Advertisement

Archives of Orthopaedic and Trauma Surgery

, Volume 123, Issue 9, pp 505–508 | Cite as

Transient osteoporosis of the navicular bone in a runner

  • O. Miltner
  • C. Niedhart
  • W. Piroth
  • M. Weber
  • C. H. Siebert
Case Report

Abstract

Introduction

Transient osteoporosis or the bone marrow oedema syndrome is described as a self-limiting disorder. Transient osteoporosis usually affects only one bone, predominantly the proximal femur. Involvement of the foot is rare and often overlooked. A disorder of the navicular bone of the foot can be found twice in the literature.

Materials and methods

We report a case of transient osteoporosis of the navicular bone of the foot in a 20-year-old, female, top-level track athlete (400 m sprinter) treated with alendronate, and a review of the literature.

Results

The therapeutic options are limited, frequently consisting of non-specific, symptomatic therapy. Some authors report favourable results with core decompression, while others have reported good results with a conservative regime of symptomatic treatment and avoidance of weight-bearing until the clinical and radiological changes have resolved. In the described case, the patient had a favourable result after a short course of treatment with alendronate. She experienced almost immediate pain reduction and presented a complete resolution of the abnormal signal intensity on MRI.

Conclusion

This rapid result makes the use of alendronate seem promising in athletes with transient osteoporosis, permitting an early return to high-level activities.

