Transient Osteoporosis Of The Hip Research Articles

Transient Osteoporosis of the Hip in Non-Pregnant Woman

Transient Osteoporosis of the Hip in Non-Pregnant Woman

Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2.

Pregnancy-associated osteoporosis (PAO) is a rare skeletal condition, which is characterized by a reduction in bone mineral density (BMD) in the course of pregnancy and lactation. Typical symptoms include vertebral compression fractures and transient osteoporosis of the hip. Since the etiology is not well understood, this prospective study was conducted in order to elucidate the relevance of pathogenic gene variants for the development of PAO. Seven consecutive cases with the diagnosis of PAO underwent a skeletal assessment (blood tests, DXA, HR-pQCT) and a comprehensive genetic analysis using a custom-designed gene panel. All cases showed a reduced BMD (DXA T-score, lumbar spine - 3.2 ± 1.0; left femur - 2.2 ± 0.5; right femur - 1.9 ± 0.5), while the spine was affected more severely (p < 0.05). The trabecular and cortical thickness was overall reduced in HR-pQCT, while the trabecular number showed no alterations in most cases. The genetic analysis revealed three novel mutations in LRP5, COL1A1, and COL1A2. Our data show that previously unrecognized monogenic bone disorders play an important role in PAO. Pregnancy should be considered a skeletal risk factor, which can promote the initial clinical onset of such skeletal disorders. The underlying increased calcium demand is essential in terms of prophylactic and therapeutic measures, which are especially required in individuals with a genetically determined low bone mass. The implementation of this knowledge in clinical practice can enable the partial recovery of the skeleton. Consistent genetic studies are needed to analyze the frequency of pathogenic variants in women with PAO.

Research progress on pathogenesis of temporary osteoporosis in hip

Transient osteoporosis of the hip(TOH) is classified as a type of bone marrow edema syndrome. TOH is lack of previous study and there is still controversy about his pathogenesis. In recent years, with the development of multi-discipline, such as imaging, pathology, molecular biology, the study has found that the pathological mechanism is complex, while its mechanism is still not clear, which need further research. This paper summarizes the research progress on the pathogenesis of TOH from neurogenic, osteonecrosis, abnormal vascular function, subchondral fracture, heredity and regional acceleration and son on.

Diagnostic Imaging of Pregnant Women - The Role of Magnetic Resonance Imaging.

SummaryBackgroundPresentation of magnetic resonance imaging (MRI) findings in pregnant women in the Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland.Material/MethodsForty-three symptomatic pregnant women underwent MRI between 9 and 33 weeks of gestation (mean of 23 weeks). Moreover, we included 2 pregnant women who underwent fetal MRI and had incidental abnormalities.ResultsIn 9 cases, we excluded the suspected brain abnormalities. In 4 cases, we found unremarkable changes in the brain without clinical significance. One patient was diagnosed with multiple sclerosis, one with cortical dysplasia, one with pineal hemorrhage and one with a brain tumor. On abdominal MRI, 2 patients had normal findings, one patient had colon cancer with a hepatic metastasis, one patient had a hepatic angioma, one patient had an extraadrenal pheochromocytoma, one patient had an abscess in the iliopsoas muscle, 9 patients had myomas, two patients had ovarian simple cysts, two endometrial cysts, three dermoid cysts, one patient had sacrococcygeal teratoma, one patient had a cystadenofibroma (partial borderline tumor), one patient had an androgenic ovarian tumor and two patients had hyperreactio luteinalis. One patient was diagnosed with transient osteoporosis of the hip and one with a stress fracture of the sacral bone.ConclusionsMagnetic resonance imaging is the best imaging modality for pregnant women. Although ultrasonography is the method of choice, doubtful cases as well as structures that cannot be examined with ultrasonography can be non-invasively evaluated with MRI.

Successful and Rapid Resolution of Transient Osteoporosis of the Hip (TOH) with Hyperbaric Oxygen Therapy (HBOT): A Case Report

Transient osteoporosis of the hip (TOH) is a condition that can cause severe and debilitating joint pain. It can be misdiagnosed as avascular necrosis of the hip (AVN). Hyperbaric oxygen therapy (HBOT) was given to a patient with severe hip pain and diagnosed with early AVN with the hopes of avoiding surgical intervention. Within 2 months, the clinical symptoms of hip pain completely resolved, and the diagnosis was changed to TOH. HBOT successfully reversed TOH, minimized the period of debilitation in this disorder and may hold promise in early AVN patients.

