Regional migratory osteoporosis – a differential diagnostic problem

Česká verzia

Authors: I. Žofková
Authors place of work: Ředitel: doc. MUDr. Vojtěch Hainer, CSc. ; Endokrinologický ústav, Praha
Published in the journal: Prakt. Lék. 2009; 89(7): 393-395
Category: Diagnostis

Summary

Transient osteoporosis of the hip (TOH) (reflex sympathetic dystrophy, marrow oedema syndrome) is acute hip demineralization associated with bone marrow oedema. The disease arises abruptly as a painful syndrome that, usually after several weeks, spontaneously disappears. The disease is assumed to be a localized variant of regional migratory osteoporosis (RMO), in which bone loss and pain gradually migrate to further weight-bearing joints of the lower extremities. TOH and RMO were described in males of middle age, but they affect even premenopausal women, often in the 3rd trimester of pregnancy.

The most serious cases of RMO may be associated with systemic bone loss. The fundamental diagnostic method in TOH and RMO is magnetic rezonance (MRI) combined with radioisotope scan using Tc⁹⁹. RMO can be successfully treated with nonsteroid anti-inflammatory drugs, calcium and vitamin D supplementation, the exclusion of mechanical load of joints and by rehabilitation. Administration of bisphosphonates is necessary in exceptional cases. Marrow oedema syndrome may cause differential diagnostic difficulties in osteoarthritis, rheumatoid arthritis, aseptic avascular necrosis, glucocorticoid-induced osteoporosis and malignancies.

Key words:
transient osteoporosis of the hip, regional migratory osteoporosis, bone marrow oedema syndrome, reflex sympathetic dystrophy.

Zdroje

1. Aigner, N., Petje, G., Steinbock, G. et al. Treatment of bone-marrow oedema of the talus with the prostacyclin analogue iloprost. An MRI-controlled investigation of a new method. J. Bone Joint. Surg. Br. 2001, 83, p. 855-858.

2. Cadet, M., Honig, S. Utility of bone densitometry in diagnostic evaluation and monitoring in regional migratory osteoporosis. J. Clin. Rheumatol. 2009, 15, p. 124-126.

3. Cahir, J.G., Toms, A.P. Regional migratory osteoporosis. Eur. J. Radiol. 2008, 67, p. 2-10.

4. Castellano, K., Plantalech, L. Regional transient osteoporosis, and reflex sympathetic dystrophy: the same disease? Medicina (B. Aires) 2005, 65, p. 425-428.

5. Crespo, E., Sala, D., Crespo, R. et al. Transient osteoporosis. Acta Orthop. Belg. 2001, 67, p. 330-337.

6. Curtis, P.H. Jr., Kincaid, W.E. Transitory demineralization of the hip in pregnancy: a report of three cases. J. Bone. Point Surg. 1959, 41, p. 1321-1333.

7. Horouchi ,K., Shigara, N., Fujita, N. et al. Regional migratory osteoporosis: a case report. J. Orthop. Sci. 2004, 9, p. 178-181.

8. Karantanas, A.H., Nicolakopoulos, I., Korompilias, A.V. et al. Regional migratory osteoporosis in the knee: MRI findings in 22 patients and review of the literature. Eur. J. Radiol. 2008, 67, p. 34-41.

9. Korompilias, A.V., Karantanas, A.H., Lykissas, M.G. et al. Transient osteoporosis. J. Am. Acad. Orthop. Surg. 2008, 16, p. 408-409.

10. Korompilias, A.V., Karantanas, A.H., Lykissas, M.G. et al. Bone marrow edema syndrome. Skeletal Radiol. 2009, 38, p. 425-436.

11. Ma, F.Y., Falkenberg, M. Case reports: transient osteoporosis of the hip: an atypical case. Clin. Orthop. Relat. Res. 2006, 44, p. 245-249.

12. McWalter, P., Hassan, A. Transient osteoporosis of the hip. Ann. Saudi Med. 2009, 29, p. 146-148.

13. Moosikasuwan, J.B., Miller, T.T., Math, K. et al. Shifting bone marrow edema of the knee. Skeletal Radiol. 2004, 33, p. 380-385.

14. Schapira, D., Gutierrez, G., Mor, M. et al. Successful pemidronate treatment of severe and refractory regional migratory osteoporosis. J. Clin. Rheumatol. 2001, 7, p. 188-190.

15. Straten, V.H., Franssen, M.J., den Broeder, A.A. et al. Regional migratory osteoporosis in a patient with ankylosing spondylitis. Scand. J. Rheumatol. 2009, 38, p. 63-65.

16. Toms, A.P., Marshall, T.J., Becker, E. et al. Regional migratory osteoporosis: a review illustrated by five cases. Clin. Radiol. 2005, 60, p. 425-438.

17. Trevisan, C., Ortolani, S. Bone loss and recovery in regional migratory osteoporosis. Osteoporosis Int. 2002, 13, p. 901-906.

18. Varenna, M., Zucchi, F., Binelli, L. et al. Intravenous pamidronate in the treatment of transient osteoporosis of the hip. Bone 2002, 31, p. 96-101.

19. Yamamoto, T., Bullough, P.G. Subchondral insufficiency fracture of the femoral head and media femoral condyle. Skeletal Radiol. 2000, 29, p. 40-44.

20. Yamasaki, S., Masuhara, K., Miki, H. et al. Three cases of regional migratory osteoporosis. Arch. Orthop. Trauma Surg. 2003, 123, p. 439-441.