Clinical Rheumatology

, Volume 35, Issue 10, pp 2517–2522 | Cite as

Risk factors in transient osteoporosis: a retrospective study on 23 cases

  • Carlo TrevisanEmail author
  • Raymond Klumpp
  • Riccardo Compagnoni
Original Article


The aim of this study is to verify the prevalence of risk factors for transient osteoporosis (TO) in a cohort of patients selected by strict diagnostic criteria. Retrospective observational cohort study on outpatients’ data. Inclusion criteria were: (1) acute onset of pain at a lower limb joint exacerbated by weight bearing; (2) no history of trauma, tumors, rheumatic diseases, or infection; (3) presence bone marrow edema on MRI in a weight bearing joint without signs of intraarticular lesions; (4) no hyperesthesia and/or allodynia and/or sweeting changes. The following risk factors were search for in all patients: (1) previous episode of TO; (2) disorders of bone metabolism; (3) cigarette smoke; (4) sudden lower limb overuse; (5) presence of osteoporosis/osteopenia. Twenty-three patients (8 females, 15 males, mean age 48.4 years) fulfilled the inclusion criteria. An average of 1.96 risk factors for TO was present in the cohort. The most frequent risk factor was overuse (in 15 patients, 65.2 %) and the second risk factor was bone metabolism disorders (in 10 patients, 43.5 %). Seven patients (30.4 %) were heavy smokers (more than 20 cigarettes per day) and seven patients showed a previous episode of TO. Six patients (26.1 % of the overall cohort but 60 % of those investigated with DEXA) resulted osteoporotic or osteopenic. Our results suggest there are risk factors that must be investigated in these patients. The presence of these risk factors might support the thesis that their disorder is tied to a decoupling between microdamage accumulation and self-reparative ability of bone tissue. The identification of risk factors with a precise diagnostic pathway can accelerate the diagnostic process and reduce recurrences.


Bone Bone marrow oedema Migratory osteoporosis Transient osteoporosis 


Compliance with ethical standards

This is a retrospective observational cohort study of outpatients clinical records conducted under the principles of Helsinki’s Declaration with the approval of our hospital’s ethics committee.