Transient osteoporosis of the hip with a contralateral delayed involvement

Transient osteoporosis of the hip with a contralateral delayed involvement

Transient Osteoporosis of the Hip: A Mysterious Cause of Hip Pain in Adults.

Background:Transient osteoporosis of the hip (TOH) is a poorly understood and forgotten clinical entity. The diagnosis is often delayed, and inappropriate treatment is provided, due to the lack of its awareness among the clinicians.Materials and Methods:Twelve patients (11 male and one female) within the age group of 35–50 years, were identified retrospectively from the hospital records between July 2011 and June 2015 who had evidence of TOH on clinical and radiological parameters.Results:All the patients were treated conservatively by nonweight bearing mobilization, anti-inflammatory drugs, bisphosphonates, calcium, and Vitamin D supplements. None of our patients had any symptoms after 6 months of conservative management. The disease did not progress, and there was no evidence of hip joint involvement in any of the cases. Plain radiographs were not diagnostic in the early detection of TOH. Magnetic resonance imaging was found to be highly specific and sensitive in diagnosing TOH. The clinical condition of TOH is characterized by its acute onset of hip pain in middle-aged people, and its symptoms are out of proportion to the radiological findings.Conclusion:The TOH is a nondestructive and self-limiting condition of the hip, which responds well to the conservative treatment. We believe that TOH could be a subset of complex regional pain syndrome type 1, as it has many similarities in clinical presentation and management. Awareness of this entity is important to the clinicians for an early diagnosis and to avoid unnecessary treatment for other mimicking conditions.

Radiological morphology variances of transient osteoporosis of the hip.

Although several morphological abnormalities or variances of the hip joint have been proposed to be associated with hip joint degeneration, few studies have investigated any radiological features in patients with transient osteoporosis of the hip (TOH). The purpose of this study is to evaluate the morphological variances of the hip joint in TOH patients radiographically. The TOH group consisted of 31 hips in 31 patients. Age- and gender-matched asymptomatic hips in patients with unilateral osteonecrosis of the femoral head were served as controls. Radiographs and MRI were utilized to examine the following parameters: acetabular dysplasia, acetabular overcoverage, acetabular retroversion, and asphericity of the femoral head-neck junction. Also, localization of the main bone marrow edema (BME) lesion was investigated. TOH patients had a significantly higher incidence of acetabular retroversion (52% with a positive cross-over sign and 29% with posterior wall deficiency) than the controls (13%, P=0.0023; 6%, P=0.043, respectively), which was also confirmed by smaller acetabular anteversion angles on axial MRI. In addition, TOH patients tended to show asphericity of the anterior femoral head-neck junction compared to controls (39% vs. 13%, P=0.040). In 90% of the TOH patients, the main BME lesion was located in the subchondral area of the superior portion of the femoral head, and 77% of the lesion were recognized as a band-like pattern in MRI. Acetabular retroversion and asphericity of the femoral head-neck junction were more commonly observed in TOH patients compared to controls. The main BME lesion was most frequently located in the superior portion of the femoral head.

Transient osteoporosis of the hip: review of the literature.

Transient osteoporosis of the hip (TOH) is a temporary clinical condition of unknown etiology which usually resolves with conservative therapy though may be complicated by fracture or progression to avascular necrosis (AVN). TOH may be slightly more prevalent in men but when it occurs in women, it is most often seen in the latter part of pregnancy. Though fracture is a rare complication of TOH when it occurs, it is most often associated with TOH occurring in pregnancy. Magnetic resonance imaging (MRI) is the best method to diagnosis TOH. Low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and homogenous pattern of edema (the femoral head and/or neck) with normal subchondral area are in favor of TOH. A shortened course to recovery is reported by use of bisphosphonates, calcitonin, or teriparatide. Based on reported cases, core decompression is not superior to medical therapy. Transient osteoporosis of the hip, which often has no known etiology, usually resolves with conservative therapy but may predispose the patient to fracture or avascular necrosis. Diagnostic method of choice is magnetic resonance imaging. Bisphosphonates, calcitonin, or teriparatide are reported as a useful approach to reduce duration of recovery.

