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Transient osteoporosis of the hip: review of the literature

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Abstract

Transient osteoporosis of the hip (TOH) is a temporary clinical condition of unknown etiology which usually resolves with conservative therapy though may be complicated by fracture or progression to avascular necrosis (AVN). TOH may be slightly more prevalent in men but when it occurs in women, it is most often seen in the latter part of pregnancy. Though fracture is a rare complication of TOH when it occurs, it is most often associated with TOH occurring in pregnancy. Magnetic resonance imaging (MRI) is the best method to diagnosis TOH. Low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and homogenous pattern of edema (the femoral head and/or neck) with normal subchondral area are in favor of TOH. A shortened course to recovery is reported by use of bisphosphonates, calcitonin, or teriparatide. Based on reported cases, core decompression is not superior to medical therapy. Transient osteoporosis of the hip, which often has no known etiology, usually resolves with conservative therapy but may predispose the patient to fracture or avascular necrosis. Diagnostic method of choice is magnetic resonance imaging. Bisphosphonates, calcitonin, or teriparatide are reported as a useful approach to reduce duration of recovery.

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Abbreviations

AVN:

avascular necrosis

BMD:

bone mineral density

BME:

bone marrow edema

BMES:

Bone marrow edema syndrome

DXA:

dual-energy X-ray absorptiometry

PTH:

parathyroid hormone

PTH-rP:

parathyroid hormone-related peptide

RMO:

regional migratory osteoporosis

STIR:

short-tau inversion recovery

TOH:

transient osteoporosis of the hip

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Acknowledgements

The authors express their appreciation to Namrata Gumaste, divisional assistant, NYU Langone Medical Center, for a helpful revision of this manuscript.

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Authors and Affiliations

  1. Fellow in Endocrinology and Metabolism, NYU School of Medicine, New York, NY, USA

    K. Asadipooya

  2. Division of Endocrinology and Metabolism, NYU Langone Medical Center, 522 1st Ave, Smilow 707B, New York, NY, 10016-6402, USA

    K. Asadipooya

  3. Division of Metabolism, Endocrinology and Genetics, Department of Internal Medicine, Endocrinology and Genetics MS 2024, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

    L. Graves

  4. Medicine (Endocrinology) and ObGyn, Co-Director of Osteoporosis and Metabolic Bone Disease, Department of Medicine, NYU School of Medicine, New York, NY, USA

    L. W. Greene

  5. Division of Endocrinology and Metabolism, NYU Langone Medical Center, 650 First Avenue, 7th floor, New York, NY, 10016, USA

    L. W. Greene

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The abstract of part of this study has been presented as an oral presentation at the American Society of Bone and Mineral Research (ASBMR), September 12–14, 2014, Houston, TX [1].

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Asadipooya, K., Graves, L. & Greene, L.W. Transient osteoporosis of the hip: review of the literature. Osteoporos Int 28, 1805–1816 (2017). https://doi.org/10.1007/s00198-017-3952-0

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