnosed with cirrhosis; 1 with pre-cirrhotic changes; and 2 with fibrosis. These results suggested that ON occurred in the late stages of liver disease when serum enzyme concentrations had returned to normal or were only mildly elevated.