Transient regional osteoporosis of the hip with extensive bone marrow edema (BME): Dramatic improvement after three months of Alendronate therapy

Yasser Emad; Yasser Ragab; Mariam Ahmed Saad; Johannes J Rasker

doi:10.1016/j.radcr.2021.05.066

Transient regional osteoporosis of the hip with extensive bone marrow edema (BME): Dramatic improvement after three months of Alendronate therapy

Radiol Case Rep. 2021 Jul 3;16(9):2487-2490. doi: 10.1016/j.radcr.2021.05.066. eCollection 2021 Sep.

Authors

Yasser Emad^{1

2}, Yasser Ragab^{3

4}, Mariam Ahmed Saad⁵, Johannes J Rasker⁶

Affiliations

¹ Rheumatology Department, Faculty of Medicine, Cairo University, Kasr Alainy St, 11562 Cairo, Egypt.
² Rheumatology Department, Dr. Erfan and Bagedo General Hospital, King Fahad St. (Al Sitteen), 21452, Jeddah, Saudi Arabia.
³ Radiology Department , Dr. Erfan and Bagedo General Hospital , King Fahad St. (Al Sitteen), 21452, Jeddah, Saudi Arabia.
⁴ Radiology Department, Faculty of Medicine, Cairo University, Kasr Al-Ainy St, 11562 Cairo, Egypt.
⁵ Medical Oncology Department, National Cancer Institute, Cairo, Egypt.
⁶ Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, Drienerlolaan 5, 7522NB Enschede, the Netherlands.

Abstract

Transient osteoporosis of the hip, also termed transient bone marrow edema, is a painful condition often occurring after trivial trauma. It can be diagnosed with MRI in patients whose radiographs are negative or inconclusive. In this case report we describe a 39-year-old female patient with this rare entity, who was successfully treated with oral Alendronate, active vitamin D and calcium supplementation combined with avoiding of weight bearing on the affected hip. She improved clinically within three months and on contrast enhanced MRI studies, as performed before and after treatment, complete regression of bone marrow edema was shown already after three months of treatment. The literature was reviewed regarding the pathophysiology of transient osteoporosis of the hip and the beneficial effects of Alendronate in this domain. The report is important because it will increase the awareness among clinicians and radiologists about this entity, as in neglected cases transient regional osteoporosis of the hip may progress to avascular necrosis with complete loss of hip function.

Keywords: AVN, avascular necrosis; Alendronate; BME, Bone marrow edema; BMES, Bone marrow edema syndromes; FAI, femoro-acetabular impingement; MRI, magnetic resonance imaging; RMO, regional migratory osteoporosis; RSD, reflex sympathetic dystrophy; STIR, short tau inversion recovery; TBME, transient Bone marrow edema; TOH, transient osteoporosis of the hip; Transient bone marrow edema syndrome; Transient regional osteoporosis of the hip.

Publication types

Case Reports