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Archives of Osteoporosis

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01-12-2017 | Original Article

Pregnancy-associated transient osteoporosis of the hip: results of a case-control study

Authors: Peyman Hadji, Jelena Boekhoff, Melitta Hahn, Lars Hellmeyer, Olaf Hars, Ioannis Kyvernitakis

Published in: Archives of Osteoporosis | Issue 1/2017

Abstract

Summary

The etiology and underlying mechanisms of transient of osteoporosis of the hip (TOH) during pregnancy are still unclear, since no systematic analyses exist. Our results support the hypothesis that TOH is a multifactorial disease, which is associated with immobility, dental problems, and lack of exercise in childhood.

Introduction

Pregnancy-associated transient osteoporosis of the hip (TOH) is a rare but severe form of osteoporosis, which may affect a subgroup of women in the last trimester of pregnancy or immediately postpartum. Common symptoms include acute pain of the hip(s) due to bone marrow edema or even hip fractures. The exact underlining mechanisms of this disorder are still unknown since no published systematic analyses exist.

Methods

Out of a total of 52 TOH patients, 33 TOH patients could be matched with 33 healthy controls according to age, region, and gravity. The aim of this retrospective case-control study was to evaluate the risk factors for TOH in a homogenous population of women.

Results

The baseline characteristics of the two study groups were similar. Overall, 12.1% of the TOH patients sustained a hip fracture. Expectedly, 90.9% of the TOH patients complained about pain of the hip (p ≤ 0.001). TOH patients suffered more frequently from severe dental problems during childhood (p = 0.023) and performed less often sports before and after puberty (p ≤ 0.001), whereas the frequency of immobilization during pregnancy was threefold higher compared to the control group (p = 0.007). We found a significant increase of the TOH risk in patients with dental problems in childhood (OR 3.7; CI 1.3–10.7) as well as in patients with lack of exercise during childhood (OR 4.2; CI 1.3–12.9).

Conclusions

Our results support the hypothesis that pregnancy-associated TOH is a multifactorial disease, to which several individual factors may contribute. Hereby, we found significant associations with immobility, dental problems, and lack of exercise in childhood.

Curtiss PH Jr, Kincaid WE (1959) Transitory demineralization of the hip in pregnancy. A report of three cases. J Bone Joint Surg Am 41-A:1327–1333CrossRefPubMed

Wilson AJ, Murphy WA, Hardy DC, Totty WG (1988) Transient osteoporosis: transient bone marrow edema? Radiology 167(3):757–760CrossRefPubMed

Cano-Marquina A, Tarin JJ, Garcia-Perez MA, Cano A (2014) Transient regional osteoporosis. Maturitas 77(4):324–329CrossRefPubMed

Kovacs CS (2014) Osteoporosis presenting in pregnancy, puerperium, and lactation. Current opinion in endocrinology, diabetes, and obesity 21(6):468–475CrossRefPubMed

Brodell JD, Burns JE Jr, Heiple KG (1989) Transient osteoporosis of the hip of pregnancy. Two cases complicated by pathological fracture. J Bone Joint Surg Am 71(8):1252–1257CrossRefPubMed

Goldman GA, Friedman S, Hod M, Ovadia J (1994) Idiopathic transient osteoporosis of the hip in pregnancy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 46(3):317–320CrossRef

Emami MJ, Abdollahpour HR, Kazemi AR, Vosoughi AR (2012) Bilateral subcapital femoral neck fractures secondary to transient osteoporosis during pregnancy: a case report. J Orthop Surg (Hong Kong) 20(2):260–262CrossRef

Anai T, Urata K, Mori A, Miyazaki F, Okamoto S (2013) Transient osteoporosis of the hip in pregnancy associated with generalized low bone mineral density—a case report. Gynecol Obstet Investig 76(2):133–138CrossRef

Kovacs CS (2001) Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 86(6):2344–2348PubMed

10.

Plenk H Jr, Hofmann S, Eschberger J, Gstettner M, Kramer J, Schneider W et al (1997) Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res 334:73–84CrossRef

11.

Okada Y, Tsukada S, Saito M, Tasaki A (2016) Simultaneous bilateral transient osteoporosis of the hip without pregnancy. Case Rep Orthop 2016:8491461PubMedPubMedCentral

12.

