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Idiopathic Transient Osteoporosis of the Hip

- See: Musculoskeletal Considerations in Pregancy

- Discussion:
    - uncommon disease which is a diagnosis of exclusion;
    - most often seen in women during the third trimester of pregnancy and in middle-aged men;
    - typically there is no antecendent trauma;
    - up to 40% of patients may show involvement in other joints;

- Clinical Findings:
    - groin pain, and mild limited ROM of hip;
    - patients may be unable to bear weight even if hip pain is minimal;
    - ESR may be elevated;

- Radiographs:
    - radiographic findings may lag behind clinical symptoms by 1-2 months;
    - osteopenia diffusely involves femoral head and neck;
    - may be confused w/ AVN or femoral neck stress frx;
    - joint space is preserved;

- Bone Scan:
    - sensitive but not specific;
    - technetium 99m may show increased uptake before x-ray changes appear;
    - scan will show increased diffuse uptake of the whole femoral head w/ tapering over femoral neck and increased uptake in acetabulum;
    - scan usually returns to normal 12-15 months after onset of symptoms;
    - bone scan may also show increased uptake in other osteopenic joints;

- MRI:
    - decreased signal intensity of bone marrow on T1-images;
    - increased signal intensity relative to the intensity of normal marrow on T2-images;
          - joint effusions are characteristically seen on T2-images;

- Clinical Course:
    - spontaneous recovery usually occurs within 2-9 months after treatment w/ joint protection, limited wt bearing, & analgesics;
          - in pregnancy, symptoms tend to resolve in the first few postpartum months;
    - stress fracture can occur in the inadequately protected hip

Transient osteoporosis of the hip in pregnancy. Review of the literature and a case report.  

Transient osteoporosis of the hip: MR imaging.                                                       

Transient osteoporosis.                 

Transient osteoporosis of the hip of pregnancy. Two cases complicated by pathological fracture.              

Transient painful osteoporosis of the hip in pregnancy.           

Transient osteoporosis of the hip. Magnetic resonance imaging.                               

Transient marrow edema syndrome of the hip: results after core decompression. A prospective MRI-controlled study in 22 patients.

Changes in bone mineral density in transient osteoporosis of the hip.