Disclosures: Trent C. Edwards, MD: No financial relationships or conflicts of interest

Case Diagnosis: Transient Osteoporosis of the Hip

Case Description or Program Description: A 50-year-old male presented with the insidious onset of right hip pain. His pain was located in the groin, with radiation to the right lateral hip. It was notably worse in the morning, but improved with ambulation throughout the day. Patient had full passive and active range of motion and strength, but had positive testing with FABER, FADIR, and log roll. X-rays were obtained which demonstrated minimal degenerative changes, consistent with hip osteoarthritis. Patient proceeded to receive an intra-articular hip injection without improvement of symptoms. Additionally, the patient’s oxycodone dose was up-titrated without symptom relief. Due to continued concern for a possible stress fracture or labrum tear, an MRI was ordered demonstrating transient osteoporosis of the right hip. Most notably, the addition of calcium and vitamin D supplementation for one month significantly improved his pain. He was able to ambulate 50% further, and his pain was well controlled with solely the use of Tylenol.

Setting: Outpatient Clinic at an Academic Institute

Assessment/Results: A right hip x-ray was obtained at the patient’s most recent follow up visit, 3 months after the initiation of calcium and vitamin D supplementation, which confirmed transient osteoporosis over a simple stress reaction.

Discussion (relevance): Transient Osteoporosis of the hip (TOH) is a self-limiting and idiopathic condition that is characterized by unexplained hip pain. TOH is most commonly seen in healthy, middle-aged males with a male: female ratio of 3:1. With correct conservative treatment, recovery is seen in an average of six months.

Conclusions: It is important to consider Transient Osteoporosis on the differential diagnosis when encountering a patient that presents with refractory hip pain. When suspected, an MRI should be obtained to confirm the diagnosis. Treatment is primarily conservative using calcium and vitamin D, with occasional supplementation of bisphosphonates to reduce the duration of recovery.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/transient-osteoporosis-of-the-hip-a-case-report/