Transient Osteoporosis of the Hip – OrthoInfo

Transient osteoporosis of the hip is a rare condition that causes temporary bone loss in the upper portion of the thighbone (femur).

People with transient osteoporosis of the hip will experience a sudden onset (start) of pain that worsens with walking or other weight-bearing activities. In many cases, the pain increases over time and may become disabling.

Painful symptoms gradually decrease and usually go away within 6 to 12 months. Bone strength in the hip also returns to normal in most people.

Despite the name, transient osteoporosis of the hip is very different from the more common age-related osteoporosis. Age-related osteoporosis is a painless, progressive (develops over time) condition that leads to a weakening of the bones throughout the body. It can put people at greater long-term risk for broken bones.

For more information about age-related osteoporosis: Osteoporosis

The hip is one of the body’s largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).

The hip is a ball-and-socket joint. In a healthy hip, the femoral head (ball) fits firmly into the acetabulum (socket).

In transient osteoporosis of the hip, the femoral head weakens and loses density (bone mass). During the time that the bone is weakened, it is at greater risk for breaking.

Transient osteoporosis most often occurs in the hip joint, but can also affect other joints in the leg, such as the knee, ankle, and foot.

Transient osteoporosis of the hip most often occurs in young or middle-aged men (between the ages of 30 and 60). It is also more common in women who are in the late stages of pregnancy (the last 3 months) or who have recently given birth. A study published in the Journal of Obstetrics and Gynecology in 2017 estimates that the condition affects 1 in 250,000 pregnant females.

Currently, there is no clear explanation for what causes this condition. Researchers are studying this disease and several theories have been proposed, although none are proven.

Some of the causes that have been suggested include:

• Obstruction (blockage) of some of the small blood vessels that surround the hip
• Hormonal changes
• Abnormal mechanical stresses (external load or force) on the bone

• Sudden onset of pain, typically in the front of the thigh, the groin, the side of the hip, or the buttocks
• Pain that intensifies with weight bearing and may lessen with rest
• No previous accident or injury to the hip that would trigger pain
• Slightly limited motion: Gentle hip motion is usually painless, but pain may intensify with extreme motions of the hip
• Pain that gradually increases over a period of weeks or months and may be so intense that it is disabling
• A noticeable limp as you try to protect the joint and ease the pain

Medical History and Physical Examination

Your doctor will talk to you about your symptoms and when they first started. They may ask you whether you can remember any injury to your hip.

During the physical examination, your doctor will have you move your leg in different directions to measure your range of motion and try to reproduce the pain. Most patients with transient osteoporosis of the hip have more pain when they move the hip themselves (active range of motion) as opposed to when the doctor moves the hip for them (passive range of motion).

In addition, pain is often felt only with extremes of hip movements, and it usually worsens with any weightbearing. This difference in how the pain is felt (severe pain with weightbearing, but minimal pain with passive range of motion) is one of the clues to the diagnosis of transient osteoporosis.

During the exam, your doctor will test the range of motion in your hip.

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Tests

• X-rays. In the early course of the disease (the first 6 weeks), X-ray images may show a slight decrease in the bone density of the femoral head, but this may be hard to see. Several months later, X-rays may show a dramatic loss of bone density with a near complete disappearance of the femoral head. This temporary loss of bone density is why the disease is termed “transient osteoporosis of the hip.”

This X-ray of the pelvis shows early changes in bone density in the affected hip (arrows).

Reproduced from Korompilias AV, Karantanas AH, Lykissas MG, Beris AE: Transient osteoporosis. J Am Acad Orthop Surg 2008; 16:480-489.

• Other imaging scans. Because X-rays may not show bone loss until the condition is well-advanced, your doctor may order other types of imaging tests to identify the cause of your symptoms.

  Computed tomography (CT) scans and magnetic resonance imaging (MRI) scans can provide more detailed images. MRI scans provide clear images of the soft tissues (muscles, tendons, and ligaments) around the hip.

  A nuclear medicine bone scan can more clearly show changes in bone caused by infection or injury. (A nuclear medicine bone scan should not be confused with a dual energy X-ray absorptiometry (DEXA) scan. A DEXA scan is a study that tests for general bone density, and while it is the gold standard in testing for age-related osteoporosis, it is not effective in diagnosing transient osteoporosis of the hip.)

