Transient Osteoporosis Of The Hip Research Articles

Transient osteoporosis of the hip in pregnancy

Transient osteoporosis of the hip is an uncommon bone marrow oedema syndrome of unknown pathophysiology affecting previously healthy pregnant women and young to middle-aged men. The disorder is characterised by hip pain, reduced mobility, and the risk of fracture, which is significantly higher in pregnant than in non-pregnant individuals. Diagnosis is by magnetic resonance imaging. Other than a single case-control study, published literature is limited to case series and case reports, with no evidence to guide management, risk of fracture, mode of delivery, safety of breastfeeding and risk of recurrence. An international pregnancy registry may be useful to try to answer some of these questions.

Presence of subchondral fracture in cases diagnosed as transient osteoporosis of the hip: a retrospective independent reader-based study.

Transient osteoporosis of the hip (TOH) is an uncommon, typically self-limited diagnosis of uncertain etiology. We hypothesize that TOH represents an underlying subchondral fracture, and a discrete fracture line can often be detected on high-resolution MRI. A retrospective PACS query identified patients meeting imaging criteria for TOH with intense bone marrow edema (BME) in the femoral head on MRI. Those with poor quality studies, other underlying pathologies, or antecedent trauma were excluded. Three musculoskeletal radiologists independently reviewed each case for presence of a definite subchondral fracture line on small field of view (FOV) MR images of the affected hip. Extent of BME, reciprocal acetabular BME, and joint effusion size were also recorded. Binomial logistic regression was performed to determine statistically significant predictors of subchondral fracture. Fifty patients met inclusion criteria (29 females, 0 pregnant). Mean age was 62±12 years (range 35-84). Average duration of symptoms before MRI was 102±135 days. Ten patients had bone densitometry within 2 years of MRI, six demonstrating osteopenia or osteoporosis. Subchondral fractures were unanimously identified in 44/50 (88%). Interclass correlation coefficient with absolute agreement was 0.73, 95% CI (0.57-0.84), indicating near-excellent agreement. Most cases demonstrated a large joint effusion (23/50, 46%) and acetabular BME (31/50, 62%). Increasing size of joint effusion was a statistically significant predictor of subchondral fracture (p=0.05), with 6.9 higher odds. There was a strong correlation with osteopenia/osteoporosis and fracture (p<0.001). Discrete subchondral fractures were identified unanimously on small FOV imaging in the majority of TOH cases.

The correlation between transient osteoporosis of the hip and pregnancy: A review.

Transient osteoporosis of the hip is indubitably a comparatively infrequent entity affecting both men and women worldwide. Its occurrence in the course of pregnancy, specifically in the third trimester, and lactation are of paramount concernment. The exact association between transient hip osteoporosis and pregnancy is precarious. Etiology and potential pathophysiological mechanisms behind this correlation are still to be utterly defined. Magnetic resonance imaging is highly regarded as the gold standard imaging method for assiduous assessment of this disorder. Physicians of copious medical specialties should practice scrupulous techniques for early and pertinent diagnosis when pregnant women are presented with persistent hip pain, as differential diagnosis with femoral head avascular necrosis can be exceedingly arduous. Treatment is predominantly conservative with protected weight-bearing and analgesic medication in the first line of management. In terms of prognosis, the disease ordinarily resolves spontaneously after a few months. Further research is required in order to elucidate the ambiguity surrounding the establishment of globally approved diagnosis and treatment guidelines for pregnancy-associated transient hip osteoporosis. This paper aims to accentuate the significance of this particular disorder by providing a succinct review of the existing literature, augmenting clinicians' knowledge about the features of pregnancy-related transient proximal femur osteoporosis.

