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Many other risk factors have been associated with ONFH. Gaucher disease is a metabolic disorder in which an enzyme deficiency causes abnormal accumulation of glucocerebroside in macrophages, which infiltrate the bone marrow causing compression and vascular compromise. A study of patients with Gaucher disease and ONFH found that it was more prevalent in patients who had a prior splenectomy.  Caisson disease, also referred to as decompression syndrome or the bends, occurs when gaseous bubbles enter tissues after exposure to rapid changes in barometric pressure, including mine or tunnel work, deep sea diving, or riding in an unpressurized aircraft. Dysbaric osteonecrosis occurs when gas bubbles enter the medullary canal and constrict blood flow. HIV also has been associated with ONFH, but it is unclear whether it is from a disease-specific mechanism, antiretrovirals, or other confounding risk factors. Similarly, systemic lupus erythematosus has been associated with ONFH through the disease process itself, corticosteroid use, cytotoxic medications, and vasculitis. Radiation treatment is also believed a risk factor for ONFH, but there has been no determination of a dose-response relationship or explanation for why unilateral ONFH can occur after equal radiation exposure to both femoral heads. ONFH has also been linked to pregnancy, inflammatory bowel disease, malignant tumors, gout, and smoking.