Transient osteoporosis

Classification according to ICD-10
M81.6	Localized osteoporosis [Lequesne]
ICD-10 online (WHO version 2019)

As transient osteoporosis , even transient osteoporosis or bone marrow edema syndrome ( KMÖS ), is a painful time-limited disease of the hip , rarely other bones, called whose cause has not yet been clarified. The classic leading symptom of transient osteoporosis is spontaneous pain in the area of ​​the hip joints .

Curtiss and Kincaid first described transient osteoporosis in three pregnant women in 1959. Some scientists classify transient osteoporosis as the reversible first stage of bone necrosis , stage "ARCO 0", but this is not the general consensus. However, there is agreement that transient osteoporosis is self-limiting and does not turn into bone necrosis.

Transient osteoporosis mostly affects middle-aged men and significantly less often women (around 3: 1); if the etiology is unknown, it is also referred to as idiopathic bone marrow edema syndrome (BMES).

Transient osteoporosis can also be secondary:

• in the last trimester of pregnancy and subsequently during breastfeeding (postpartum), also known as pregnancy-associated osteoporosis , sometimes associated with compression fractures (especially of the lumbar spine )
• with algodystrophy (Sudeck's disease)
• as a traumatic bone marrow contusion ( bone bruise )

Finding

Clinically, the patients show acute, slowly increasing stress pain and groin pain with a limping gait, but rarely night or rest pain. Most of the time, abduction , flexion and internal rotation are slightly restricted, whereby the restriction of movement is significantly less than the functional disability and pain would suggest.

Blood tests remain negative without increased inflammation levels ( C-reactive protein and sedimentation rate ). The rheumatism serology is also negative.

In primary BMOs (BMOs, bone marrow contusion, microfractures and stress BMO), the native x-ray is normal, since osteopenia is only visible on x-rays if the bone marrow has lost about 40% bone density . Occasionally, only focal osteopenia (“transient osteoporosis”) can appear after 4–6 weeks. All others are secondary BMOs that show the more or less characteristic changes in the underlying disease.

Both the diagnosis and the differential diagnosis with a differentiation from osteonecrosis can usually be made reliably with magnetic resonance imaging (MRI). There is typically a reduced signal intensity in the T1-weighted images and a greatly increased signal intensity in the T2-weighted images and especially in the STIR sequences, but without a necrosis zone or subchondral fracture line. This bone marrow edema usually shows up in the femoral head and femoral neck down to the intertrochanteric region, where the edema area is sharply demarcated. This extent and sharp delimitation is typical and distinguishes transient osteoporosis as well as a lack of necrosis zone and lack of subchondral change from femoral head necrosis.

Alternatively, a skeletal scintigraphy can be performed, which also shows a greatly increased signal intensity as a sign of increased bone metabolism, but without a recess ( cold defect ) in the femoral head, which excludes osteonecrosis.

therapy

The treatment of primary BMO consists of partial or complete relief, pain therapy ( analgesics and NSAIDs ) and physiotherapy with the aim of avoiding microfractures and pathological compression fractures of the less resilient bone. Amino bisphosphonates can be helpful and speed healing. Calcitonin and cortisone were often used, but could not show any detectable effect in studies. Due to the time-limited process, patient reassurance and patience are necessary. Whereas the femoral head necrosis performed surgical relief drilling of the femoral head is not indicated.

Without sound evidence of efficacy are in the off-label use (ie outside the approval), the hyperbaric oxygen therapy , prostacyclin and prostacyclin analogs such. B. Ilomedin or Iloprost , used for treatment.

Despite therapy, the symptoms persist for at least 4 weeks, often around 3–6 months. A protracted course over 12–18 months is possible; chronification has not been described. The transient osteoporosis heals without consequences.

Individual evidence

1. ↑ Alphabetical index for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 665
2. ^ PH Curtiss Jr., WE Kincaid: Transitory deminieralization of the hip in pregnancy. A report of three cases. Journal of Bone and Joint Surgery 1959, Volume 41-A, pages 1327-1333
3. ↑ Olcay Guler, Selahattin Ozyurek, Selami Cakmak, Mehmet Isyar, Serhat Mutlu, Mahir Mahirogullari: Evaluation of results of conservative therapy in patients with transient osteoprosis of hip . Acta Orthopædica Belgica 2015, volume 81, edition 3, pages 420-426
4. ↑ Filip Gemmel, Hugo C. Van Der Veen, Willem D. Van Schelven, James MP Collins, Isabelle Vanneuville, Paul C. Rijk: Multi-modality imaging of transient osteoporosis of the hip Acta Orthopædica Belgica 2012, Volume 78, Pages 619– 627.
5. ↑ Petje include: Aseptic necrosis of bone in children. Orthopedist 10 (2002) 1027-1038. doi: 10.1007 / s00132-004-0634-3
6. ↑ Thorsten Schmidt: Infusion, femoral head drilling or infusion after femoral head drilling in the treatment of atraumatic femoral head necrosis (FKN) and bone marrow edema syndrome . Dissertation at the Department of Orthopedics at the University of Regensburg Clinic, 2009 (pdf; 1.3 MB).

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !