I have recently encountered a young man who developed transient osteoporosis of the talus , 4 months after having it in the hip.
Dear Raju
I had two similar cases.
The first one but the diagnosis given by the musculoskeletal radiologists was osteonecrosis and treated mainly from my point of view with load prevention, Cast for the ankle, vit D and observation. In my case the third joint involved was the other hip and then the lateral condyle of the knee. We did not give aledronate as we feared further necrosis. It took time but went alright. We had to involve the rheumatologist as well, who took over the case and we were reviewing the case frequently for fracture or deformities. Calcitonine was suggested but not given.
In the second case the hips were involved (one after the other) after a long transcontinental flight. Again load prevention with crutches and vit D with calcium given. In this case the diagnosis given was transient osteoporosis. The rheumatologist suggested for this that low oxygenation and pressure difference were the potential causes. I really do not know as there is not a lot of inforation.
Both patients were young males.
My experience is very limited and really if we believe the radiologist's opinion I had the experience of one patient only, although both were treated in similar ways.
Iv. bisphosphonates have been proven to be effective in treating transient migratory osteoporosis in several German studies (See early papers by Johan Ringe). They specifically reduce or remove bone marrow edema, which is the main driver of pain in the area. I use 2 doses of iv. zoledronic acid 5 mg 3 months apart with excellent results. The maximal effect on pain is within 3 months, but varies a lot. Unfortunately radiologist have gotten into the habit to denote virtually all cases with bone marrow edema (or bone marrow lesions) osteonecrosis, which is wrong. All the available histological data from Bone Marrow Edema lesions show characteristics in line with a repair phenomenon, without any signs of necrosis. In the case of transient osteoporosis a general skeletal weakness leading to micro damage and repair (i.e. the bone marrow edema). Bisphosphonates will not only reduce pain, but also by its bone strengthening effects reduce the risk of subsequent new episodes with pain.
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