Transitory demineralization of the femoral head.
TL;DR: The typical clinical setting, joint fluid findings, and roentgenographic appearance obviate the need for biopsy of the femoral head, and none of the various forms of therapy seem to alter the two- to four-month course of the syndrome appreciably.
Abstract: Transitory demineralization of the femoral head may occur with accompanying pain and disability. The typical clinical setting, joint fluid findings, and roentgenographic appearance obviate the need for biopsy of the femoral head. None of the various forms of therapy which have been proposed seem to alter the two- to four-month course of the syndrome appreciably.
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TL;DR: Transient osteoporosis usually resolves spontaneously in six to eight months, after only protected weight-bearing and treatment of the symptoms; avascular necrosis is usually progressive, but early operative intervention may delay the progression or reduce the symptoms in some patients
Abstract: Transient osteoporosis of the hip is an uncommon, usually self-limited, distinct clinical entity of unknown etiology6633 3639465355 . Classically, it is characterized by disabling pain in the hip without antecedent trauma and by striking radiographic evidence of osteopenia that is isolated to the hip. The syndrome is not widely recognized, perhaps because of its relative infrequency, and radiographs may be unrevealing early in its course. Therefore, transient osteoporosis may be confused with a variety of other conditions6385#{176}’5355 , with avascular necrosis perhaps being the most common misdiagnosis. Although it may be difficult to distinguish between these two conditions in the early stages, it is essential to make the differential diagnosis so that an appropriate treatment plan can be selected. Transient osteoporosis usually resolves spontaneously in six to eight months, after only protected weight-bearing and treatment of the symptoms; avascular necrosis is usually progressive, but early operative intervention may delay the progression or reduce the symptoms in some patients9’#{176}54 . Curtiss and Kincaid’3, in 1959, reported transient demineralization of the hip in three women during the last trimester of pregnancy; this was apparently the first well documented description of what was later termed transient osteoporosis of the hip by Lequesne38, in 1968. Transient osteoporosis has had many names, including transitory demineralization, migratory osteolysis, algodystrophy of the hip, and, most recently, bone-marrow edema syndrome. Unlike avascular necrosis, transient osteoporosis seems to be uncommon, with less than 200 cases having been reported in the literature since its first description53. Typically, patients are initially seen with acute, progressive pain in the hip; an antalgic gait; and a functional disability involving the affected extremity. Approximately one month after the onset of the symptoms, radiographs reveal demineralization of the femoral head and neck without involvement of the joint space. The spontaneous resolution of the symptoms af-
248 citations
TL;DR: This nonspecific term should be reserved only for patients who do not develop radiographically evident focal osteopenia, since all patients with transient osteoporosis recover completely, without intervention.
Abstract: The bone marrow edema (BME) pattern of signal intensity changes on magnetic resonance (MR) images (decreased on T1-weighted and increased on T2-weighted) is a nonspecific finding encountered with several entities, including transient osteoporosis of the hip, transient BME syndrome, osteonecrosis, trauma, infection, and infiltrative neoplasm. Transient osteoporosis, an unusual but distinct syndrome characterized by self-limited pain and radiographically evident osteopenia, can be distinguished from other causes of the BME pattern, particularly osteonecrosis, on the basis of clinical findings and the development of radiographically evident focal osteopenia within 8 weeks after the onset of pain. This is an important distinction, since all patients with transient osteoporosis recover completely, without intervention. The term transient BME syndrome can be used to describe any patient in whom a reversible BME pattern is seen on MR images. Although the transient BME syndrome is also self-limited and quite likely related to transient osteoporosis, the authors believe that to avoid confusion, this nonspecific term should be reserved only for patients who do not develop radiographically evident osteopenia.
233 citations
TL;DR: Although its cause is unknown, osteoporosis appears to be a regional rather than a systemic process, and the hip was the most commonly affected joint.
Abstract: We describe the clinical features and course of disease in 56 patients (33 men and 23 women) with transient regional osteoporosis. The median age at hospitalization was 48 years. All patients had monoarticular or oligoarticular joint pain that was aggravated by weight bearing. Eighteen also had pain at rest in the involved joints and 6 had nocturnal pain. The joints of the lower extremities were affected in 54 patients; the hip was the most commonly affected joint. There was little evidence of synovitis. Osteoporosis was diagnosed on the basis of characteristic clinical findings and the results of roentgenograms and bone scans. The osteoporosis resolved spontaneously over several months. Treatment consisted of joint protection, initiation of gradual ambulation, and administration of nonsteroidal anti-inflammatory agents. Although its cause is unknown, osteoporosis appears to be a regional rather than a systemic process.