  If you are pregnant, your doctor may decide to delay imaging studies until the last stages of your pregnancy, or even until after the delivery. Generally, MRI is safe to obtain in pregnancy, although you should discuss this with your orthopaedic surgeon, your primary doctor, and your obstetrician if you are considering this test.

• Laboratory tests. Currently there is no blood test that helps to diagnose this disorder. However, blood tests are often very helpful in ruling out other causes of hip pain, such as metabolic (nutritional) disorders, endocrine (hormonal) disorders, and metastatic disease (cancer).

Bone Marrow Edema

One of the most common signs of transient osteoporosis of the hip is bone marrow edema. Bone marrow is a spongy substance that produces blood cells and is located in the hollow part of long bones. In bone marrow edema, the bone marrow is inflamed and full of fluid.

An MRI scan of a hip affected by transient osteoporosis will usually reveal bone marrow edema. Because of this, MRI is one of the most useful studies to help diagnose the condition.

This MRI image shows edema surrounding the affected hip. Edema causes the bone to appear white in the MRI image.

Reproduced from Korompilias AV, Karantanas AH, Lykissas MG, Beris AE: Transient osteoporosis. J Am Acad Orthop Surg 2008; 16:480-489.

Because transient osteoporosis goes away on its own, treatment focuses on minimizing symptoms and preventing any damage to the bones while they are weakened by the disorder.

• Non-steroidal anti-inflammatory medication (NSAIDs). Drugs like ibuprofen and naproxen may relieve pain and inflammation.
• Weightbearing restrictions. Your doctor may advise you to temporarily limit or eliminate weightbearing activities. Using crutches, a cane, a walker, or other walking aid, will help relieve the stress of weightbearing on the affected hip, and may prevent a fracture of the temporarily weakened bone.
• Physical therapy. To help maintain strength and flexibility in the muscles supporting your hip, your doctor may also recommend a series of exercises that you can do as the pain lessens. Water exercises may be helpful not only because they ease movement, but also because they relieve weight bearing.
• Nutrition. Proper nutrition, including Vitamin D and calcium, may help promote the healing process and rebuilding of bone.

With proper diagnosis and treatment, most patients with transient osteoporosis of the hip can expect their symptoms to end within 6 to 12 months. Bone strength in the hip also will return to normal in most cases.

In a small percentage of patients, transient osteoporosis appears again later in life. It can return to the same hip or even in the hip that was not originally affected. It is difficult to predict whether the condition will come back.

To Top

Osteoporosis Hip Pain | Treatments

If you’re one of the 54 million Americans who have osteoporosis or low bone density, you have an increased risk of bone fractures and chronic pain. 

Half of American women and a quarter of men over 50 will break a bone because of osteoporosis. This widespread disease most often affects your hips, wrist, and spine.

Can Osteoporosis Cause Hip Pain?

Yes. Osteoporosis can affect the femoral head and the pelvic bones comprising your hip joint.

u

Osteoporosis is a prevalent cause of hip pain and hip fractures. In fact, hip fractures are by far the most debilitating and painful of osteoporosis-related breaks.  

Most people who have osteoporosis-related hip fractures live with chronic pain, a noticeable limp, and end up needing a walker or other walking aid.

What Is Osteoporosis?

Osteoporosis is a bone disease that causes progressive bone loss.

Osteoporosis develops gradually, and as you lose bone density, your bones become porous and weak. The bone mass loss increases your risk of fractures, deformity, and severe pain.

Your hips are vulnerable to age-related osteoporosis, which is sometimes called wear-and-tear, and transient osteoporosis.

What Is Transient Osteoporosis?

Despite sharing a similar name, transient osteoporosis is very different from age-related osteoporosis, which is often painless in its early stages.

Transient osteoporosis is a rare form of the disease that causes temporarily weakened bone in the upper part of the femur.

It causes a sudden onset of pain that’s worse when you walk or participate in other weight-bearing activities.

While gentle hip movements don’t trigger pain in the early stages of the disease, extreme motions cause pain from day one.