Regional osteoporosis due to osteoclast activation as a trigger for the pain-like behaviors in tail-suspended mice.

Pathological conditions with refractory skeletal pain are often characterized by regional osteoporotic changes such as transient osteoporosis of the hip, regional migratory osteoporosis, or complex regional pain syndrome (CRPS). Our previous study demonstrated that the acidic microenvironment created by osteoclast activation under high bone turnover conditions induced pain-like behaviors in ovariectomized mice through the stimulation of acid-sensing nociceptors. The aim of the present study was to examine whether regional transient osteoporotic changes are related to pain-like behaviors in the hind limb using tail-suspended model mice. The hind limbs of tail-suspended mice were unloaded for 2 weeks, during which time the mice revealed significant regional osteoporotic changes in their hind limbs accompanied by osteoclast activation. In addition, these changes were significantly recovered by the resumption of weight bearing on the hind limbs for 4 weeks. Consistent with the pathological changes in the hind limbs, pain-like behaviors in the mice were induced by tail suspension and recovered by the resumption of weight bearing. Moreover, treatment with bisphosphonate significantly prevented the triggering of the regional osteoporosis and pain-like behaviors, and antagonists of the acid-sensing nociceptors, such as transient receptor potential channel vanilloid subfamily member 1 and acid-sensing ion channels, significantly improved the pain-like behaviors in the tail-suspended mice. We, therefore, believe that regional transient osteoporosis due to osteoclast activation might be a trigger for the pain-like behaviors in tail-suspended model mice. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1226-1236, 2017.

Pregnancy-associated transient osteoporosis of the hip: results of a case-control study.

Pregnancy-associated transient osteoporosis of the hip (TOH) is a rare but severe form of osteoporosis, which may affect a subgroup of women in the last trimester of pregnancy or immediately postpartum. Common symptoms include acute pain of the hip(s) due to bone marrow edema or even hip fractures. The exact underlining mechanisms of this disorder are still unknown since no published systematic analyses exist. Out of a total of 52 TOH patients, 33 TOH patients could be matched with 33 healthy controls according to age, region, and gravity. The aim of this retrospective case-control study was to evaluate the risk factors for TOH in a homogenous population of women. The baseline characteristics of the two study groups were similar. Overall, 12.1% of the TOH patients sustained a hip fracture. Expectedly, 90.9% of the TOH patients complained about pain of the hip (p≤0.001). TOH patients suffered more frequently from severe dental problems during childhood (p=0.023) and performed less often sports before and after puberty (p≤0.001), whereas the frequency of immobilization during pregnancy was threefold higher compared to the control group (p=0.007). We found a significant increase of the TOH risk in patients with dental problems in childhood (OR 3.7; CI 1.3-10.7) as well as in patients with lack of exercise during childhood (OR 4.2; CI 1.3-12.9). Our results support the hypothesis that pregnancy-associated TOH is a multifactorial disease, to which several individual factors may contribute. Hereby, we found significant associations with immobility, dental problems, and lack of exercise in childhood.

Recurrent Transient Osteoporosis during Pregnancy and Treatment with Oral Bisphosphonates: A Case Report

Transient osteoporosis of the hip (TOH), also known as “Bone marrow edema Syndrome”, is a rare disorder mainly affecting pregnant women in their third trimester, as well as middle-aged, overweight men. A 30-year-old Caucasian female G2P2, with history of transient osteoporosis of both ankles and C-Section during the last pregnancy in 2011, presented progressively severe bilateral hip pain with onset already in the 12th gestational week. Imaging of the pelvis and bilateral hips with MRI obtained 6 days after the C-Section demonstrated bilateral bone-marrow edema of the hips. The patient was treated with a monthly single dose of 150 mg ibandronate acid per os, for 3 months and physiotherapy. Repeated MRI performed 5 months postpartum revealed a complete remission of the disease. In contrast to the first onset of transient osteoporosis during the first pregnancy, which was only treated conservatively without bisphosphonates, the remission of the disease and patient’s recovery with oral ibandronate therapy showed to be 4 months shorter. This case is unique in literature for both describing the onset of this rare disease twice in the same patient as well as its oral therapeutic approach.