THU439 Baby's Coming, Break A Leg! A Case Of Transient Osteoporosis Of The Hip

Abstract Disclosure: A. Khan: None. A. Syeda: None. H.B. Aftab: None. Introduction: Pregnancy-associated osteoporosis (PAO) is a rare condition presenting as fragility fractures usually in the latter part of pregnancy or immediate postpartum period. Vertebral fractures are more commonly reported but femoral fractures have also been described in the literature as a distinct entity: transient osteoporosis of the hip (TOH). We present a case of bilateral (B/L) femoral fractures in a woman during pregnancy and in the postpartum period. Case: A 31-year-old, gravida 1 female developed left leg pain at 26 weeks of gestation. The pain radiated from her left lower back to her left knee. It was severe in intensity resulting in her walking with crutches. Subsequent MRI of the left hip showed subchondral insufficiency fracture of the femoral head with prominent bone marrow edema extending from the head into the femoral neck. She was managed conservatively with non-weight bearing status and oral analgesics. She had an uncomplicated vaginal delivery at 39 weeks of gestation. During the first postpartum week she developed right hip pain. MRI of right hip revealed nondisplaced right femoral head subchondral insufficiency fracture with associated effusion and synovitis. She recovered within the next 3 months with resolution of her pain with conservative management. Other than limited calcium intake in childhood, there were no other identifiable risk factors for osteoporosis. Bone density scan revealed normal Z-scores at the lumbar spine and non-dominant wrist. The hips were not evaluated. Workup for secondary causes of osteoporosis was unremarkable including normal serum calcium, PTH, phosphorus, magnesium, SPEP, tissue transglutaminase antibodies, estradiol, LH, FSH, prolactin levels. However, 24-hour urine calcium level was low at 11 (35-250) mg/24hr. Elevated levels of bone specific alkaline phosphatase and urine N-telopeptide (NTX) were noted at 19.9 (5.3-19.5) mcg/L and 110 (4-64) nM BCE/mM creatinine, respectively. Patient was continued on vitamin D and calcium supplements. She breastfed for the initial 2 months but was advised to stop. At her most recent follow up visit 4 months postpartum patient was doing well. Discussion: TOH is a rare entity, and presentation as B/L femoral fractures is exceedingly rare. During pregnancy and lactation, the skeletal system undergoes bone loss to compensate for the calcium demand of the fetal skeletal system. In TOH, venous stasis from the gravid uterus resulting in bone marrow edema is the proposed mechanism in addition to pregnancy associated bone loss. In our patient, a low 24-hr urine calcium could suggest low calcium intake which could have contributed to the fracture as well. While recurrence of PAO has been described, no recurrence of TOH has been reported in subsequent pregnancies. Our case highlights the importance of keeping this rare entity on the differential in pregnant women presenting with back or hip pain. Presentation: Thursday, June 15, 2023

P01 An unusual case of pregnancy associated osteoporosis presenting with bilateral neck of femur fractures

