Zoledronic acid is effective in the management of migratory osteoporosis unresponsive to conservative treatment and risedronate: A case report.

We describe a case of a 55-year-old woman with migratory osteoporosis (MO) which initially presented as pain with bone marrow edema (BME) evident in magnetic resonance imaging (MRI) of the left ankle and was managed with non-weight-bearing (NWB). The patient was already treated with per os risedronate for postmenopausal osteoporosis. After significant initial improvement, pain and BME relapsed in the left ankle and additionally expanded to insult the foot, while 3 months later the left hip was also affected. Since the combination of NWB, analgesics and risedronate had failed to control the disease, a single infusion of 5mg zoledronic acid (ZA) was administered. One month later the pain in all affected sites was disappeared and BME resolved as shown by MRI performed 3.5 months following ZA infusion. The patient, eventually, returned to her daily routine. This case underlines the effectiveness of ZA in MO and the need for more aggressive treatment in this disease.

A case of regional migratory osteoporosis.

We present the case of a middle-aged man with three episodes of regional migratory osteoporosis of the lower extremities occurring over a period of 8 years. Symptoms included a sudden onset of unilateral bone and joint pain. After initiation of pamidronate treatment, symptoms improved significantly. Regional migratory osteoporosis is a rare, but probably underdiagnosed condition with an unclear etiology. This case illustrates the importance of recognition of the disease in order to inform the patient, start treatment, and prevent unnecessary invasive procedures. Although in literature, not much is reported about treatment strategies, our patient was successfully treated with pamidronate after failure of oral bisphosphonates.

Regional migratory osteoporosis of the knee: a literature overview.

The purpose of this article is to review the clinical syndrome of regional migratory osteoporosis (RMO) of the knee and to highlight all the important aspects of diagnosis and management that can be helpful to the physician. RMO is a rare, self-limiting disease characterized by migrating arthralgia, bone marrow edema and osteoporosis. The pathogenesis of RMO remains controversial and is not yet fully elucidated. A thorough presentation of the disease is conducted with presentation of the clinical features (progressive pain and local tenderness), differential diagnosis and appropriate diagnostic criteria. The role of MRI is underlined and strategies for the treatment of RMO are presented.

Regional Migratory Osteoporosis - A Rare Cause of Knee Pain (Case Report).

Introduction: Regional migratory osteoporosis (RMO) is an unusual phenomenon characterized by migrating arthralgia of the lower limbs due to underlying bone marrow edema. Case Report: We discuss a 57-year-old male with a 3-month history of atraumatic medial knee pain. Magnetic resonance imaging demonstrated bone marrow edema of the medial femoral condyle that resolved with rest and simple analgesia, followed by posterolateral knee pain and similar imaging changes in the lateral femoral condyle. Conclusion: Most cases of RMO spontaneously resolve with limitation of weight-bearing and simple analgesia. For recurrent cases, surgical intervention may be required.

Transient regional osteoporosis of the hip with extensive bone marrow edema (BME): Dramatic improvement after three months of Alendronate therapy.

Transient osteoporosis of the hip, also termed transient bone marrow edema, is a painful condition often occurring after trivial trauma. It can be diagnosed with MRI in patients whose radiographs are negative or inconclusive. In this case report we describe a 39-year-old female patient with this rare entity, who was successfully treated with oral Alendronate, active vitamin D and calcium supplementation combined with avoiding of weight bearing on the affected hip. She improved clinically within three months and on contrast enhanced MRI studies, as performed before and after treatment, complete regression of bone marrow edema was shown already after three months of treatment. The literature was reviewed regarding the pathophysiology of transient osteoporosis of the hip and the beneficial effects of Alendronate in this domain. The report is important because it will increase the awareness among clinicians and radiologists about this entity, as in neglected cases transient regional osteoporosis of the hip may progress to avascular necrosis with complete loss of hip function.

