Skip to main content

Bone marrow edema syndrome

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

References

  1. 1.

    Curtiss PH Jr, Kincaid WE. Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am 1959; 41: 1327–1333.

    PubMed  Google Scholar 

  2. 2.

    Hofmann S, Kramer J, Vakil-Adli A, Aigner N, Breitenseher M. Painful bone marrow edema of the knee: differential diagnosis and therapeutic concepts. Orthop Clin N Am 2004; 35: 321–333.

    Article  Google Scholar 

  3. 3.

    Lakhanpal S, Ginsburg WW, Luthra HS, Hunder GG. Transient regional osteoporosis. A study of 56 cases and review of the literature. Ann Intern Med 1987; 106: 444–450.

    PubMed  CAS  Google Scholar 

  4. 4.

    Hofmann S, Engel A, Neuhold A, Leder K, Kramer J, Plenk H Jr. Bone-marrow oedema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression. J Bone Jt Surg Br 1993; 75: 210–216.

    CAS  Google Scholar 

  5. 5.

    Koo KH, Dussault R, Kaplan PA, et al. Age-related marrow conversion in the proximal metaphysis of the femur: evaluation with T1-weighted MR imaging. Radiology 1998; 206: 745–748.

    PubMed  CAS  Google Scholar 

  6. 6.

    Trevisan C, Ortolani S. Bone loss and recovery in regional migratory osteoporosis. Osteoporos Int 2002; 13: 901–906.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Rosen RA. Transitory demineralization of the femoral head. Radiology 1970; 94: 509–512.

    PubMed  CAS  Google Scholar 

  8. 8.

    Zanetti M, Bruder E, Romero J, Hodler J. Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 2000; 215: 835–840.

    PubMed  CAS  Google Scholar 

  9. 9.

    Hofmann S, Kramer J, Breitenseher M, Pietsch M, Aigner N. The painful bone marrow edema in the knee: differential diagnosis and therapeutic possibilities. Orthopade 2006; 35: 463–477.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Beltran J, Shankman S. Magnetic resonance imaging of bone marrow disorders of the knee. Magn Reson Imaging Clin N Am 1994; 2: 463–473.

    PubMed  CAS  Google Scholar 

  11. 11.

    Noorda RJ, van der Aa JP, Wuisman PI, David EF, Lips PT, van der Valk P. Transient osteoporosis and osteogenesis imperfecta. A case report. Clin Orthop Relat Res 1997; 337: 249–255.

    PubMed  Article  Google Scholar 

  12. 12.

    Funk JL, Shoback DM, Genant HK. Transient osteoporosis of the hip in pregnancy: natural history of changes in bone mineral density. Clin Endocrinol 1995; 43: 373–382.

    Article  CAS  Google Scholar 

  13. 13.

    Berger CE, Kroner AH, Minai-Pour MB, Ogris E, Engel A. Biochemical markers of bone metabolism in bone marrow edema syndrome of the hip. Bone 2003; 33: 346–351.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Parker RK, Ross GJ, Urso JA. Transient osteoporosis of the knee. Skeletal Radiol 1997; 26: 306–309.

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Toms AP, Marshall TJ, Becker E, Donell ST, Lobo-Mueller EM, Barker T. Regional migratory osteoporosis: a review illustrated by five cases. Clin Radiol 2005; 60: 425–438.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Horiuchi K, Shiraga N, Fujita N, Yamagishi M, Yabe H. Regional migratory osteoporosis: a case report. J Orthop Sci 2004; 9: 178–181.

    PubMed  Article  Google Scholar 

  17. 17.

    Eustace S, Keogh C, Blake M, Ward RJ, Oder PD, Dimasi M. MR imaging of bone oedema: mechanisms and interpretation. Clin Radiol 2001; 56: 4–12.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    van de Berg BC, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE. Idiopathic bone marrow edema lesions of the femoral head: predictive value of MR imaging findings. Radiology 1999; 212: 527–535.

    Google Scholar 

  19. 19.

    Karantanas AH, Drakonaki E, Karachalios T, Korompilias AV, Malizos K. Αcute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome. Eur J Radiol 2008; 67: 22–33.

    PubMed  Article  Google Scholar 

  20. 20.

    Karantanas AH, Nikolakopoulos I, Korompilias AV, Apostolaki E, Skoulikaris N, Eracleous E. Regional migratory osteoporosis in the knee: MRI findings in 22 patients and review of the literature. Eur J Radiol 2008; 67: 34–41.

    Article  Google Scholar 

  21. 21.

    Duncan H, Frame B, Frost H, Arnstein AR. Regional migratory osteoporosis. South Med J 1969; 62: 41–44.

    PubMed  CAS  Google Scholar 

  22. 22.

    Doury P. Bone marrow oedema, transient osteoporosis, and algodystrophy. J Bone Jt Surg Br 1994; 776: 993–994.

    Google Scholar 

  23. 23.

    Lakhanpal S, Ginsburg WW, Luthra HS, Hunder GG. Transient regional osteoporosis. A study of 56 cases and review of the literature. Ann Intern Med 1987; 106: 444–450.

    PubMed  CAS  Google Scholar 

  24. 24.

    Fazekas JE, Losada R, Fruauff AA, Ortiz O, Katz DS. Migratory transient osteoporosis of the hip occurring before and during pregnancy. J Women’s Imaging 2002; 4: 80–85.

