TRANSIENT MIGRATORY OSTEOPOROSIS

TRANSIENT MIGRATORY OSTEOPOROSIS
or, IDIOPATHIC TRANSIENT OSTEOPOROSIS
or, BONE MARROW OEDEMA SYNDROME

• Definition: An acute condition of unknown etiology characterized by severe pain in hip, mainly found in middle aged men & less often in women of late pregnancy.
• Etiology: Unknown
• Site: Most common- Hip joint, then Ankle,  Foot & Knee.
• B/L- 30%
• Pathophysiology: Sub-lethal reversible episode of ischemia associated with hyperemia of surrounding bone.
• Clinical Features: ~Acute onset of Hip pain, Limp, Local muscle wasting
  ~Pain migrating to ankle, foot or knee;
  ~No H/O Trauma
  ~Slowly resolving after 4-6 months.
• X-RAY: Demineralization of Head & Neck
• Bone Scan: Increased activity
• MRI:
  1)Diffuse– Bone oedema;
  2)Focal– Focal lesion in the zone of greatest bone strain; after 3 months of diffuse form &
  3)Residual– resolving; intensity of normal fatty marrow; small residual lesion in head/neck
• D/D: Osteonecrosis, Osteomyelitis, Neoplasm, PVNS, RA etc.
• Treatment: Rest +/- Analgesics   >resolves in 6 months
  Role of Bisphosphonates in some cases.
  Core decompression if no relief in pain.

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