American Journal of Internal Medicine
Volume 7, Issue 2, March 2019, Pages: 27-32
Received: Mar. 4, 2019;
Accepted: Apr. 4, 2019;
Published: May 15, 2019
Views 541 Downloads 119
Nissim Ohana, Department of Orthopeadic Surgery, Meir Medical Center, Kfar Saba and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Dimitri Sheinis, Department of Orthopeadic Surgery, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
Daniel Benharroch, Independent Physician, Department of Pathology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
A complex and often confusing nomenclature is currently used for relatively rare syndromes characterized by sudden onset of joint pain in the lower limbs, absence of trauma, bone marrow edema and its resolution, both confirmed by the MRI, as well as a self-limiting course. These include transient osteoporosis of the hip (TOH), of the knee (TOK), of the foot and ankle and transient bone marrow edema syndrome. Our purpose was to review the literature in order to substantiate the hypothesis that these apparently different conditions may be synthesized into a single disease entity, termed transient primary bone marrow edema syndrome (TPBMES). Of a total of 546 patients scrutinized, 342 had TOH, 105 had TOH of pregnancy, and 49, mainly females, showed transient foot-and-ankle osteoporosis. TPBMES occurred also with systemic osteoporosis or in a migratory pattern. The six proposed subsets of TPBMES have in common a MRI-based diagnosis and remission, as well as a self-limiting course. Thus, the hypothesis of a single disease entity is sustainable. We conclude that the education of the medical profession regarding this rare disease should expand. The causes of the prolonged symptoms seen in the systemic osteoporosis and migratory subsets warrant further studies. The efficiency of our suggested modality of management should be validated in a large cohort.
Transient Primary Bone Marrow Edema Syndrome - A Synthesis, American Journal of Internal Medicine.
Vol. 7, No. 2,
2019, pp. 27-32.
Klontzas ME, Vassalou EE, Zibis AH, Bintoudi A, Karantanas A. MR imaging of transient osteoporosis of the hip: An update on 155 hip joints. Eur J Radiol 2015;84:431-436.
Wilson AJ, Murphy WA, Hardy DC, Totty WG. Transient osteoporosis: transient bone marrow edema? Radiology1988;167;757-760.
Geith T, Niethammer T, Milz S, Dietrich O, Reiser M, Baur-Melnyk A. Transient bone marrow edema syndrome versus osteonecrosis: perfusion patterns at dynamic contrast-enhanced MR imaging with high temporal resolution can allow differentiation. Radiology2017;283:478-485.
Lakhanpal S, Ginsburg WW, Luthra HS, Hunder GG. Transient regional osteoporosis. A study of 56 cases and review of the literature. Ann Intern Med 1987;106:444-449.
Malizos KN, Zibis AH, Dailiana Z, Hantes M, Karahalios T, Karantanas AH. MR imaging findings in transient osteoporosis of the hip. Eur J Radiol 2004;50:238-244.
Singh D, Ferrero A, Rose B, Goldberg A, Cullen N. Bone marrow edema syndrome of the foot and ankle. Foot & Ankle Specialist 2016;9:218-226.
Curtiss PH Jr, Kincaid WE. Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am1959;41:1327-33.
Lequesne M. Transient osteoporosis of the hip: a non-traumatic variety of Sudeck’s atrophy. Ann Rheum Dis1968;27:463–71.
Vardi G, and Turner PJ. Transient osteoporosis of the knee. The Knee 2004;11:21.
Balakrishnan A, Schemitsch EH, Pearce D, McKee MD. Distinguishing transient osteoporosis of the hip from avascular necrosis. Can J Surg 2003;46:187-92.
Trevisan C, Ortolani S, Monteleone M, Marinoni EC. Regional migratory osteoporosis: a pathogenetic hypothesis based on three cases and the review of the literature. Clin Rheumatol 2002;21:418-425.
Karantanas AH, Nikolakopoulos I, Korompilias AV, Apostolaki E, Skoulikaris N, Eracleous E. Regional migratory osteoporosis of the knee: MRI findings in 22 patients and review of the literature. Eur JRadiol 2008;67:34-41.
Smith A, Lopez-Sola M, McMahon K, et al. Multivariate pattern analysis utilizing structural and functional MRI - in individuals with musculoskeletal pain and healthy controls: a systematic review. Sem Arthritis Rheum 2017; 47:418-431.
YamagushiR, Yamamoto T, Motomura G, et al. Radiological morphology variances of transient osteoporosis of the hip. J Orthop Sci 2017; 22:687-692.
Guler O, Ozyurek S, Cakmak S, Isyar M, Mutlu S, Mahirogullari M. Evaluation of results of conservative therapy in patients with transient osteoporosis of the hip. Acta Orthop Belg 2015;81:420-426.
Horas K, Fraissler L, Maier G, et al. High prevalence of Vitamin D deficiency in patients with bone marrow edema syndrome of the foot and ankle. Foot & Ankle Int 2017;38:760-766.
Arayssi TK, Tawbi HA, Usta IM, et al. Calcitonin in the treatment of transient osteoporosis of the hip. Sem Arthritis Rheumatism 2003;32:388-397.
Emad Y, Ragab Y, El-Shaarawy N, Rasker JJ. Transient osteoporosis of the hip, complete resolution after treatment with aledronate as observed by MRI description of eight cases and review of the literature. ClinRheumatol 2012;31:1641-1647.
Flores-Robles BJ, Sanz-SanzJ, Sanabria-Sanchinel AA. Zoledronic acid treatment in primary bone marrow edema syndrome. J Pain Palliat Care Pharmacother2017; 31:52-56.
Goldman GA, Friedman S, Hod M, Ovadia J. Idiopathic transient osteoporosis of the hip in pregnancy. Int J Gynecol Obstet 1994;46:317-320.
Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I. Pregnancy-associated transient osteoporosis of the hip: results of a case-control study. Arch Osteoporos2017; 12:11. doi:10.1007/s11657-017-0310-y.
Sprinchorn AE, O'Sullivan R, and Beischer AD. Transient bone marrow edema of the foot and ankle and its association with reduced systemic bone mineral density. Foot & Ankle Int2011;32:508-512.
Toms AP, Marshall TJ, Becker E, Donell ST, Lobo-Mueller EM, Barker T. Regional migratory osteoporosis: a review illustrated by five cases. Clin Radiol 2005;60:425-438.