Transient osteoporosis is usually progressive, eventually causing debilitating hip pain and increasing your risk of hip fractures.

The good news is that transient osteoporosis resolves within 6-12 months, your bone strength returns, and your painful symptoms gradually subside.

What Causes Osteoporosis of the Hip?

Your age and family history influence your risk of age-related osteoporosis. Additionally, a diet with insufficient calcium and vitamin D can contribute to your risk of the disease.

Medical conditions, including endocrine disorders, irritable bowel syndrome, kidney disease, lupus, and rheumatoid arthritis, also increase your risk of osteoporosis.

Medical researchers haven’t found a specific cause for transient osteoporosis.

r

Problems with your blood vessels, hormonal imbalances, and abnormal mechanical stresses can increase your risk of temporary bone loss in your upper thigh bone.

What Are the Symptoms of Osteoporosis of the Hip?

Age-related osteoporosis can develop for years without causing any symptoms.

Often the first sign of hip osteoporosis is a fracture from doing something as commonplace as leaning out of your car window to get a parking ticket.

On the other hand, transient osteoporosis causes sudden and severe pain that intensifies with weight-bearing exercise, and your pain subsides with rest.

Transient osteoporosis symptoms intensify over weeks or months and eventually become debilitating. Patients often develop a noticeable limp and need a walking aid until their condition subsides.

Bone marrow edema is another sign of transient osteoporosis. Bone marrow is the spongy material inside the hollows of long bones that produces blood cells. Bone marrow edema occurs when this tissue is inflamed and full of fluid.

What Are the Treatment Options for Osteoporosis of the Hip?

The team of orthopedic surgeons at OrthoNeuro in Columbus, Ohio, provides thorough exams and testing, including magnetic resonance imaging (MRI) scans and X-rays to diagnose age-related and transient osteoporosis.



Once your physician understands your needs, they create a comprehensive treatment plan to address both forms of hip osteoarthritis. They combine proper nutrition, physical therapy, and medication.

Common age-related osteoporosis may improve with estrogen hormone therapy, selective estrogen receptive modulators, calcitonin, and bisphosphonates.

Your doctor could also prescribe calcium and vitamin D supplements as well as dietary changes.

Physical therapy can help build strength and flexibility in the muscles supporting and stabilizing your hip.

You may have weight-bearing restrictions if you have transient osteoporosis.

In this case, you may opt for water exercises and therapeutic movements with assistive devices. Nonsteroidal anti-inflammatory drugs (NSAIDs) may help with your pain.

Call OrthoNeuro or schedule a consultation online today if you have any concerns about hip osteoporosis.

Our team of orthopedic hip specialists supports your healing process, minimizing symptoms and helping you get back to your regular activities.

Make an Appointment with an OrthoNeuro Hip Specialist Today!

If you have been suffering from symptoms of osteoporosis hip pain, schedule an appointment with one of our Board Certified Orthopedic Hip Specialists at one of our 7 convenient locations throughout Greater Columbus. 

We will evaluate your unique lifestyle and goals to determine which type of treatment is best for you. Best of all, most patients can be seen within 24 hours of making an appointment.

Osteopenia – symptoms, causes, diagnosis, treatment

Osteopenia is a condition in which bone mineral density decreases. In addition, bone strength also decreases. This is accompanied by an increased risk of fracture. Osteopenia is often confused with osteoporosis. The difference between them is that in the first disease, bone loss is not so significant. Therefore, many people live with osteopenia for a long time without knowing about it. Let us consider in more detail what is the peculiarity of the pathology and how to avoid it.

What are osteoporosis and osteopenia? Why is osteoporosis dangerous?

As we grow older, the bones begin to thin out – this is a normal physiological process. With age, the rate of formation of new cells decreases compared to the rate of reabsorption of old cells. Against the background of an imbalance of such mechanisms, a change in the structure of bone tissue occurs, the bones lose their mass. As a result of a decrease in the amount of minerals in the chemical composition of bone tissues, they become brittle and more prone to fractures.

Maximum bone density is reached by 29–31 years of age, after which age regression occurs. But it is worth noting that the stronger the skeleton at this age, the later the osteopenic condition will develop. However, there are rare situations when low mineral density is considered acceptable and bone mass does not decrease.