209 citations
TL;DR: The hallmark that separates BMES from other conditions presented with BME pattern is its self-limited nature and early differentiation from other aggressive conditions with long-term sequelae is essential in order to avoid unnecessary treatment.
Abstract: Bone marrow edema syndrome (BMES) refers to transient clinical conditions with unknown pathogenic mechanism, such as transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and reflex sympathetic dystrophy (RSD). BMES is primarily characterized by bone marrow edema (BME) pattern. The disease mainly affects the hip, the knee, and the ankle of middle-aged males. Many hypotheses have been proposed to explain the pathogenesis of the disease. Unfortunately, the etiology of BMES remains obscure. The hallmark that separates BMES from other conditions presented with BME pattern is its self-limited nature. Laboratory tests usually do not contribute to the diagnosis. Histological examination of the lesion is unnecessary. Plain radiographs may reveal regional osseous demineralization. Magnetic resonance imaging is mainly used for the early diagnosis and monitoring the progression of the disease. Early differentiation from other aggressive conditions with long-term sequelae is essential in order to avoid unnecessary treatment. Clinical entities, such as TOH, RMO, and RSD are spontaneously resolving, and surgical treatment is not needed. On the other hand, early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance.
133 citations
Cites background from "Transitory demineralization of the ..."
...According to Rosen, venous obstruction and secondary localized hyperemia may be the cause of the transitory demineralization of the femoral head [7]....
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...Transient demineralization of the hip usually involves healthy middle-aged men and rarely women, almost exclusively during the third trimester of pregnancy or the immediate postpartum period [1, 7]....
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...Many hypotheses have been proposed in order to explain the pathogenesis and characteristic manifestations of the disease, but the etiology of BMES remains unknown [6, 7]....
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TL;DR: The purpose of this report is to elucidate the diagnostic and therapeutic aspects of TOH and to stimulate the physician's awareness of this condition, recognition of which may prevent unnecessary invasive procedures and inadequate treatment.
119 citations
References
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TL;DR: Three cases have been presented of a syndronme occurring in pregnant women, characterized by pain of varying severity in one or both hips or thighs and develops in the last trimester of pregnancy, which suspect it to be of neurogenic origin.
Abstract: Three cases have been presented of a syndronme occurring in pregnant women. This syndrome is characterized by pain of varying severity in one or both hips or thighs and develops in the last trimester of pregnancy. Roentgenograms show a spotty demineralization with sharply localized margins, involving one or both femoral heads, a small part of the femoral neck, and the acetabulum. In each of the three patients, the pain subsided and the roentgenographic appearance returned to normal within several months after delivery.
We do not know the cause of this syndrome, but suspect it to be of neurogenic origin.
360 citations
TL;DR: The clinical presentation was marked by the rapid development of disability, limp, and pain on movement, and the permanence of recovery was assessed by reviewing all the cases except one after an average interval of 2 years.
Abstract: *Given at a meeting of the Heberden Society in November, 1967. tA.I.H.P. Assistant at the Clinique Rhumatologique (Chairman: Prof. S. de S6ze), H6pital Lariboisi6re, 6, Rue Guy Patin, Paris Xe, France. (3) The clinical presentation was marked by the rapid development of disability, limp, and pain on movement. (4) The course was constant, the greatest disability occurring in 2nd to 3rd month being invariably followed by recovery. (5) The permanence of recovery was assessed by reviewing all the cases except one after an average interval of 2 years.
147 citations
TL;DR: The main causes for localized osteoporosis are inactivity of the affected part and generalized disturbance when confined to a local region.
Abstract: Excerpt Osteoporosis is most often a generalized disturbance and when confined to a local region usually results from inactivity of the affected part. The main causes for localized osteoporosis (os...
82 citations
82 citations
TL;DR: Clinical data on nine adults who had unexplained transient roentgenologic osteoporosis of one hip are presented and the findings and course of illness were similar enough among the patients to cause confusion.
Abstract: Clinical data on nine adults who had unexplained transient roentgenologic osteoporosis of one hip are presented. The findings and course of illness were similar enough among the patients t...
34 citations