Abstract Introduction Pregnancy- and lactation-associated osteoporosis (PAO) is a rarely observed condition of skeletal fragility. We present the case of a patient diagnosed with PAO after sustaining bilateral femoral neck fractures one day postpartum. PAO usually presents with vertebral fractures in the third trimester or early postpartum. Femoral fractures are rare, making our case more unusual. PAO is considered a separate entity from transient osteoporosis of the hip (TOH) which is another uncommon cause of hip fracture in pregnancy. Our patient had clinical and imaging features compatible with TOH but with evidence of generalised osteoporosis on DEXA, supporting a diagnosis of PAO. Case description Our 35-year-old primigravida has a past medical history of anxiety, depression and schizoaffective disorder. She had been taking high dose sodium valproate for 8 years prior to pregnancy. From the 26th week of her pregnancy she experienced severe and progressive hip and pelvic pain which limited her mobility. She required crutches to mobilize short distances and spent significant periods of time in a wheelchair. Her symptoms were attributed to pubic symphysis dysfunction and managed conservatively. An elective caesarean section was carried out at 37 + 4 weeks. Day one postpartum her leg gave way causing her to trip in the shower and she experienced a sudden and severe worsening of pain. X-ray revealed a displaced subcapital right femoral neck fracture. MRI confirmed this and showed an additional non-displaced left intracapsular femoral neck insufficiency fracture. She underwent a right total hip replacement and left sided dynamic hip screw fixation. Blood tests showed normal calcium, phosphate and parathyroid hormone. Vitamin D was 47 ng/ml. TTG antibody was negative. An X-ray of her whole spine excluded any vertebral fractures. Genetic tests for osteogenesis imperfecta were negative. DEXA showed severe osteoporosis in her spine with a T score ranging from −3.7 to −4.1. Her low bone mineral density (BMD) was thought to be due to a combination of relative immobility, long term sodium valproate treatment and PAO. She was discharged with oral calcium and vitamin D supplementation and advised not to breastfeed. She recovered well and now mobilises independently. She has not sustained any further fractures. Her sodium valproate dose was significantly reduced without worsening of her psychiatric symptoms. Repeat DEXA one year later showed a 10% improvement in BMD at her spine. She now takes high dose vitamin D monotherapy with an aim to keep her vitamin D level above 75 ng/ml. Discussion During pregnancy, the foetus has high calcium demands, especially in the third trimester when mineralisation of the fetal skeleton occurs. If the maternal adaptations to meet this demand are insufficient, the risk of maternal skeletal resorption increases. Studies have shown a transient reduction in maternal bone mass during pregnancy and lactation. Women presenting with PAO are often found to have pre-existing conditions or risk factors for reduced BMD. We focused on addressing our patient’s main modifiable risk factor by reducing her sodium valproate dose. The evidence base for treatment of PAO is lacking and there is no consensus on the best way to manage this condition. Spontaneous improvement in BMD is known to occur in the months following pregnancy and lactation as we observed in our case. Most women are offered calcium and vitamin D supplementation and advised to avoid breast feeding, as our patient was. Bisphosphonates, denosumab, strontium ranelate and teriparatide have all been tried in individual cases as there is suggestion that these agents may increase BMD more than calcium and vitamin D supplementation alone. However, some experts feel that safety concerns around the use of bisphosphonates during reproductive years outweigh any potential benefits. PAO usually presents with back pain and/or height loss due to vertebral fractures which are typically multiple. TOH is considered a separate condition which usually presents with acute onset of pelvic, hip or groin pain due to femoral head oedema. The symptoms are severe, progressive and typically affect mobility. In extreme cases fractures may occur. These are usually unilateral but are occasionally bilateral femoral fractures. The gold standard for diagnosis is with MRI which demonstrates oedema of the femoral head and may show an associated joint effusion. This would fit with the clinical history and imaging findings for our patient. Key learning points PAO is a rare cause of fragility fractures with an estimated incidence of 4 cases per million pregnancies quoted in the literature. It is important to consider it as a possible cause of hip and pelvic pain in pregnancy. Our patient’s presentation was particularly unusual as there are only a handful of cases in the literature of hip fracture occurring in PAO, bilateral fractures being more uncommon still. One of the issues for discussion highlighted by this case is the difficulty in knowing how to treat women presenting with fragility fractures due to PAO. Studies have been limited by the rarity of the condition. None of the anti-resorptive or anabolic agents used in osteoporosis are licensed for PAO so the decision to use them needs to be individualized and should consider the potential risks of these treatments in women of child-bearing age. When these agents have been trialed for PAO they have been discontinued prior to any subsequent pregnancies. Cases of shortened gestational age, low birthweight and transient neonatal hypocalcaemia have been observed but no serious adverse maternal or fetal events to date. Another key discussion point in this case relates to the similarities and differences between the two conditions of PAO and TOH which are both rare causes of fragility fractures. In case reports of TOH, BMD measurement by DEXA has often not been reliably carried out. The diagnosis is commonly made by clinical history and MRI appearances alone. In cases where DEXA has been done it usually demonstrates regional osteoporosis in the affected hip(s) with near normal spinal BMD. However, some cases of TOH report significant generalised osteoporosis in addition which makes distinguishing between these two conditions even more challenging. Thankfully, both conditions generally have a favorable prognosis, as we found with our case.

Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis.

