Disclosures: Jami G. Montagnino, MD: No financial relationships or conflicts of interest
Case Description: The patient presented with three months of left hip pain requiring new use of an assistive device without preceding trauma. Exam was notable only for antalgic gait and painful hip internal rotation. Radiographs revealed mild osteoarthritis of the hips. MRI hip showed diffuse marrow edema of the left proximal femur consistent with transient osteoporosis of the hip (TOH) versus early avascular necrosis (AVN). Symptoms resolved after several months of protected weight-bearing and physical therapy. One year later, patient returned with similar history and exam on the contralateral side. MRI showed resolution of left sided edema, but new marrow edema on the right proximal femur.
Setting: Academic Outpatient Musculoskeletal Clinic
Patient: A 73-year-old man with sequential bilateral transient osteoporosis of hip Assessment/
Results: Nine months of conservative treatment led to near resolution of right hip symptoms, with mild residual stiffness.
Discussion: TOH is uncommon with unclear etiology. It can be difficult to diagnose since radiographic evidence of osteoporosis typically lags behind symptom onset. MRI allows for early diagnosis due to high sensitivity and ability to evaluate for AVN. Protected weight-bearing is important to reduce fracture risk as TOH may represent early osteonecrosis. The usual presentation is a middle-aged man or pregnant woman with acute onset pain. Our patient had none of the commonly associated risk factors, including: trauma, substance use, corticosteroids, or vascular insults. To our knowledge this is the first reported case of sequential bilateral TOH in an elderly male.
Conclusion: Transient osteoporosis, though uncommon, should remain on the differential for patients with severe hip pain and normal radiographs. TOH may be a precursor to AVN, therefore workup should include MRI and treatment should include protected weight bearing with close follow up.
Level of Evidence: Level V
To cite this abstract in AMA style:
Montagnino JG, Concannon L. Sequential Bilateral Transient Osteoporosis of the Hip in an Older Male: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/sequential-bilateral-transient-osteoporosis-of-the-hip-in-an-older-male-a-case-report/. Accessed May 31, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sequential-bilateral-transient-osteoporosis-of-the-hip-in-an-older-male-a-case-report/