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. 1998;18:35–42.

The pathology of transient regional osteoporosis.

E F McCarthy 1
PMCID: PMC2378158  PMID: 9807706

Abstract

Biopsy specimens from 19 patients with transient regional osteoporosis were studied. All patients presented with pain. There were nine patients with transient osteoporosis of the hip. Six of these specimens were therapeutic core biopsies, and three were femoral heads removed during total hip replacement. The other patients with osteoporosis in different locations had biopsies to rule out infection or neoplasm. Five of these patients had transient osteoporosis of the knee. Three had ankle involvement and two had involvement of the tibial shaft. Plain radiographs were available for study in all cases, and either a bone scan or an MRI was studied in each case. Except for one patient who was lost to follow-up, all had resolution of symptoms and radiographic changes. The histologic changes in the biopsies were distinctive, although they were present in varying degrees. There was edema and reactive bone formation in the marrow spaces. In addition, osteoclastic bone resorption was active in 14 of the 19 cases. Although lipid cysts were sometimes found in the marrow spaces, there was no evidence of fat necrosis or bone necrosis. The high bone turnover and absence of fat necrosis suggests that this disorder is a vasomotor response rather than an early stage of osteonecrosis. Awareness of these characteristic histologic changes should enable the pathologist to make a specific diagnosis of transient regional osteoporosis when a biopsy is required.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Apel D. M., Vince K. G., Kingston S. Transient osteoporosis of the hip: a role for core decompression? Orthopedics. 1994 Jul;17(7):629–632. doi: 10.3928/0147-7447-19940701-13. [DOI] [PubMed] [Google Scholar]
  2. Beaulieu J. G., Razzano C. D., Levine R. B. Transient osteoporosis of the hip in pregnancy. Clin Orthop Relat Res. 1976 Mar-Apr;(115):165–168. [PubMed] [Google Scholar]
  3. CURTISS P. H., Jr, KINCAID W. E. Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am. 1959 Oct;41-A:1327–1333. [PubMed] [Google Scholar]
  4. Dihlmann W., Delling G. Ist die transitorische Hüftosteoporose eine transitorische Osteonekrose? Z Rheumatol. 1985 Mar-Apr;44(2):82–86. [PubMed] [Google Scholar]
  5. Froberg P. K., Braunstein E. M., Buckwalter K. A. Osteonecrosis, transient osteoporosis, and transient bone marrow edema: current concepts. Radiol Clin North Am. 1996 Mar;34(2):273-91, x. [PubMed] [Google Scholar]
  6. Hayes C. W., Conway W. F., Daniel W. W. MR imaging of bone marrow edema pattern: transient osteoporosis, transient bone marrow edema syndrome, or osteonecrosis. Radiographics. 1993 Sep;13(5):1001–1012. doi: 10.1148/radiographics.13.5.8210586. [DOI] [PubMed] [Google Scholar]
  7. Lagier R., Boussina I., Mathies B. Algodystrophy of the knee. Anatomo-radiological study of a case. Clin Rheumatol. 1983 Mar;2(1):71–77. doi: 10.1007/BF02032072. [DOI] [PubMed] [Google Scholar]
  8. Lagier R. Partial algodystrophy of the knee. An anatomico-radiological study of one case. J Rheumatol. 1983 Apr;10(2):255–260. [PubMed] [Google Scholar]
  9. Lagier R., de Montmollin B., Krucker V. Case report 256. Parcellar algodystrophy of the left femoral head [i.e. localized (focal) transient osteoporosis] associated with synovial chondromatosis of the hip. Skeletal Radiol. 1984;11(1):69–72. doi: 10.1007/BF00361137. [DOI] [PubMed] [Google Scholar]
  10. Lakhanpal S., Ginsburg W. W., Luthra H. S., Hunder G. G. Transient regional osteoporosis. A study of 56 cases and review of the literature. Ann Intern Med. 1987 Mar;106(3):444–450. doi: 10.7326/0003-4819-106-3-444. [DOI] [PubMed] [Google Scholar]
  11. Lequesne M. Transient osteoporosis of the hip. A nontraumatic variety of Südeck's atrophy. Ann Rheum Dis. 1968 Sep;27(5):463–471. doi: 10.1136/ard.27.5.463. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Pantazopoulos T., Exarchou E., Hartofilakidis G. A. Idiopathic transient osteoporosis of the hip. J Bone Joint Surg Am. 1973 Mar;55(2):315–321. [PubMed] [Google Scholar]
  13. Parker R. K., Ross G. J., Urso J. A. Transient osteoporosis of the knee. Skeletal Radiol. 1997 May;26(5):306–309. doi: 10.1007/s002560050241. [DOI] [PubMed] [Google Scholar]
  14. Plenk H., Jr, Hofmann S., Eschberger J., Gstettner M., Kramer J., Schneider W., Engel A. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res. 1997 Jan;(334):73–84. [PubMed] [Google Scholar]
  15. Potter H., Moran M., Schneider R., Bansal M., Sherman C., Markisz J. Magnetic resonance imaging in diagnosis of transient osteoporosis of the hip. Clin Orthop Relat Res. 1992 Jul;(280):223–229. [PubMed] [Google Scholar]
  16. Reinus W. R., Fischer K. C., Ritter J. H. Painful transient tibial edema. Radiology. 1994 Jul;192(1):195–199. doi: 10.1148/radiology.192.1.8208937. [DOI] [PubMed] [Google Scholar]
  17. Renier J. C., Baslé M., Masson C., Brégeon C., Audran M. Algodystrophies itératives des membres inférieurs, migratrices sur les pieds, compliquées de deux fractures de fatigue. Etude histologique osseuse. Rev Rhum Ed Fr. 1993 Jun;60(6):469–473. [PubMed] [Google Scholar]
  18. Rosen R. A. Transitory demineralization of the femoral head. Radiology. 1970 Mar;94(3):509–512. doi: 10.1148/94.3.509. [DOI] [PubMed] [Google Scholar]
  19. Schapira D. Transient osteoporosis of the hip. Semin Arthritis Rheum. 1992 Oct;22(2):98–105. doi: 10.1016/0049-0172(92)90003-v. [DOI] [PubMed] [Google Scholar]
  20. Steiner R. M., McKeever C. Regional migratory osteoporosis. J Can Assoc Radiol. 1973 Mar;24(1):70–75. [PubMed] [Google Scholar]
  21. Swezey R. L. Transient osteoporosis of the hip, foot and knee. Arthritis Rheum. 1970 Nov-Dec;13(6):858–868. doi: 10.1002/art.1780130616. [DOI] [PubMed] [Google Scholar]
  22. Turner D. A., Templeton A. C., Selzer P. M., Rosenberg A. G., Petasnick J. P. Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions. Radiology. 1989 Apr;171(1):135–140. doi: 10.1148/radiology.171.1.2928517. [DOI] [PubMed] [Google Scholar]
  23. Wilson A. J., Murphy W. A., Hardy D. C., Totty W. G. Transient osteoporosis: transient bone marrow edema? Radiology. 1988 Jun;167(3):757–760. doi: 10.1148/radiology.167.3.3363136. [DOI] [PubMed] [Google Scholar]

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