The optimal management of pregnancy and lactation-associated osteoporosis (PLO) has not been designated. To systematically review the best available evidence regarding the effect of different therapeutic interventions on bone mineral density (BMD) and risk of fractures in these patients. A comprehensive search was conducted in PubMed/Scopus databases until December 20, 2022. Data were expressed as weighted mean difference (WMD) with 95% CI. The I2 index was employed for heterogeneity. Studies conducted in women with PLO who received any antiosteoporosis therapy were included. Studies including women with secondary causes of osteoporosis or with transient osteoporosis of the hip were excluded. Data extraction was independently completed by 2 researchers. Sixty-six studies were included in the qualitative analysis (n = 451 [follow-up time range 6-264 months; age range 19-42 years]). The increase in lumbar spine (LS) BMD with calcium/vitamin D (CaD), bisphosphonates, and teriparatide was 2.0% to 7.5%, 5.0% to 41.5%, and 8.0% to 24.4% at 12 months, and 11.0% to 12.2%, 10.2% to 171.9%, and 24.1% to 32.9% at 24 months, respectively. Femoral neck (FN) BMD increased by 6.1% with CaD, and by 0.7% to 18% and 8.4% to 18.6% with bisphosphonates and teriparatide (18-24 months), respectively. Meta-analysis was performed for 2 interventional studies only. Teriparatide induced a greater increase in LS and FN BMD than CaD (WMD 11.5%, 95% CI 4.9-18.0%, I2 50.9%, and 5.4%, 95% CI 1.2-9.6%, I2 8.1%, respectively). Due to high heterogeneity and lack of robust comparative data, no safe conclusions can be made regarding the optimal therapeutic intervention in women with PLO.

A Molecular Troika of Angiogenesis, Coagulopathy and Endothelial Dysfunction in the Pathology of Avascular Necrosis of Femoral Head: A Comprehensive Review.

Avascular necrosis of the femoral head (ANFH) is a painful disorder characterized by the cessation of blood supply to the femoral head, leading to its death and subsequent joint collapse. Influenced by several risk factors, including corticosteroid use, excessive alcohol intake, hypercholesterolemia, smoking and some inflammatory disorders, along with cancer, its clinical consequences are thrombus formation due to underlying inflammation and endothelial dysfunction, which collaborates with coagulopathy and impaired angiogenesis. Nonetheless, angiogenesis resolves the obstructed free flow of the blood by providing alternative routes. Clinical manifestations of early stage of ANFH mimic cysts or lesions in subchondral bone, vasculitis and transient osteoporosis of the hip, rendering it difficult to diagnose, complex to understand and complicated to cure. To date, the treatment methods for ANFH are controversial as no foolproof curative strategy is available, and these depend upon different severity levels of the ANFH. From an in-depth understanding of the pathological determinants of ANFH, it is clear that impaired angiogenesis, coagulopathy and endothelial dysfunction contribute significantly. The present review has set two aims, firstly to examine the role and relevance of this molecular triad (impaired angiogenesis, coagulopathy and endothelial dysfunction) in ANFH pathology and secondly to propose some putative therapeutic strategies, delineating the fact that, for the better management of ANFH, a combined strategy to curtail this molecular triangle must be composed rather than focusing on individual contributions.

Transient osteoporosis of the hip in pregnancy – a case series

Objective Transient Osteoporosis of the Hip is a self-limiting disorder of severe hip joint pain presenting in pregnancy or postpartum, of which magnetic resonance imaging (MRI) is the modality of choice for diagnosis. Clinical data regarding transient osteoporosis of the hip is limited, precluding evidence-based decision-making such as recommended mode of delivery. In this case-series retrospective study, we aim to describe the natural course of transient osteoporosis of the hip during pregnancy and the postpartum period including implications of the mode of delivery. Methods All women diagnosed with unilateral/bilateral transient osteoporosis of the hip by MRI during pregnancy or postpartum between 2010 and 2019 at a single tertiary medical center were retrospectively studied. All MRI scans were reviewed by an experienced radiologist at the same single tertiary medical center. Data obtained from patients’ electronic medical records and telephone questionnaires included maternal baseline characteristics, obstetric history, and current pregnancy obstetric and clinical outcome characteristics. Outcomes of normal vaginal delivery (NVD) and cesarean delivery (CD) were compared and analyzed. Results Thirty-four women were diagnosed with unilateral or bilateral transient osteoporosis of the hip during pregnancy (17 women) and postpartum (17 women). The mean maternal age was 34.18 ± 4.75 years. A family history of osteoporosis was reported in a rate of 29.4%. The rate of smokers was 47.1%, 32.4% of pregnancies were conceived by in-vitro fertilization (IVF), pre-pregnancy and term body mass index (BMI) were 22.03 and 27.6, respectively. No significant differences were found between NVD and CD in all parameters evaluated. Of 15 women with a sequential pregnancy, two were diagnosed with transient osteoporosis of the hip (13.3%) Conclusion Women diagnosed with transient osteoporosis of the hip had advanced maternal age, low BMI, family history of osteoporosis, prevalent smoking and IVF pregnancies. Transient osteoporosis of the hip was bilateral in 25% and presented postpartum in 50% of cases. There was no significant difference in maternal outcomes between NVD and CD. Higher awareness of this potential diagnosis during pregnancy and postpartum may improve patient management and outcomes.

Transient osteoporosis of the hip in pregnancy

Transient osteoporosis of the hip in pregnancy

Transient osteoporosis of the hip during pregnancy: Report of two clinical cases

Transient osteoporosis of the hip is a self limiting condition that is difficult to diagnose. It affects both men and pregnant women. The purpose of this article is to show two clinical cases that underwent two different treatments. Early diagnosis can indeed avoid surgical treatment.

Prevalence of Transient Osteoporosis of the Hip Among Patients Presenting With Hip Pain in a Major Tertiary Hospital in Saudi Arabia.

Transient osteoporosis of the hip, or acute bone marrow edema syndrome, is a rare condition characterized by a decrease in bone mineral density of the proximal femur, which resolves with conservative management over 6-24 months. At presentation, the patient complains of sudden onset of localized pain in the hip, which is aggravated by weight-bearing. However, the prevalence and risk factors for this condition are still unclear. Objective: This study aims to identify the prevalence of transient osteoporosis of the hip among patients who present with hip pain and underwent magnetic resonance imaging of the hip. This is a retrospective investigation that involved collecting data from patients' records in a tertiary hospital in Saudi Arabia. Included candidates were patients who presented with hip pain, had an MRI done between 2016 and 2019 inclusive, and were older than 14 years. The collected data involved the age and gender of patients, the hip's affected side, and the diagnosis. Data analysis was executed through SPSS version 26 (IBM Corp., Armonk, NY). Three hundred and fourteen patients matched our inclusion criteria. The prevalence of transient osteoporosis of the hip was 2.5%. All of them were males and half were above 40 years, 50% had pain in the left side, and 75% had a small joint effusion. The femoral head was the most affected part of the joint in patients with transient osteoporosis of the hip. Among our patients, the most common cause of hip pain was gluteus medius tendonitis (12.9%), where 33.1% of patients with hip pain had normal examination and investigations, and 15.2% had more than one condition. Risk factors for transient osteoporosis of the hip are pain in the left hip joint (p-value=0.023) and an age between 41 and 50 years (p-value=0.012). The prevalence of transient osteoporosis of the hip is low, yet it requires confirmation by studies with a more robust design. Males older than 40 years and left-side hip pain are at higher risk.

Transient Osteoporosis of the Hip: A Case Report of a U.S. Soldier.