The rate of bone loss varies between men and women. In men (regardless of age), it remains constant, about 0. 4% per year. In women, this parameter directly depends on the hormonal background. So, before the onset of menopause, it ranges from 0.7% to 1% per year. And during menopause, it increases significantly, reaching up to 2% per year.

Causes of osteopenia

The process of bone formation is largely related to genetic factors. It can be influenced by various individual characteristics (in particular, gender, age category, physical activity). Therefore, osteopenia is able to develop when some “failures” occur at various levels. Not the last role is played by genetic changes, for example, hereditary predisposition, early menopause. Other risk factors include:

1. Underweight.
2. Sedentary lifestyle (sedentary work, lack of physical activity).
3. Abuse of caffeinated drinks.
4. Bad habits (use of tobacco and alcohol products).
5. Calcium deficiency in the body.
6. Chronic inflammation due to disease (eg, rheumatoid arthritis).
7. Severe diseases of internal organs (liver, lungs, kidneys).
8. Celiac disease (autoimmune, hereditary disease of the digestive tract).
9. Radiation therapy and chemotherapy within the last six months.

Symptoms

As a rule, osteopenia does not cause discomfort, does not provoke pain, as long as there are no bone fractures. Pathology can be asymptomatic for many years before a diagnosis is made. At the same time, fractures that occur against the background of osteopenia (for example, of the hip or vertebrae) are very painful.

However, sometimes there are symptoms that indirectly indicate a pathology. Among them are disorders of the gastrointestinal tract, failure of metabolic processes, frequent injuries to the limbs. It is important for each person who has been diagnosed to adjust their lifestyle, to choose a medical correction.

Diagnosis

The presence of osteopenia is easy to establish: it is enough to determine the bone density. Many techniques have been created, but DERA has more information content. This is a dual energy x-ray absorptiometry capable of detecting a decrease in bone mass at an early stage (at 2%). Additionally, the doctor prescribes laboratory diagnostics to check hormonal parameters, the content of calcium and phosphorus, the lack of which triggers the mechanism for the development of osteopenia. Sometimes doctors resort to instrumental diagnostic methods – computer or magnetic resonance imaging.

As a preventive measure, laboratory diagnostics is recommended for women over 55 years of age. Especially if, in addition to menopause, there are risk factors: the European type, the presence of osteoporosis in the next of kin, underweight, the systematic use of corticosteroids, and the abuse of bad habits.

According to statistics, most often osteopenia occurs in women over the age of 55 years. However, men are also susceptible to the disease. The difference lies in the fact that against the background of a higher BMD, changes begin later.

Treatment of osteopenia

If a patient is diagnosed with osteopenia, they are prescribed lifestyle adjustments and a diet that includes foods rich in vitamin D, calcium and other micronutrients. It is important to treat the underlying disease, which provoked a violation of their absorption, for example, celiac disease.

The choice of drug treatment tactics is carried out on an individual basis, taking into account the results of diagnostics, concomitant diseases and general health. The doctor also takes into account all risk factors (hereditary predisposition, body type, the presence of chronic pathologies), establishing the risk of fractures in the coming years.

An integral part of therapy is lifestyle modification. So, if a person abuses alcohol and tobacco products, he needs to give up these addictions. With a sedentary lifestyle, you can not do without regular, but moderate physical activity (for example, swimming or yoga).

It is also important to ensure a sufficient daily intake of calcium and vitamin D. If dietary intake cannot be managed, special supplements are allowed. Women over 70 require 800 IU of vitamin D per day, men and women of other age groups 600 IU per day, and young children (under one year old) 400 IU per day.

For calcium, adult women (over 55) and men (over 70) need 1200 mg per day. It must be taken fractionally, not more than 600 mg at a time. For women over 45 years of age and men over 55 years of age, the recommended dosage is 1000 mg per day.

Doctors often prescribe specialized drugs to combat osteopenia: bisphosphonates, calcitonin, teriparatide. Sometimes hormone replacement therapy with estrogen and progesterone is required.

