Transient osteoporosis of the hip in pregnancy complicated by femoral neck fracture: a case report

Pathological femoral neck fracture in a male patient due to non-simultaneous bilateral transient hip osteoporosis: A case report: Statements and Declarations

We report a case of a 31-year-old man who developed a non-simultaneous bilateral transient hip osteoporosis (THO) complicated with an atraumatic undisplaced pathological femoral neck fracture (FNF) of his left hip. He was successfully treated with internal fixation on the left hip, and a follow-up Magnetic Resonance Imaging evidenced satisfactory resolution on the right side. Diagnosis and management of THO are usually challenging as symptoms before pathological FNFs might be misdiagnosed. This case highlights the importance of suspecting pathological FNFs when pain persists despite conservative treatment. Finally, surgical treatment is strongly recommended if a pathological FNF is confirmed.

Level of evidence

Level IV.

Unilateral Atraumatic Femoral Neck Fracture in the Peripartum Period: Case Report and Literature Review

Transient osteoporosis of the hip (TOH) refers to a temporary, focal reduction in bone mineral density that selectively affects bones in weight-bearing joints of young pregnant females. Due to inherent difficulties in diagnosing this pathology, it is difficult to estimate the incidence and it is conceivable that TOH is vastly underreported. In a rare subset of patients, TOH may progress to pathological fractures. We report a case of a 38-year-old pregnant woman who developed an atraumatic, displaced femoral neck fracture during her last trimester. Diagnosis and adequate management of TOH represents a clinical challenge as symptoms that precede the fracture are often non-specific, while the timing of the surgical treatment (i.e. before or after delivery) is debatable.

Pregnancy associated transient osteoporosis of the hip (PR-TOH): A non-obstetric indication to caesarean section. A case report with literature review

Pregnancy related transient osteoporosis of the hip (PR-TOH) is a rare condition that manifests with sudden pain located in the groin region, anterior thigh and buttocks. It is a benign and in the majority of cases self-limiting disease, related to bone marrow oedema. It occurs during the third trimester of pregnancy or less frequently during the post-partum period. Hip movements are usually restricted by pain and it often becomes a non-obstetric indication for Caesarean delivery. Here, we report a case of unilateral PR-TOH diagnosed by magnetic resonance imaging (MRI) and a literature review.

Transient osteoporosis of pregnancy in a 34-year-old female

A 34-year-old Caucasian female presented during the third trimester of her pregnancy with bilateral hip pain that became progressively severe. Imaging of her pelvis and bilateral hips with MRI obtained during her third trimester of pregnancy demonstrated bilateral bone-marrow edema of the femoral heads and the sacrum at S1. Repeat MRI performed at 6 months postpartum revealed resolution of edema. MRI is considered the best diagnostic test for this condition in regards to sensitivity and specificity.

Changes in bone mineral density in transient osteoporosis of the hip

Transient osteoporosis of the hip is a disorder characterised by pain, and associated with temporary osteopaenia. Although osteopaenia is the essence of the condition, data do not exist about the local bone density of the femoral neck if no medication is administered. We describe three patients who were treated with limitation of weight-bearing only. Repeated bone mineral density measurements were obtained, and that at the femoral neck was lowest two months after the onset of the condition. The mean reduction in bone mineral density when compared with an age-matched control group was 13% (3% to 24%). Spontaneous recovery was observed in all patients.

Late presentation of a displaced subcapital fracture of the hip in transient osteoporosis of pregnancy

Transient osteoporosis of the hip is rare and has two demographic peaks, one during the third trimester of pregnancy and the other around the fifth to sixth decade of life. During pregnancy, osteoporosis presents with insidious onset of hip pain and antalgic limp with no antecedent infection or trauma. Radiographs show pronounced osteopenia of the femoral head and neck with preservation of the joint space. 1 Bone scan and magnetic resonance imaging are sensitive but not specific for diagnosis, and laboratory studies are typically normal. 2 We present the case of a patient with a displaced, grossly unstable subcapital hip fracture who presented 5 months postpartum and describe successful treatment by open reduction and internal fixation with a muscle-pedicle bone graft.

Calcitonin in the treatment of transient osteoporosis of the hip

BACKGROUND

Transient osteoporosis of the hip (TOH) is a rare clinical disorder of unknown etiology characterized by hip pain and functional disability that resolve spontaneously in 6-24 months.

OBJECTIVES

To report 2 patients with TOH during pregnancy who had rapid resolution of their illness with the use of calcitonin. To review the literature on TOH with special emphasis on its treatment.

METHODS

A MEDLINE search of studies published from 1966 to 2002 was performed to review treatment options for TOH and their effect on the natural history of the disease.

RESULTS

Our 2 patients developed hip pain during pregnancy with classical changes of TOH on MRI. Both patients received calcitonin, 1 during pregnancy and 1 postpartum with resolution of their symptoms within 6 to 9 weeks. Previous reports in the literature of treatment of TOH showed that antiresorptive agents (bisphosphonates and calcitonin) had shortened the duration of the illness compared with the natural history of the disease.

CONCLUSIONS

TOH is an under-recognized entity associated with pain and disability. The use of antiresorptive agents may be of help in reducing the duration of the disease.

RELEVANCE

To increase the recognition of TOH and to consider therapeutic interventions to shorten the duration of the disease.

[Reflex sympathetic dystrophy involving the ankle in pregnancy: characteristics and therapeutic management]

We report the case of a multigravida presenting in the first trimester of pregnancy with reflex sympathetic dystrophy involving both ankles. Preferential location of reflex sympathetic dystrophy in pregnancy is classically the hip (9 times out of 10). Symptoms develop mostly with primipara in the third trimester of pregnancy or in post-partum. Fracture is the major risk of reflex sympathetic dystrophy. Peculiarities of reflex sympathetic dystrophy's treatment in the course of pregnancy are evoked. The end of the pregnancy can be shortened with the aim of stabilizing disease even to activate its healing. Pathophysiologic mechanisms of reflex sympathetic dystrophy in pregnancy seem multiple and complex. Our observation, by its atypical characteristics, recalls it.

Hip pain in the third trimester of pregnancy

Transient osteoporosis of the hip (TOH) is characterized by disabling hip joint pain, a limited range of hip motion, focal loss of radiodensity on plain radiographs and increased tracer uptake in bone scintigraphy (Hoffman and Kramer, 1997).

Diagnosis of femoral shaft fracture in pregnancy by ultrasound

Images

Current concepts in imaging of the pelvis and hip

Over the past decade, imaging evaluation of orthopedic conditions of the pelvis and hips has become increasingly complex. Although the conventional radiograph remains the initial examination of choice, the decision between secondary tests, such as computed tomography, MR imaging, or scintigraphy is far from clear. A thorough understanding of current imaging technology is necessary for the clinician to choose the most appropriate examination for a given situation. This article reviews the current status of orthopedic imaging in the areas of acute trauma, stress injuries, osteonecrosis, arthropathies, tumors, and interventional imaging.