  1. 1.
    Cano-Marquina A, Tarín JJ, García-Pérez MÁ, Cano A (2014) Transient regional osteoporosis. Maturitas 77:324–329CrossRefPubMedGoogle Scholar
  2. 2.
    Korompilias AV, Karantanas AH, Lykissas MG, Beris AE (2008) Transient osteoporosis. J Am Acad Orthop Surg 16:480–489CrossRefPubMedGoogle Scholar
  3. 3.
    Curtiss PH Jr, Kincaid WE (1959) Transitory demineralization of the hip in pregnancy: a report of three cases. J Bone J Surg Am 41:1327–1333Google Scholar
  4. 4.
    Hofmann S, Engel A, Neuhold A, Leder K, Kramer J, Plenk H Jr (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) 75:210–216Google Scholar
  5. 5.
    Doury P (1994) Bone-marrow oedema, transient osteoporosis, and algodystrophy. J Bone Joint Surg (Br) 76:993–994Google Scholar
  6. 6.
    Turner DA, Templeton AC, Selzer PM, Rosenberg AG, Petasnick JP (1989) Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions. Radiology 171:135–140CrossRefPubMedGoogle Scholar
  7. 7.
    Frost HM (1992) Perspectives: bone’s mechanical usage windows. Bone Miner 19:257–271CrossRefPubMedGoogle Scholar
  8. 8.
    Trevisan C, Ortolani S, Monteleone M, Marinoni EC (2002) Regional migratory osteoporosis: a pathogenetic hypothesis based on three cases and a review of the literature. Clin Rheumatol 21:4184–25CrossRefGoogle Scholar
  9. 9.
    Uzun M, Ayhan E, Beksac B, Karaman O (2013) Regional migratory osteoporosis and transient osteoporosis of the hip: are they all the same? Clin Rheumatol 32:919–923CrossRefPubMedGoogle Scholar
  10. 10.
    Van Wagenen K, Pritchard P, Taylor JA (2013) Transient osteoporosis of the hip: a case report. J Can Chiropr Assoc 57:116–122PubMedPubMedCentralGoogle Scholar
  11. 11.
    Gruber HE, Gutteridge DH, Baylink DJ (1984) Osteoporosis associated with pregnancy and lactation: bone biopsy and skeletal features in three patients. Metabol Bone Dis Rel Res 5:159–165CrossRefGoogle Scholar
  12. 12.
    Guler O, Ozyurek S, Cakmak S, Isyar M, Mutlu S, Mahirogullari M (2015) Evaluation of results of conservative therapy in patients with transient osteoporosis of hip. Acta Orthop Belg 81:420–426PubMedGoogle Scholar
  13. 13.
    Singh D, Ferrero A, Rose B, Goldberg A, Cullen N (2015) Bone Marrow Edema Syndrome of the Foot and Ankle: Mid- to Long-Term Follow-up in 18 Patients. Foot Ankle Spec. 2015 Oct 12 [Epub ahead of print]Google Scholar
  14. 14.
    Ringe JD, Dorst A, Faber H (2005) Effective and rapid treatment of painful localized transient osteoporosis (bone marrow edema) with intravenous ibandronate. Osteoporos Int 16:2063–2068CrossRefPubMedGoogle Scholar
  15. 15.
    Klontzas ME, Vassalou EE, Zibis AH, Bintoudi AS, Karantanas AH (2015) MR imaging of transient osteoporosis of the hip: an update on 155 hip joints. Eur J Radiol 84:431–436CrossRefPubMedGoogle Scholar
  16. 16.
    Cahir JG, Toms AP (2008) Regional migratory osteoporosis. Eur J Radiol 67:2–10CrossRefPubMedGoogle Scholar
  17. 17.
    Davis KW (2009) Transient migratory osteoporosis or insufficiency fracture? J Clin Rheumatol 15:153CrossRefPubMedGoogle Scholar
  18. 18.
    Holzer I, Snir N, Ben-Galim P, Maman E, Rosenblatt Y, Dekel S (2009) Transient osteoporosis of the hip: long-term outcomes in men and nonpregnant women. Current Orthopaedic Practice 20:161–163CrossRefGoogle Scholar
  19. 19.
    Lakhanpal S, Ginsburg WW, Luthra HS, Hunder GG (1987) Transient regional osteoporosis. A study of 56 cases and review of the literature. Ann Intern Med 106:444–450CrossRefPubMedGoogle Scholar
  20. 20.
    Bircher C, Afors K, Bircher M (2012) Transient osteoporosis of the hip in pregnancy resulting in bilateral fracture of the neck of the femur. Int J Gynaecol Obstet 116:176–177CrossRefPubMedGoogle Scholar
  21. 21.
    Emami MJ, Abdollahpour HR, Kazemi AR, Vosoughi AR (2012) Bilateral subcapital femoral neck fractures secondary to transient osteoporosis during pregnancy: a case report. J Orthop Surg (Hong Kong) 20:260–262Google Scholar
  22. 22.
    Noorda RJ, van der Aa JP, Wuisman PI, David EF, Lips PT, van der Valk P (1997) Transient osteoporosis and osteogenesis imperfecta. A case report. Clin Orthop 337:249–255CrossRefPubMedGoogle Scholar
  23. 23.
    Karagkevrekis CB, Ainscow DA (1998) Transient osteoporosis of the hip associated with osteogenesis imperfecta. J Bone Joint Surg (Br) 80:54–55CrossRefGoogle Scholar
  24. 24.
    Young SD 3rd, Nelson CL, Steinberg ME (2008) Transient osteoporosis of the hip in association with osteogenesis imperfecta: two cases, one complicated by a femoral neck fracture. Am J Orthop (Belle Mead NJ) 37:88–91Google Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2016

Authors and Affiliations

  1. 1.UOC Ortopedia Ospedale Bolognini SeriateSeriateItaly
  2. 2.Scuola di Specialità in Ortopedia e TraumatologiaUniversità degli Studi Milano Bicocca AO BologniniSeriateItaly
  3. 3.Orthopedic Dept. Ospedale BologniniSeriateItaly

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