It is worth noting that long-term use of various bisphosphonates can lead to side effects that have some peculiarities (for example, aseptic necrosis of the jaw). However, they are rare. These drugs are prescribed when the benefits of preventing bone fractures far outweigh the possible risks of side effects of these drugs.

Often, the treatment of osteopenia does not require the use of specialized medications, since not everyone has it leading to bone fractures or progressing to osteoporosis. At the same time, prolonged use of such drugs is often accompanied by side effects that can lead to serious complications. In such clinical situations, the doctor prescribes dynamic monitoring of bone density through densitometry.

Prevention of osteopenia

Maintaining a healthy lifestyle is important to minimize the risk of osteopenia. You need to eat right to get enough calcium. It is important to ensure an adequate intake of vitamin D, to minimize the use of alcohol-containing products, to engage in moderate physical activity and not to abuse tobacco products.

At a young age, measures to strengthen bone tissue are important, since it reaches its maximum at about 30 years of age. But even after 30 years, it will be useful to adjust the lifestyle. Thanks to a balanced diet, regular physical activity, the process of loss of bone tissue density significantly slows down, and the development of osteoporosis is prevented.

Stages of development

There are three main stages of osteopenia:

1. At the first stage, there are no visible manifestations, there is a non-critical decrease in bone density. Various microelements (in particular, phosphorus, calcium, manganese) begin to be washed out of the body.
2. In the second stage, there is already a strong decrease in bone density, which is accompanied by an increased risk of fractures. Some patients have pain in the interscapular region or the lumbar spine. There are discomfort during movement, a feeling of stiffness.
3. At the third stage, the pathology becomes chronic. A person has regular exacerbations of symptoms at regular intervals, complications appear in the form of arthritis, arthrosis, osteoporosis and other diseases.

Types of disease

Osteopenia is in many ways similar to osteoporosis, except for the intensity of the course and possible complications. Specialists classify only osteoporosis, but its characteristics are also relevant in relation to osteopenia. For classification, the causes of development, the shape of the flow and location are taken into account. Let’s consider them in more detail.

Osteopenia in women

According to statistics, it occurs more often than in men. This is due to the peculiarities of the hormonal background. At the same time, women over 50 years of age and those who have begun menopause are at risk. Abortions, breastfeeding, and professional sports have a negative effect on the structure of bones. In such situations, you need to get more beneficial trace elements and estrogens.

Osteopenia in children

At an early age, the pathology is diagnosed very rarely (may appear against the background of genetic abnormalities, hypertrophy). Sometimes it occurs in adolescence during puberty.

Classification by cause of occurrence

There are four main types of pathology:

1. Senile. It appears against the background of age-related degenerations, the development of looseness of the bone structure.
2. Post-traumatic. This is an acute form of the disease, which arises as a result of serious injuries, mechanical damage to the bones.
3. Postmenopausal. It occurs in more than 70% of women during menopause, which indicates hormonal disruptions in the body.
4. Medicinal. It is expressed by a negative reaction of bone tissues to long-term use of corticosteroids and other heavy drugs.

Complications

If you do not provide timely assistance (lifestyle correction, drug therapy), then there is a high risk of fractures of the arms, legs, neck and back. With the progression of the pathology, a partial limitation of motor functions appears. Some patients develop osteoarthritis, sciatica, rheumatism. In advanced cases, disability is possible.

Prevention of bone loss and fractures

To minimize the risk of developing pathology, it is important not to abuse alcohol and tobacco products, get enough trace elements and vitamin D. It is also important to be careful when moving – by preventing falls, it is possible to reduce the likelihood of fractures, which caused by osteoporosis.

Specialists of the medical center “Miracle Doctor” at the initial appointment will conduct an examination and prescribe the necessary studies. When making a diagnosis of osteopenia, an appropriate treatment regimen will be prescribed. A positive result is guaranteed. To make an appointment for an initial appointment, it is enough to leave a request on the website with contact details. The administrator will contact you shortly to clarify the details.

