Single Dose Therapy of Zoledronic Acid for the Treatment of Transient Osteoporosis of Hip

OBJECTIVE: To shorten the natural course of transient osteoporosis of hip (TOH), which is a self-limiting idiopathic condition and requires 6–12 months for the resolution of symptoms, various therapies including treatment with bisphosphonates have been attempted. There exist fewer case reports evaluating the effect of bisphosphonates in TOH and most of them lack radiographic evidence of resolution of disease. The present study was carried out with an aim to evaluate the clinical and radiological outcomes of TOH patients subsequent to treatment with a single dose of zoledronic acid. METHODS: Data of 19 adult male and non-pregnant female patients with TOH treated with zoledronic acid were included in the study. Efficacy was assessed using changes in clinical signs and symptoms, visual analogue scale pain score, and changes in bone marrow edema (BME) in magnetic resonance imaging (MRI). RESULTS: Mean age of the patients was 42.1 years, 17 being males. The mean time of onset of symptom was 4 weeks. Subsequent to treatment, the patients were pain-free and had no limp within an average of 2.8 weeks (range, 2–5 weeks) and remained asymptomatic at a mean follow-up of 35 months (range, 6–54 months). The post-treatment MRI showed resolution of BME in approximately 84% (16/19) of patients at 3 months. No major adverse events were reported. None of the patients progressed to avascular necrosis at their last follow-up. CONCLUSION: Intravenous single dose administration of zoledronic acid provides early pain relief and complete reversal of TOH. Consequently, zoledronic acid is proposed as a new paradigm in the management of TOH.

Osteoporosis transitoria del embarazo: caso clínico / Transient osteoporosis of pregnancy: clinical case

La osteoporosis transitoria del embarazo es una entidad rara y autolimitada, de etiología desconocida. Se presenta el caso clínico de una mujer de 29 años que comenzó en semana 34 con un cuadro de dolor localizado en cadera derecha con impotencia funcional e inestabilidad en la bipedestación y dificultad para la marcha. Tras finalizar su gestación en semana 39 con un parto eutócico sin complicaciones, se incrementó el cuadro doloroso durante el puerperio precoz, con bloqueo de rotación interna y externa de miembro inferior derecho a la exploración. En la radiografía y en la resonancia magnética se evidenció una fractura intracapsular desplazada de fémur derecho, que precisó corrección quirúrgica. A pesar del tratamiento quirúrgico, el cuadro empeoró, localizándose posteriormente también en el miembro contralateral. Las pruebas de imagen fueron compatibles con una osteoporosis transitoria de ambas caderas. La clínica remitió paralelamente a la resolución radiológica del cuadro de forma definitiva a los 8 meses.

The transient osteoporosis of pregnancy is a rare and self-limited disease with an unknown etiology. We present the case of a 29 years old woman, who started at the 34th week of pregnancy with focalised pain on the right hip, with functional disability and instability in standing and gait difficulty. During the 39th week of pregnancy after giving birth without complication, the pain increased during the early puerperium. The medical examination revealed that the internal and external rotation of the inferior limb was blocked. X-ray and MRI showed a displaced intracapsular fracture in the right femur, which needed a surgical correction. Despite of the treatment, the pain worsened and focalised itself also on the left hip. Imaging tests were consistent with transient osteoporosis of both hips. The pain eased in parallel with the radiological resolution of the osteoporosis until its permanent resolution after 8 months.

Treatment of Transient Osteoporosis of the Hip with Intravenous Zoledronate: A Case Report

Transient osteoporosis of the hip (TOH) is a rare disorder of unknown etiology that is characterized by acute onset of disabling bone pain. The locally increased bone turnover and low bone mineral density (BMD) associated with this disorder indicate a potential role for an antiresorptive agent such as bisphosphonate as a treatment. A previously healthy 46-year-old man developed the sudden onset of pain in his right buttock and inguinal area, especially during walking and caused him to limp. A thorough medical workup including X-ray, MRI, and bone SPECT revealed transient osteoporosis of the hip, and he was treated with an infusion of zoledronate (5 mg). Two weeks later, he was fully recovered from pain and the gait disturbance. A follow-up MRI of the hip joint taken after 6 months showed complete resolution. The use of intravenous zoledronate provided a successful outcome in the treatment of TOH. The possibility of TOH should be considered in patients complaining of sudden hip pain and a limping gait. MR imaging played an important role for differentiation of TOH from other aggressive conditions with long term sequelae.

CT Evidence for Subchondral Trabecular Injury of the Femoral Head in Transient Osteoporosis of the Hip: A Case Report

A 28-yr-old woman presented with both hip pain that started sequentially during the peripartum period. Diagnosis of transient osteoporosis of the hip (TOH) was made based on typical findings of plain radiographs and magnetic resonance images. The subchondral trabeculae of the femoral head were evaluated on serially taken coronal multiplanar reformation computerized tomogram images. At 4 weeks after pain onset, marked decrease in the sclerotic density with irregular discontinuation was observed in the primary compression trabeculae. At 12 weeks, a focal area of irregular thickening of trabeculae was observed. At 20 weeks, sclerotic density of trabeculae recovered markedly and the focal area of irregular trabecular thickening disappeared. At 1 yr, subchondral trabeculae recovered almost completely. The evidence of subchondral trabecular injury was observed in the femoral heads of TOH.

The 1 Case Report of the Transient Osteoporosis of the Hip / 대한정형외과학회잡지

Transient osteoporosis of the hip is a self-limited condition of uncertain etiology and pathogenesis that affects young and middle aged adults. Even its clinical features are similar to the features of osteonecrosis the prognosis and clinical end result are quite different. So differential diagnosis between the two is very important. We present a case of transient osteoporosis of the hip in middle aged man, which was completely reeovered after conservative treatment.