Transient Primary Bone Marrow Edema Syndrome - A Synthesis

Abstract

A complex and often confusing nomenclature is currently used for relatively rare syndromes characterized by sudden onset of joint pain in the lower limbs, absence of trauma, bone marrow edema and its resolution, both confirmed by the MRI, as well as a self-limiting course. These include transient osteoporosis of the hip (TOH), of the knee (TOK), of the foot and ankle and transient bone marrow edema syndrome. Our purpose was to review the literature in order to substantiate the hypothesis that these apparently different conditions may be synthesized into a single disease entity, termed transient primary bone marrow edema syndrome (TPBMES). Of a total of 546 patients scrutinized, 342 had TOH, 105 had TOH of pregnancy, and 49, mainly females, showed transient foot-and-ankle osteoporosis. TPBMES occurred also with systemic osteoporosis or in a migratory pattern. The six proposed subsets of TPBMES have in common a MRI-based diagnosis and remission, as well as a self-limiting course. Thus, the hypothesis of a single disease entity is sustainable. We conclude that the education of the medical profession regarding this rare disease should expand. The causes of the prolonged symptoms seen in the systemic osteoporosis and migratory subsets warrant further studies. The efficiency of our suggested modality of management should be validated in a large cohort.