Transient regional osteoporosis of the hip with extensive bone marrow edema (BME): Dramatic improvement after three months of Alendronate therapy

Yasser Emad,Yasser Ragab,Mariam Ahmed Saad,Johannes J Rasker

doi:10.1016/j.radcr.2021.05.066

Yasser Emad, Yasser Ragab + Show 2 more

Open Access

https://doi.org/10.1016/j.radcr.2021.05.066

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Abstract

Transient osteoporosis of the hip, also termed transient bone marrow edema, is a painful condition often occurring after trivial trauma. It can be diagnosed with MRI in patients whose radiographs are negative or inconclusive. In this case report we describe a 39-year-old female patient with this rare entity, who was successfully treated with oral Alendronate, active vitamin D and calcium supplementation combined with avoiding of weight bearing on the affected hip. She improved clinically within three months and on contrast enhanced MRI studies, as performed before and after treatment, complete regression of bone marrow edema was shown already after three months of treatment. The literature was reviewed regarding the pathophysiology of transient osteoporosis of the hip and the beneficial effects of Alendronate in this domain. The report is important because it will increase the awareness among clinicians and radiologists about this entity, as in neglected cases transient regional osteoporosis of the hip may progress to avascular necrosis with complete loss of hip function.

Highlights

Bone marrow edema (BME) is a radiological term describing a region with low signal intensity on T1-weighted magnetic resonance imaging (MRI) but with high signal intensity on T2 MRI or in short tau inversion recovery sequences [1,2]
BME can be encountered in diverse hip disorders in both adult and pediatric populations with different underlying etiologies like inflammatory arthropathy, transient osteoporosis of the hip (TOH), avascular necrosis (AVN), acute stress fractures, primary bone neoplasms, myeloproliferative bone marrow disorders, hemoglobinopathy, and infection
There is no consensus regarding the management of TOH; in case of persistent BME condition it may progress to AVN of the involved hip

Summary

Introduction

Bone marrow edema (BME) is a radiological term describing a region with low signal intensity on T1-weighted magnetic resonance imaging (MRI) but with high signal intensity on T2 MRI or in short tau inversion recovery sequences [1,2]. The current case report presents a female patient with TOH and extensive unilateral hip BME pattern that showed almost complete regression on follow-up MRI after 3 months of treatment with oral Alendronate Sodium 70 mg (Fosamax tablet, Merck research laboratories, United States). Careful clinical assessment indicated that the patient has a limping and antalgic gait pattern, as well as an inability to bear weight on the affected side and the right hip was painful on internal and external rotation. The patient was diagnosed as a case of unilateral TOH involving the right hip She was prescribed oral Alendronate 70 mg weekly, as well as calcium and active vitamin-D Alfacalcidol1mcg (One-Alpha Capsules; Leo Laboratories Limited, Ballerup, Denmark)supplements, and she was strictly advised to avoid full weight bearing on the affected right hip. The fact that the knee joint is innervated by branches of the femoral nerve anteriorly and branches of the sciatic, obturator, and saphenous nerves posteriorly explains why isolated knee pain can be the only symptom of hip diseases and is sometimes difficult to grasp

Discussion

Conclusions