Transient osteoporosis of the hip is described as an uncommon, self-limiting condition that typically affects middle-aged men and pregnant women in their third trimester. Transient osteoporosis most commonly affects the hip, but cases have been described in the knee, ankle, and foot. Symptoms include pain, limited range of motion, and antalgic gait. A greater level of awareness of transient osteoporosis of the hip as a differential diagnosis for hip pain will obviate unnecessary, inefficient, or unproductive interventions and treatments. Transient osteoporosis of the hip is a self-limiting disease process that requires only symptomatic treatment such as basic analgesia, physical therapy, and activity modification. On average, recovery is seen within 6-12 months.

Transient osteoporosis of the hip: a novel vascular manifestation of COVID-19?

Transient osteoporosis of the hip: a novel vascular manifestation of COVID-19?

Deep Learning for the Differential Diagnosis between Transient Osteoporosis and Avascular Necrosis of the Hip.

Differential diagnosis between avascular necrosis (AVN) and transient osteoporosis of the hip (TOH) can be complicated even for experienced MSK radiologists. Our study attempted to use MR images in order to develop a deep learning methodology with the use of transfer learning and a convolutional neural network (CNN) ensemble, for the accurate differentiation between the two diseases. An augmented dataset of 210 hips with TOH and 210 hips with AVN was used to finetune three ImageNet-trained CNNs (VGG-16, InceptionResNetV2, and InceptionV3). An ensemble decision was reached in a hard-voting manner by selecting the outcome voted by at least two of the CNNs. Inception-ResNet-V2 achieved the highest AUC (97.62%) similar to the model ensemble, followed by InceptionV3 (AUC of 96.82%) and VGG-16 (AUC 96.03%). Precision for the diagnosis of AVN and recall for the detection of TOH were higher in the model ensemble compared to Inception-ResNet-V2. Ensemble performance was significantly higher than that of an MSK radiologist and a fellow (P < 0.001). Deep learning was highly successful in distinguishing TOH from AVN, with a potential to aid treatment decisions and lead to the avoidance of unnecessary surgery.

Neridronate for transient osteoporosis of the hip in a child

Transient osteoporosis of the hip (TOH) is usually reported in middle-aged men or during pregnancy as a benign self-limiting condition. Nevertheless, its impact on quality of life in terms of pain and disability is considerable. Also, it can lead to insufficiency fractures or, more rarely, evolve into osteonecrosis. This condition is anecdotally described in the pediatric age and very little is known about how it may affect the growing bone. We herein describe a case of TOH in a 10-year-old child treated at our pediatric rheumatology service and summarize the pediatric cases of TOH previously reported in literature. There are two points of interest in our case report, the first one being the unusual complication of TOH with a femoral physis fracture and the second the complete recovery after the off-label therapy with bisphosphonates. We suggest that interventional medical treatment could be considered in selected cases of juvenile TOH, to prevent any possible irreversible damage on the femoral physis. As far as we know, this is the first report of neridronate employment in children affected by TOH.

Transient osteoporosis of the hip in an old woman: a case report

Transient osteoporosis of the hip is a rare disease. It mainly affects pregnant women during the third trimester and also adult men. We report the case of an elderly patient who presented this rare pathology. A 65-year-old woman, with type 2 diabetes, with no other medical history, developed over the course of two months mechanical pain in the right hip joint with progressive loss of function, she had no fever and no other rheumatologic sign. She didn’t complain of weight loss or asthenia. Laboratory tests revealed the following results: normal erythrocyte sedimentation rate (ESR): 21mm/h, normal CRP 3.2 mg/l, a deficiency in 25-hydroxy-vitamin D: 18 µg/ml (normal > 30µg/ml). Full blood counts, liver function, renal function, parathyroid hormone and bone remodelling tests were within normal limits. Anteroposterior X-rays of the pelvis and hips showed no anomaly. The ultrasounds of hips showed synovial thickening without joint effusion at the right hip. Magnetic resonance imaging (MRI) of the pelvis showed diffuse homogenous low intensity signal on T1-weighted images and high intensity T2-weighted images of the right femoral head and neck which demonstrate a diffuse bone edema of the head and neck of the right femur, there was no sign of osteonecrosis or stress fracture of the subchondral bone. The diagnosis of Transient osteoporosis of the right hip was retained. A conservative treatment was prescribed, we recommended rest to reduce the load on the femoral head. The use of walking aid device was necessary. Physiotherapy was initiated to reduce pain. Tramadol 100 mg per day, intravenous zoledronic acid 5mg, calcium and Vitamin D were prescribed. The patient was improved and pain free by the fourth week of treatment and she could walk without crutches and up to 01 kilometers without pain or discomfort. Transient osteoporosis of the hip is a rare entity to be considered in old women. The diagnosis is based on MRI findings. This pathology need to be distinguished from avascular necrosis of the femur.

