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Current
Chapter:
Transient Osteoporosis of the Hip
Transient osteoporosis of the hip (TOH) represents a number of challenges for treating physicians: It is an uncommon disorder, the etiology is unclear, and it is often confused with multiple other diagnosis including osteonecrosis of the femoral head (ONFH) and reflex sympathetic dystrophy. There is also significant confusion regarding nomenclature-it is known by a variety of terms including: transient osteoporosis, bone marrow edema syndrome, and regional migratory osteoporosis, migratory of osteolysis, transient hip demineralization, and regional transient osteoporosis. The pathophysiology is equally unclear. There have been at least ten possible causes proposed including neurologic, endocrine, vascular, and metabolic mechanisms (Zabalbeascoa 1999).
Although, the pathophysiologic basis for this disorder remains unclear, there is a clear distinction between the natural history of transient osteoporosis of the hip and the typical course of osteonecrosis of the femoral head. The following chapter will outline the important clinical and radiographic distinctions between these two processes and provide treating clinicians criteria necessary to establish an accurate diagnosis.
Distinguishing between TOH and ONFH has important prognostic and therapeutic significance. TOH can be expected to improve with conservative non-operative treatment while ONFH often requires surgery and has a much worse prognosis. The goal of this chapter is to provide clinicians with reliable criteria to distinguish these two important disease processes.
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Richard Illgen II, M.D.
University of Wisconsin Hospital
and Clinics
School of Medicine
Department of Orthopedics
and Rehabilitation
Madison, WI 53792
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John P. Heiner, M.D.
University of Wisconsin Hospital
and Clinics
School of Medicine
Department of Orthopedics
and Rehabilitation
Madison, WI 53792
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