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Regional migratory osteoporosis – a differential diagnostic problem


Authors: I. Žofková
Authors‘ workplace: Ředitel: doc. MUDr. Vojtěch Hainer, CSc. ;  Endokrinologický ústav, Praha
Published in: Prakt. Lék. 2009; 89(7): 393-395
Category: Diagnostis

Overview

Transient osteoporosis of the hip (TOH) (reflex sympathetic dystrophy, marrow oedema syndrome) is acute hip demineralization associated with bone marrow oedema. The disease arises abruptly as a painful syndrome that, usually after several weeks, spontaneously disappears. The disease is assumed to be a localized variant of regional migratory osteoporosis (RMO), in which bone loss and pain gradually migrate to further weight-bearing joints of the lower extremities. TOH and RMO were described in males of middle age, but they affect even premenopausal women, often in the 3rd trimester of pregnancy.

The most serious cases of RMO may be associated with systemic bone loss. The fundamental diagnostic method in TOH and RMO is magnetic rezonance (MRI) combined with radioisotope scan using Tc99. RMO can be successfully treated with nonsteroid anti-inflammatory drugs, calcium and vitamin D supplementation, the exclusion of mechanical load of joints and by rehabilitation. Administration of bisphosphonates is necessary in exceptional cases. Marrow oedema syndrome may cause differential diagnostic difficulties in osteoarthritis, rheumatoid arthritis, aseptic avascular necrosis, glucocorticoid-induced osteoporosis and malignancies.

Key words:
transient osteoporosis of the hip, regional migratory osteoporosis, bone marrow oedema syndrome, reflex sympathetic dystrophy.


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