Repeated Low Back Pain Caused by Regional Migratory Osteoporosis of the Sacroiliac Joint.

INTRODUCTION: Regional migratory osteoporosis (RMO) is a rare, self-limiting disorder characterized by migratory arthralgia that mainly occurs in the weight-bearing joints of the lower extremities. RMO is most commonly observed in middle-aged men, and its etiology is unknown. We report the case of a middle-aged man who experienced repeated low back pain that was caused by RMO of the sacroiliac joint (SIJ). CASE REPORT: In this case, the patient initially complained of left low back pain; however, there were no specific findings in plain radiography of the lumbar spine and pelvis. In addition, blood chemistry test findings were normal. Magnetic resonance imaging (MRI)revealed a diffuse bone marrow edema in the left SIJ. Conservative treatment was effective, and the pain was relieved within 3 months. However, 2 months later, a similar pain developed on the right side. MRI showed bone marrow edema in the right SIJ and the left-sided lesion had disappeared. The symptom was relieved by conservative treatment. After 5 months, the pain disappeared and the MRI findings became normal. During the next 2 years of follow-up, there is no recurrence of the illness. CONCLUSIONS: To the best of our knowledge, this is the first report of RMO with a lesion that moved to the SIJ of both sides. We believe that knowledge of this disorder can prevent invasive procedures, particularly, in treating a patient with low back pain.

Transient Migratory Osteoporosis of the Hip and Talus: A Case Report.

INTRODUCTION: Transient migratory osteoporosis (TMO) is a rare and self-limiting condition of unknown etiology. The hip joint is the most common joint to get involved in this disease followed by a knee, ankle, and foot. CASE REPORT: We report a case, which illustrates the importance of recognizing the typical clinical and radiological features of TMO of the hip and ankle, thereby allowing an appropriate form of treatment. Spontaneous resolution of symptoms occurred in the patient. CONCLUSION: TMO can present a diagnostic challenge, but awareness of the typical presenting features and investigation findings can often avoid diagnostic difficulties.

Risk factors in transient osteoporosis: a retrospective study on 23 cases.

The aim of this study is to verify the prevalence of risk factors for transient osteoporosis (TO) in a cohort of patients selected by strict diagnostic criteria. Retrospective observational cohort study on outpatients' data. Inclusion criteria were: (1) acute onset of pain at a lower limb joint exacerbated by weight bearing; (2) no history of trauma, tumors, rheumatic diseases, or infection; (3) presence bone marrow edema on MRI in a weight bearing joint without signs of intraarticular lesions; (4) no hyperesthesia and/or allodynia and/or sweeting changes. The following risk factors were search for in all patients: (1) previous episode of TO; (2) disorders of bone metabolism; (3) cigarette smoke; (4) sudden lower limb overuse; (5) presence of osteoporosis/osteopenia. Twenty-three patients (8 females, 15 males, mean age 48.4 years) fulfilled the inclusion criteria. An average of 1.96 risk factors for TO was present in the cohort. The most frequent risk factor was overuse (in 15 patients, 65.2 %) and the second risk factor was bone metabolism disorders (in 10 patients, 43.5 %). Seven patients (30.4 %) were heavy smokers (more than 20 cigarettes per day) and seven patients showed a previous episode of TO. Six patients (26.1 % of the overall cohort but 60 % of those investigated with DEXA) resulted osteoporotic or osteopenic. Our results suggest there are risk factors that must be investigated in these patients. The presence of these risk factors might support the thesis that their disorder is tied to a decoupling between microdamage accumulation and self-reparative ability of bone tissue. The identification of risk factors with a precise diagnostic pathway can accelerate the diagnostic process and reduce recurrences.

Bone Marrow Edema Syndrome of the Foot and Ankle: Mid- to Long-Term Follow-up in 18 Patients.