Keywords

Transient osteoporosis Navicular bone Biphosphonate 

References

  1. 1.
    Aigner N, Petje G, Steinboeck G, Schneider W, Krasny C, Landsiedl F(2001) Treatment of bone-marrow oedema of the talus with prostacyclin analogue iloprost. J Bone Joint Surg Br 83:855–858CrossRefPubMedGoogle Scholar
  2. 2.
    Berenson JR, Lichtenstein A, Poerter L, Dimopolous MA, Bordoni R, George S, Lipton A, Keller A, Ballester O, Kovacs MJ, Blacklock HA, Bell R, Simeone J, Reitsma DJ, Heffernan M, Seaman J, Knight RD (1996) Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. N Engl J Med 334:488–493CrossRefPubMedGoogle Scholar
  3. 3.
    Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer C, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541PubMedGoogle Scholar
  4. 4.
    Bramlett KW, Killian JT, Nasca RJ, Daniel WW (1987) Transient osteoporosis. Clin Orthop 222:197–202Google Scholar
  5. 5.
    Calvo E, Alvarez L, Fernandez-Yruegas D, Vallejo C (1997) Transient osteoporosis of the foot: bone marrow edema in 4 cases studied with MRI. Acta Orthop Scand 68:577–580PubMedGoogle Scholar
  6. 6.
    Curtiss PH, Kincaid WE (1959) Transitory demineralisation of the hip in pregnancy: a report of three cases. J Bone Joint Surg Am 41:1327–1333Google Scholar
  7. 7.
    Diel IJ, Solomayer EF, Costa SD, Gollan C, Goerner C, Wallwiener D, Bastert G (1998) Reduction in new metastases in breast cancer with adjuvant clodronate treatment. N Engl J Med 339:357–363Google Scholar
  8. 8.
    Doury P(1980) Regional osteoporosis of the hip treated with calcitonin continued. J Rheumatol 7:114–116Google Scholar
  9. 9.
    Ducan H, Frame B, Frost HM (1967) Migratory osteolysis of the lower extremities. Ann Intern Med 66:1165–1173PubMedGoogle Scholar
  10. 10.
    Dunn CJ, Galinet LA, Wu H, Nugent RA, Schlachter TS, Staite ND, Aspar DG, Elliott GA, Essani NA, Rohloff NA (1993) Demonstration of novel anti-arthritic and anti-inflammatory effects of diphosphonates. J Pharmacol Exp Ther 266:1691–1698PubMedGoogle Scholar
  11. 11.
    Felix R, Bettex JD, Fleisch H (1981) Effect of diphosphonates on the synthesis of prostaglandins in cultured calvaria cells. Calcif Tissue Int 33:549–552PubMedGoogle Scholar
  12. 12.
    Frohberg PK, Braunstein EM, Buckwalter KA (1996) Osteonecrosis, transient osteoporosis and transient bone marrow oedema: current concepts. Radiol Clin North Am 34:273–291PubMedGoogle Scholar
  13. 13.
    Gallant GG, Fischer RL, Sziklas J (1994) Transient regional osteoporosis of the ankle and foot. A report of four cases and review of the literature. Orthop Rev. 23:405–409Google Scholar
  14. 14.
    Guerra JJ, Steinberg ME (1995) Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Surg Am 77:616–624PubMedGoogle Scholar
  15. 15.
    Hauzeur JP, Perlmutter N, Appelboom T, Pasteels JL (1991) Medullary impairment at an early stage of non traumatic osteonecrosis of the femoral head. Rheumatol Int 11:215–217PubMedGoogle Scholar
  16. 16.
    Hofmann S, Kramer J, Plenk H (1993) Bone marrow oedema syndrome and transient osteoporosis of the hip. An MRI controlled study of treatment by core decompression. J Bone Joint Surg Br 75:210–216PubMedGoogle Scholar
  17. 17.
    Hofmann S, Kramer J, Schneider W, Plenh H (1997) Transient osteoporosis may represent a reversible early form of avascular necrosis of the hip joint. Curr Orthop 11:164–172Google Scholar
  18. 18.
    Hofmann S, Schneider W, Breitenseher M (2000) Transient osteoporosis as a reversible subtype of osteonecrosis of the hip joint. Orthopaede 29:411–419CrossRefGoogle Scholar
  19. 19.
    Hortobagyi GN, Theriault RL, Porter L, Porter L, Blayney D, Sinoff C, Wheeler H, Simeone JF, Seaman JJ, Knight RD, Heffeman M, Mellars K, Reitsman DJ (1998) Efficiacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. N Engl J Med 335:1785–1791CrossRefGoogle Scholar
  20. 20.
    Judd DB, Kim DH, Hrutkay JM (2000) Transient osteoporosis of the talus. Foot Ankle Int 21:134–137PubMedGoogle Scholar
  21. 21.
    Lakhanpal S, Ginsburg WW, Luthra HS, Hunder G (1987) Transient regional osteoporosis. Ann Intern Med 106:444–450PubMedGoogle Scholar
  22. 22.
    Lequesne M (1968) Transient osteoporosis of the hip: a non traumatic variety of Sudeck atrophy. Ann Rheum Dis 27:463–467PubMedGoogle Scholar
  23. 23.
    O`Mara RE, Pinals RS (1970) Bone scanning in regional migratory osteoporosis. Case report. Radiology 97:579–581PubMedGoogle Scholar
  24. 24.
    Radke S, Vispo-Seara J, Walther M, Ettl V, Eulert J (2001) Transient bone marrow oedema of the foot. Int Orthop 25:263–267CrossRefPubMedGoogle Scholar
  25. 25.
    Reade B, Atlas G, Distazio J, Kruljac S (1998) Mueller-Weiss syndrome: an uncommon cause of midfoot pain. J Foot Ankle Surg 37:535–539PubMedGoogle Scholar
  26. 26.
    Rogers MJ, Chilton KM, Coxon F, Lawry J, Smith MO, Suri S, Russell RG (1996) Bisphosphonates induce apoptosis in mouse macrophage-like cells by a nitric-oxide-independent mechanism. J Bone Miner Res 11:1482–1491PubMedGoogle Scholar
  27. 27.
    Rosen RA (1970) Transitory demineralisation of the femoral head. Radiology 94:509–512PubMedGoogle Scholar
  28. 28.
    Samdani A, Lachmann E, Nagler W (1998) Transient osteoporosis of the hip during pregnancy: a case report. Am J Phys Med Rehabil 77:153–156CrossRefPubMedGoogle Scholar
  29. 29.
    Scheinberg MA, Aristides RSA, Svartman C (1978) Transient regional osteoporosis of the hip treated with calcitonin. J Rheumatol 5:236–238PubMedGoogle Scholar
  30. 30.
    Sharp M, Noble S, Spencer CM (2001) Alendronate: an update of its use in osteoporosis. Drugs 61:999–1039PubMedGoogle Scholar
  31. 31.
    Swezey RL (1970) Transient osteoporosis of the hip, foot and knee. Arthritis Rheum 13:858–868PubMedGoogle Scholar
  32. 32.
    Vande Berg BE, Malghem JJ, Labaisse MA, Noel HM, Maldague BE (1993) MR imaging of avascular necrosis and transient marrow oedema of the femoral head. Radiographics 13:501–520PubMedGoogle Scholar
  33. 33.
    Vande Berg BE, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE (1999) Idiopathic bone marrow edema lesions of the femoral head. Predictive value of MR imaging findings. Radiology 212:527–535PubMedGoogle Scholar
  34. 34.
    Wilson AD, Murphy WA, Hardy DC, Totty WC (1988) Transient osteoporosis: transient bone marrow oedema. Radiology 167:757–760PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • O. Miltner
    • 1
  • C. Niedhart
    • 1
  • W. Piroth
    • 2
  • M. Weber
    • 1
  • C. H. Siebert
    • 1
  1. 1.Orthopaedic Department of the UK AachenAachenGermany
  2. 2.Radiology Department of the UK AachenAachenGermany

Personalised recommendations