Displaced femoral neck fracture in a pregnant patient diagnosed with transient osteoporosis of the hip.

Transient osteoporosis of pregnancy (TOP) is a self-limiting pathology with unspecified etiology. It is typically found in women in late pregnancy or early postpartum. A femoral neck fracture is an infrequent complication. Herein, we describe a TOP case in a 38-year-old female who suffered a displaced sub-capital femoral neck fracture without obvious trauma at 28weeks of gestation. The patient underwent operative treatment using closed reduction and internal fixation (CRIF), using cannulated screws, with no intraoperative complications. The postoperative radiograph revealed a collapse and further displacement of the femoral neck. A decision was made to postpone a definitive treatment to a postpartum date. The patient underwent a cesarean section at 38-week of gestation with no complications. At her latest follow-up, 24months postoperatively, the patient was asymptomatic. Pelvic and hip radiographs demonstrated consolidation of the fracture. Level of evidence: IV.

Bilateral transient osteoporosis of the hip during pregnancy: Two cases and a literature review

Bilateral transient osteoporosis of the hip during pregnancy: Two cases and a literature review

Efficacy of intravenous neridronate in transient osteoporosis of the hip.

To evaluate the efficacy and safety of intravenous (iv) neridronate in patients affected by transient osteoporosis of the hip (TOH). We retrospectively evaluated the clinical records of patients affected by TOH treated with iv neridronate in our department. We treated patients with a value of visual analogue scale (VAS)-pain ≥ 80/100 mm at diagnosis, limited range of movement and magnetic resonance images (MRI) findings suggestive of TOH. The regimen used was: one iv infusion at day 0, 3, 6, 9 (100 mg for each infusion: total of 400 mg). This protocol was repeated in refractory cases. Recovery was defined as VAS-pain level ≤20/100. Concomitant use of analgesics was allowed. Paired Student t-test was used to assess VAS-pain change. Five patients were male, 3 were female. Mean age was 54.5±2.12 years old. Mean body mass index was 26.57±2.22. Mean time to diagnosis, since the onset of the symptoms, was 75±21.21 days. Mean number of neridronate infusions was 7.5±2.56. Mean time of recovery was 57±45.96 days. Mean VAS-pain at baseline was 84±2,24. Mean VAS-pain after treatment was significantly reduced (p<0.001) with a value of 12.12±6.46. None of the patients needed analgesics after treatment. No adverse event was reported. In 5 cases, post-treatment MRI showed complete bone marrow oedema resolution. Intravenous neridronate is effective and safe in the treatment of TOH and its use may lead to a faster resolution of the disease.

Hip avascular necrosis in a healthy pregnant woman: A case report and review of literature.

BackgroundHip pain during pregnancy is very common, but hip avascular necrosis represents a very rare entity.Case reportWe report a rare case of a healthy30-year-old female patient pregnant with twins, that suffered right hip avascular necrosis in the peripartum period, her symptoms were initially neglected as a benign cause of hip pain, this led to aggressive treatment at a young age.DiscussionWith less than 100 cases reported in the literature, pregnancy is not a well-known risk factor for femoral head avascular necrosis and it should be differentiated from one of the more common hip pathologies in pregnancy which is the so-called “Pelvic pain syndrome” and transient osteoporosis of the hip.ConclusionHaving a high index of suspicion and low threshold for MRI imaging in a pregnant woman with hip pain is a must to prevent such complications.