UNLABELLED: Bone marrow edema syndrome (BMES) is a condition characterized by pain and an increase interstitial fluid within the bone marrow in the absence of a definable cause. The purpose of this study was to assess the changes in the pattern of bone edema and quality of pain over time. In patients diagnosed with BMES of the foot and ankle, we investigated the benefit of treatment with bisphosphonates and immobilization in a pneumatic walking boot compared with immobilization in a boot alone. This study is a retrospective review of 18 consecutive patients (mean age 54 years) diagnosed with foot and ankle BMES. Twelve (67%) patients were female and 6 were male with a mean age of 60.1 and 43.0 years, respectively (P < .05). The minimum follow-up was 2 years (range 2-11 years, mean 5.75 years). Five females and no males were found to suffer from generalized osteoporosis. The average duration of symptoms prior to presentation was 22 weeks and the most common bone affected was the talus (56%). More than one bone was affected in 8 (44%) patients. All patients were given a walking boot at first attendance for 8 weeks. The mean time to resolution of pain in patients treated with a pneumatic walker alone (7 patients) was 25.6 weeks (range 8-36 weeks). In the 11 patients whose pain had not improved at their first follow-up, treatment with bisphosphonates led to a more rapid resolution of pain in 13.8 weeks if given intravenously, and 24.0 weeks if given orally. Statistical analysis demonstrated a significant advantage in using a bisphosphonate versus a protected weightbearing alone (P < .01). Recurrence within the same foot and ankle occurred in 44% of patients at a mean interval of 15.6 months and migration to a different site occurred in 6% of patients. LEVELS OF EVIDENCE: Therapeutic, Level III: Retrospective, comparative trial.

MR imaging of transient osteoporosis of the hip: an update on 155 hip joints.

PURPOSE: Transient osteoporosis of the hip (TOH) presents with acute onset pain and bone marrow edema (BMe) on MR imaging. The purpose of this study is to revise the MR imaging characteristics of TOH by analyzing the data derived from 155 hip examinations. We also sought to explore the relationship between the duration of symptoms and the presence of sparing and subchondral fractures. MATERIALS AND METHODS: MR images of 155 hips (141 TOH patients) were retrospectively evaluated for the presence of insufficiency fractures and the morphology of BMe. Sparing of the medial bone marrow of the femoral head was recorded together with demographic and clinical data. Progression to regional migratory osteoporosis (RMO) and postpartum cases were also recorded. RESULTS: Our population consisted of 76.4% male and 23.6% female patients. RMO progression was recorded in 19.4% and 4 postpartum cases displayed bilateral disease. Sparing of the medial bone marrow was present at 87.7% of patients and disappeared as the disease progressed (P=0.005). BMe was restricted within the femoral head in 11.0%, extended to the femoral neck in 40% and to the femoral shaft in 49% of the cases studied. Subchondral fractures were present at 48.7% of the hips. CONCLUSION: This study describes TOH patient characteristics, the MR imaging findings (BMe pattern, microfractures), their association with symptom duration and the chance of progressing to RMO.

Transient regional osteoporosis.

Transient regional osteoporosis (TRO) is a disease that predisposes to fragility fracture in weight bearing joints of mid-life women and men. Pregnant women may also suffer the process, usually at the hip. The prevalence of TRO is lower than the systemic form, associated with postmenopause and advanced age, but may be falsely diminished by under-diagnosis. The disease may be uni- or bilateral, and may migrate to distinct joints. One main feature of TRO is spontaneous recovery. Pain and progressive limitation in the functionality of the affected joint(s) are key symptoms. In the case of the form associated with pregnancy, difficulties in diagnosis derive from the relatively young age at presentation and from the clinical overlapping with the frequent aches during gestation. Densitometric osteoporosis in the affected region is not always present, but bone marrow edema, with or without joint effusion, is detected by magnetic resonance. There are not treatment guidelines, but the association of antiresorptives to symptomatic treatment seems to be beneficial. Surgery or other orthopedic interventions can be required for specific indications, like hip fracture, intra-medullary decompression, or other.