    Article  Google Scholar 

  25. 25.

    Malizos KN, Zibis AH, Dailiana Z, Hantes M, Karahalios T, Karantanas AH. MR imaging findings in transient osteoporosis of the hip. Eur J Radiol 2004; 50: 238–244.

    PubMed  Article  Google Scholar 

  26. 26.

    Massara A, Orzincolo C, Prandini N, Trotta F. Transient regional osteoporosis. Reumatismo 2005; 57: 5–15.

    PubMed  CAS  Google Scholar 

  27. 27.

    Hogan CJ, Hurwitz SR. Treatment of complex regional pain syndrome of the lower extremity. J Am Acad Orthop Surg 2002; 10: 281–289.

    PubMed  Google Scholar 

  28. 28.

    Koch E, Hofer HO, Sialer G, Marincek B, von Schulthess GK. Failure of MR imaging to detect reflex sympathetic dystrophy of the extremities. AJR Am J Roentgenol 1991; 156: 113–115.

    PubMed  CAS  Google Scholar 

  29. 29.

    Steinberg ME, Steinberg DR. Avascular necrosis of the femoral head. In: Steinberg ME, editor. The hip and its disorders. Philadelphia: W. B. Saunders; 1991. p. 623–47.

    Google Scholar 

  30. 30.

    Turner DA, Templeton AC, Selzer PM, Rosenberg AG, Petasnick JP. Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions. Radiology 1989; 171: 135–140.

    PubMed  CAS  Google Scholar 

  31. 31.

    Soucacos PN, Xenakis TH, Beris AE, Soucacos PN, Georgoulis A. Idiopathic osteonecrosis of the medial femoral condyle. Classification and treatment. Clin Orthop Relat Res 1997; 341: 82–89.

    PubMed  Google Scholar 

  32. 32.

    Rafii M, Mitnick H, Klug J, Firooznia H. Insufficiency fracture of the femoral head: MR imaging in three patients. AJR Am J Roentgenol 1997; 168: 159–163.

    PubMed  CAS  Google Scholar 

  33. 33.

    Kim YM, Oh HC, Kim HJ. The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Jt Surg Br 2000; 82: 837–841.

    Article  CAS  Google Scholar 

  34. 34.

    Fujioka M, Kubo T, Nakamura F, et al. Initial changes of non-traumatic osteonecrosis of femoral head in fat suppression images: bone marrow edema was not found before the appearance of band patterns. Magn Reson Imaging 2001; 19: 985–991.

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Kubo T, Yamazoe S, Sugano N, et al. Initial MRI findings of nontraumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 1997; 15: 1017–1023.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Mitchell DG, Rao VM, Dalinka MK, et al. Femoral head avascular necrosis: correlation of MR imaging, radiographic staging, radionuclide imaging, and clinical findings. Radiology 1987; 162: 709–715.

    PubMed  CAS  Google Scholar 

  37. 37.

    Malizos KN, Karantanas AH, Varitimidis SE, et al. Osteonecrosis of the femoral head: etiology, imaging diagnosis and treatment. Eur J Radiol 2007; 63: 16–28.

    PubMed  Article  Google Scholar 

  38. 38.

    Iida S, Harada Y, Shimizu K, et al. Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis. AJR Am J Roentgenol 2000; 174: 735–743.

    PubMed  CAS  Google Scholar 

  39. 39.

    Ito H, Matsuno T, Minami A. Relationship between bone marrow edema and development of symptoms in patients with osteonecrosis of the femoral head. AJR Am J Roentgenol 2006; 186: 1761–1770.

    PubMed  Article  Google Scholar 

  40. 40.

    Karantanas AH. Acute bone marrow edema of the hip: role of MR imaging. Eur Radiol 2007; 17: 2225–2236.

    PubMed  Article  Google Scholar 

  41. 41.

    James SLJ, Panicek DM, Davies AM. Bone marrow oedema associated with benign and malignant bone tumours. Eur J Radiol 2008; 67:11–21.

    Article  Google Scholar 

  42. 42.

    Kim HK, Randall TS, Bian H, Jenkins J, Garces A, Bauss F. Ibandronate for prevention of femoral head deformity after ischemic necrosis of the capital femoral epiphysis in immature pigs. J Bone Jt Surg Am 2005; 87: 550–557.

    Article  Google Scholar 

  43. 43.

    Varenna M, Zucchi F, Binelli L, Failoni S, Gallazzi M, Siniqaqlia L. Intravenous pamidronate in the treatment of transient osteoporosis of the hip. Bone 2002; 31: 96–101.

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Aigner N, Petje G, Steinboeck G, Schneider W, Krasny C, Landsiedl F. Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost. An MRI-controlled investigation of a new method. J Bone Jt Surg Br 2001; 83: 855–858.

    Article  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Anastasios V. Korompilias.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Korompilias, A.V., Karantanas, A.H., Lykissas, M.G. et al. Bone marrow edema syndrome. Skeletal Radiol 38, 425–436 (2009). https://doi.org/10.1007/s00256-008-0529-1

Download citation

Keywords

  • Bone marrow edema
  • Regional migratory osteoporosis
  • Transient osteoporosis
  • Reflex sympathetic dystrophy
  • Osteonecrosis
  • MR imaging/diagnosis