Bircher C, Afors K, Bircher M (2012) Transient osteoporosis of the hip in pregnancy resulting in bilateral fracture of the neck of the femur. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 116(2):176–177CrossRef

13.

Spinarelli A, Patella V, Speciale D, Petrera M, Vittore D, Pesce V et al (2009) Hip fracture in a patient affected by transient osteoporosis of the femoral head during the last trimester of pregnancy. Orthopedics 32(5):365CrossRefPubMed

14.

Sweeney AT, Blake M, Holick MF (2000) Transient osteoporosis of hip in pregnancy. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry 3(3):291–297CrossRef

15.

Scapinelli AC, Candiotto S, Scapinelli R (1997) Reflex decalcifying algodystrophy of the hip in pregnancy (so-called transient osteoporosis). Review of the literature and four case reports. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 17(2):134–138CrossRef

16.

Funk JL, Shoback DM, Genant HK (1995) Transient osteoporosis of the hip in pregnancy: natural history of changes in bone mineral density. Clin Endocrinol 43(3):373–382CrossRef

17.

Lose G, Lindholm P (1986) Transient painful osteoporosis of the hip in pregnancy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 24(1):13–16CrossRef

18.

Beaulieu JG, Razzano CD, Levine RB (1976) Transient osteoporosis of the hip in pregnancy. Clin Orthop Relat Res 115:165–168

19.

Longstreth PL, Malinak LR, Hill CS Jr (1973) Transient osteoporosis of the hip in pregnancy. Obstet Gynecol 41(4):563–569PubMed

20.

Ververidis AN, Drosos GI, Kazakos KJ, Xarchas KC, Verettas DA (2009) Bilateral transient bone marrow edema or transient osteoporosis of the knee in pregnancy. Knee Surg Sports Traumatol Arthrosc 17(9):1061–1064CrossRefPubMed

21.

Bonacker J, Janousek M, Krober M (2014) Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report. Arch Orthop Trauma Surg 134(2):173–179CrossRefPubMed

22.

Pallavi P, Padma S, Vanitha Anna Selvi D (2012) Transient osteoporosis of hip and lumbar spine in pregnancy. J Obstet Gynaecol India 62(Suppl 1):8–9CrossRefPubMed

23.

Hadji P, Boekhoff J, Hahn M, Hellmeyer L, Hars O, Kyvernitakis I (2017) Pregnancy-associated osteoporosis: a case-control study.Osteoporos Int. doi:10.1007/s00198-016-3897-8

24.

Kim YM, Oh HC, Kim HJ (2000) The pattern of bone marrow oedema on MRI in osteonecrosis of the femoral head. J Bone Joint Surg Br 82(6):837–841CrossRefPubMed

25.

Kovacs CS, Ralston SH (2015) Presentation and management of osteoporosis presenting in association with pregnancy or lactation. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 26(9):2223–2241CrossRef

26.

Harvey NC, Cole ZA, Crozier SR, Kim M, Ntani G, Goodfellow L et al (2012) Physical activity, calcium intake and childhood bone mineral: a population-based cross-sectional study. Osteoporos Int 23(1):121–130CrossRefPubMed

27.

French SA, Fulkerson JA, Story M (2000) Increasing weight-bearing physical activity and calcium intake for bone mass growth in children and adolescents: a review of intervention trials. Prev Med 31(6):722–731CrossRefPubMed

28.

Winarno AS, Kyvernitakis I, Hadji P (2014) Successful treatment of 1-34 parathyroid hormone (PTH) after failure of bisphosphonate therapy in a complex case of pregnancy associated osteoporosis and multiple fractures. Z Geburtshilfe Neonatol 218(4):171–173CrossRefPubMed

Title: Pregnancy-associated transient osteoporosis of the hip: results of a case-control study
Authors: Peyman Hadji
Jelena Boekhoff
Melitta Hahn
Lars Hellmeyer
Olaf Hars
Ioannis Kyvernitakis
Publication date: 01-12-2017
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1/2017
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-017-0310-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pregnancy-associated transient osteoporosis of the hip: results of a case-control study

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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