P.073 Transient osteoporosis of the hip during pregnancy associated with EMG signs of acute regional denervation

Background: Transient osteoporosis is an infrequent musculoskeletal condition most often seen in middle-aged males, but can rarely present during late pregnancy in females. Patients present with sudden onset of severe joint pain. MRI typically shows T2 hypersignals and bone marrow edema. Abnormal neurophysiological findings have only rarely been described in the literature. Methods: Case report Results: A 35-year old patient presented at 34 weeks of pregnancy with acute onset of right hip and leg pain. MRI showed marked T2 hypersignals in the head of the femur with distal extension and bone marrow edema pathognomonic of transient osteoporosis. Neurophysiological studies showed normal nerve conductions of the lower extremities, but fibrillation potentials and positive sharp waves were found acutely in proximal muscles of the affected extremity and not limited to a single nerve territory. Inflammatory markers were unremarkable. Treatment was conservative with rest and reduction of weight bearing and pain resolved in the hip, but recurred in the ipsilateral knee several months after delivery suggesting evolution toward regional migratory osteoporosis. Conclusions: Transient osteoporosis of the hip may be associated with EMG signs of denervation that could suggest a contributing neurogenic mechanism. Their prevalence may be underestimated and we suggest considering serial EMG studies in its investigation.

Regional Migratory Osteoporosis of the Hip and Talus

Introduction: Transient osteoporosis of the hip (TOH) is a relatively rare disorder characterized by the loss of bone tissue in the proximal femur. Hip joint is the most common location of the disease, although it may also involve the knee, ankle or foot bones. Self-limited nature of the disease is characteristic with complete relief of symptoms occurring after 6 12 months. Case Presentation: Authors report a case with transient osteoporosis of the hip and a clear migratory pattern of osteoporosis from the hip to talus bone in the ipsilateral foot. Spontaneous resolution of symptoms occurred in the patient and he was asymptomatic in the last

Simultaneous Bilateral Transient Osteoporosis of the Hip without Pregnancy.

Transient osteoporosis of the hip (TOH) is a rare disorder characterized by acute severe coxalgia and temporary osteopenia in the proximal femur. Although most cases were unilateral or staged bilateral TOH, some authors reported that the pregnant patients simultaneously had TOH in their bilateral hips. However, there has been no report of simultaneous bilateral TOH in the patient without pregnancy. A 25-year-old Japanese woman without pregnancy had acute simultaneous bilateral hip pain. Plain X-ray of the bilateral hips did not show a periarticular osteopenia. However, magnetic resonance image obtained one week after the onset demonstrated increased T2-weighted signal intensity and decreased T1-weighted signal intensity in the bilateral femoral heads. She was treated conservatively, and follow-up magnetic resonance image at seven weeks after the onset returned to normal bone marrow signal intensity. Her bilateral coxalgia subsided gradually. At one year after the onset, she had no sign of symptomatic flair. Our experience with this case indicates that recognizing the possibility of simultaneous bilateral TOH is important unless the patient is pregnant, and magnetic resonance image is predictable test to make a diagnosis of TOH, even in the absence of abnormal finding on plain X-ray.