Treatment of osteoporosis

Osteoporosis (literally: porous bone) is a systemic skeletal disease that leads to increased bone fragility and a tendency to fracture, due to a decrease in bone mass and damage to bone tissue.
This disease affects all bones of the skeleton , which leads to the risk of fractures in the simplest situations and everyday stress.
The most dangerous areas of fractures are: the neck of the femur, spine, radius in the wrist. Due to a decrease in bone mass, it can lead to micro fractures in the spine. These fractures can occur at any time, even with minimal physical exertion. This is especially dangerous for the elderly, as bone loss occurs gradually over many years and as a result, even a normal movement can result in a fracture.

Innovative Surgery Center

Therapy and Gastroenterology Center

Orthopedics and Traumatology Center

Neurology Center

Medical Rehabilitation Center

Why does osteoporosis occur?
Our bones contain minerals, in particular calcium and phosphorus , which give bones hardness and density. Until about 25-30 years of age, a person’s bone density increases, reaching its peak by 30-35 years. After that, the reverse process begins – the density of bone tissue begins to decrease due to their “washout”. The reason for this is hormonal disorders and metabolic disorder .

In a healthy body there is a constant renewal of bone tissue – the removal of old bone and the formation of a new one. The rate of renewal slows down with age, and after 30 years, bone destruction occurs faster than their replacement with new bone tissue. Particularly in menopausal women, a decrease in estrogen levels accelerates this loss and inhibits calcium absorption and new bone formation. If calcium stores in the bones are insufficient when the aging process has already begun, then the likelihood of developing osteoporosis increases, but calcium alone is not enough to prevent osteoporosis, magnesium and vitamin D are also needed.

Fractures of the femoral neck are especially dangerous in osteoporosis, which in some cases cause the death of the patient or lead to severe disability.
In the treatment of osteoporosis, it is important that therapy is aimed at slowing or stopping mineral loss, increasing bone density, preventing bone fractures, and reducing the pain associated with the disease. With adequate treatment, the development of osteoporosis can be slowed or stopped.
Factors that increase the risk of developing osteoporosis
– Family history (family of hip fractures)
– Smoking
– Frail build (body mass index less than 23)
– Alcohol use
– Fair skin
– Excessive coffee consumption ina
– Early menopause, including surgical menopause, infertility, prolonged lactation (more than 6 months).
– Sedentary lifestyle
– Medications (corticosteroids, levothyroxine, anticonvulsants, heparin)

How to diagnose osteoporosis?

Modern medicine has a fairly effective method for recognizing osteoporosis in its early stages.
X-ray and densitometry are used to diagnose osteoporosis.
Bone densitometry is mandatory for women 1-2 years after menopause.

There are a number of other signs of osteoporosis and decreased bone density. First of all, this is growth, its decrease by more than 1-1.5 cm is a signal for contacting a specialist. Another indirect sign of osteoporosis is poor posture.
In other cases, the most common symptoms of osteoporosis are characteristic pain in the thoracic and lumbar spine. Pain is aggravated after a small physical activity and a long stay in one position. Most patients with osteoporosis complain of a significant decrease in performance and increased fatigue.
If you experience any pain or discomfort in the bones, you should immediately consult a specialist for osteoporosis.

OSTEOPOROSIS TREATMENT

For the treatment and prevention of osteoporosis, depending on its severity and severity, Vodnikov Orthopedics and Traumatology Center prescribes treatment with zoledronic acid.

Zoledronic acid is a highly effective bisphosphonate that selectively acts on bone tissue, inhibiting the destruction of bone tissue.
The action of zoledronic acid on bone tissue is based on its high affinity for mineralized bone tissue. After intravenous administration, zoledronic acid is rapidly redistributed in the bone tissue and is localized mainly in the areas of re-modeling of the bone tissue.
When using zoledronic acid in patients with postmenopausal osteoporosis, there was a statistically significant reduction in the risk of fractures by 70% by the end of 3 years of treatment. In patients with osteoporosis aged 75 years and older, treatment with zoledronic acid resulted in a 61% reduction in the risk of fractures.

Treatment of osteoporosis at the Vodnikov Medical Center

Traumatologist-orthopedist appointment
Diagnosis of osteoporosis
Physician appointment
Diagnosis
Hospitalization in the Orthopedics and Traumatology Center (1 day)
Zoledronic acid treatment o
Medical supervision after the procedure

During treatment osteoporosis with zoledronic acid in patients, there was a rapid and prolonged therapeutic response.