Surface modification of PEEK for improving osteocompatibility

Event Abstract Back to Event Surface modification of PEEK for improving osteocompatibility Shun Kunomura1* and Yasuhiko Iwasaki2, 3* 1 Kansai university, Graduate School of Science and Engineering, Japan 2 Kansai university, Faculty of Chemistry, Materials and Bioengineering, Japan 3 Kansai university, ORDIST, Japan Introduction: Currently, metallic implants such as titanium alloys and cobalt-chromium alloy are used in cementless total hip arthroplasty. Metallic implants have excellent strength and toughness and are effective as osteocompatibility materials. However, they have been known to cause complications such as transient osteoporosis of the hip results from stress shielding, metal allergy and fatigue fracture. To prevent them, polyetheretherketone (PEEK) is employed, which has excellent mechanical properties and durability. Although bone fixation devices of PEEK showed high performance, osteocompatibility of the surface is not sufficient. In order to apply PEEK for the stem of an artificial hip joint, osteocompatibility should be added. We have clarified that poly (ethylene sodium phosphate) shows the high affinity to calcium deposits generated from osteoblasts [1]. Moreover, Yang et al. reported that functions of osteoblasts were promoted on polyphosphoesters [2]. In this study, we modified the poly (ethylene sodium phosphate) on PEEK surface by self-initiated graft polymerization to improve osteocompatibility of the surface. Materials and Methods: Poly (ethylene sodium phosphate) macromonomers (PEPMA·Na) were synthesized according to a previously described method [1]. PEEK specimens were soaked in PEPMA·Na solution, kept 40°C over night to evaporate the solvent, and irradiated UV-light for several periods. PEPMA·Na immobilized PEEK (PEP-PEEK) was performed by water contact angle measurements and X-ray photoelectron spectroscopy. MC3T3-E1 cells were used to investigate the interaction between cells and the PEP-PEEK. Moreover, the specimens were soaked in the simulated body fluid (SBF) to evaluate apatite-forming ability on the surface [3]. Results: Fig. 1 shows the XPS data for PEP-PEEK surfaces and the phosphorus composition increased with an increase in the UV-irradiation time. The surface wettability of PEEK is also significantly improved by the surface modification. Although the cell adhesion of the PEP-PEEK surface was lower than the original PEEK surface, the proliferation of the adherent cells was observed. The calcium deposition on PEP-PEEK surface was preferentially occurred compare with that on the original PEEK surface as shown in Fig .2. Discussion: The enhancement of surface wettability and phosphorus composition suggests immobilization of PEPMA·Na on PEEK surface. The low cell adhesion of PEP-PEEK surface would be due to the high wettability of PEPMA·Na reduced cell adhesion. The previous literature reported that apatite-forming ability correlated with osseointegration [3]. Therefore, PEP-PEEK surface which induces calcium deposition may have osteocompatibility. Conclusion: PEPMA·Na was synthesized, and modified on the surface of PEEK by UV-irradiation. Although cell adhesion of the PEP-PEEK surface was reduced, proliferation of the adherent cells was observed. And the surface modification could significantly enhance the calcium deposition. Therefore, the PEPMA·Na-immobilization on PEEK would be useful way for improving osteocompatibility. A part of this work was supported by AMED Strategic Promotion of Innovative Research and Development

Transient osteoporosis of the hip: A Case report

Transient osteoporosis of the hip (TOH) is a rare, self-limiting condition of unknown aetiology characterised by sudden onset pain without trauma, primarily affecting middle-aged men, and women in the third trimester of pregnancy. Patients typically present with a limping gait. MRI is the imaging modality of choice and reveals focal bone marrow oedema, joint effusion and preserved joint space. TOH must be differentiated from avascular necrosis due to the different associated treatment strategies. A case of TOH is described in a healthy 65 year old man including clinical presentation, differential diagnosis, pathophysiological considerations, imaging studies and management.

Transient Osteoporosis of the Hip and Hyperbaric Oxygen Therapy: A Report of Two Cases

Transient Osteoporosis of the Hip and Hyperbaric Oxygen Therapy: A Report of Two Cases

Transient osteoporosis of hip

We report a case of transient osteoporosis of the hip (TOH) in a 50-year-old man including the clinical presentation, diagnostic studies, management, and clinical progress. TOH is a rare self-limiting condition that typically affects middle-aged men or, less frequently, women in the third trimester of pregnancy. Affected individuals present clinically with acute hip pain, limping gait, and limited ranges of hip motion. TOH may begin spontaneously or after a minor trauma. Radiographs are typically unremarkable but magnetic resonance (MR) imaging studies yield findings consistent with bone marrow edema. TOH is referred to as regional migratory osteoporosis (RMO) if it travels to other joints or the contralateral hip. TOH often resembles osteonecrosis but the two conditions must be differentiated due to different prognoses and management approaches. The term TOH is often used interchangeably and synonymously with transient bone marrow edema (TBME).

Case of Transient Osteoporosis of the Hip in Pregnancy

Case of Transient Osteoporosis of the Hip in Pregnancy