Transient osteoporosis of pregnancy:
Gebelikte geçici osteoporoz: Vaka sunumu
Tolga Ergin1, Belgin Selam1, Arda Lembet1, Harika Bodur Öztürk1, Atilla Damlac?k2, Cem Demirel1
1 Department of Obstetrics and Gynecology, Acibadem University, Istanbul, Turkey
2 Department of Radiology, Acibadem Hospital, Istanbul, Turkey
Address for Correspondence / Yaz??ma Adresi: Doç. Dr. Tolga Ergin, Tekin Sok. No: 8 Ac?badem, 34718 ?stanbul, Turkey
Mobile: + 90 532 261 15 89 e.mail: firstname.lastname@example.org
Transient osteoporosis of pregnancy is a rarely observed skeletal pa-
thology developing in the last months of pregnancy. Meticulous evalu-
ation is important for the differential diagnosis of severe and progres-
sive hip and/or groin pain in pregnant patients. MRI is a valuable and
safe technique for demonstrating bone marrow edema and skeletal
abnormalities during pregnancy. Avoidance of vaginal delivery and
non-weight bearing measures are essential in order to prevent com-
plications such as hip fractures related to transient osteoporosis of
pregnancy. We present the diagnostic evaluation and treatment of an
uncommon case of transient osteoporosis of pregnancy with resolu-
tion of symptoms and postpartum.
(J Turkish-German Gynecol Assoc 2010; 11: 163-4)
Key words: Osteoporosis, pregnancy, hip pain
Received: 12 November, 2009 Accepted: 24 January, 2010
Gebelikte geçici osteoporoz seyrek olarak gebeli?in son haftas?nda
iskelet geli?im patolojilerine neden olur. Özenli tan? ve yakla??m özel-
likle kalça ve omurga a?r?s? çeken hastalarda önem kazan?r. Vaginal
do?umdan kaç?nmak geçici osteoporoza ba?l? kalça k?r?klar?n?n ön-
lenmesinde önem arzeder. Yaz?m?zda böyle bir vaka bildirilmi?tir.
(J Turkish-German Gynecol Assoc 2010; 11: 163-4)
Anahtar kelimeler: Osteoporoz, gebelik, kalça a?r?s?
Geli? Tarihi: 12 Kas?m 2009
Kabul Tarihi: 24 Ocak 2010
Musculoskeletal symptoms such as hip, pelvis and groin pain
are common complaints of pregnancy. They are associated
with increased weight and position of gravid uterus which
affects the axial skeleton and causes neural compression by
fluid retention and hormonal changes leading to joint laxity (1).
These symptoms are usually managed conservatively without
specific diagnosis. However, there may be cases with severe
and progressive, pain especially during the second and third
trimester of pregnancy (2, 3). Transient osteoporosis of preg-
nancy (TOP) needs to be considered for differential diagnosis
in these cases.
TOP during pregnancy was first reported by Curtis and
Kincaid in 1959 (4). It is a rarely observed, self-limiting pathol-
ogy of unclear etiology with severe onset of groin and/or hip
pain progressive in character, mostly during the third trimes-
ter of pregnancy. The patient may not be able to walk or may
present with an antalgic gait due to functional disability. The
current case report presents an uncommon case of TOP dur-
ing pregnancy and reviews the literature.
A 34 year-old, nulliparous woman had severe pain of increas-
ing intensity in the right leg at 30 weeks of gestation. The pain
was aggravated by getting up, sitting down and standing up.
Clinical examination revealed mild pain without restriction of
motion in the lumbar area. Abduction and external rotation
of her right hip were limited by severe pain and she had an
antalgic gait. The right lower segment of the abdomen was
very tender to palpation at examination. She did not have
any motor or sensorial deficit according to the neurologic
examination. Lumbar discopathy was ruled out as a cause
of the pain. Laboratory tests for electrolytes, thyroid function,
rheumatoid factor and antinuclear antibody were normal.
Magnetic resonance imaging (MRI) scans of the hips revealed
alterations at the right coccygeofemoral junction consistent
with transient osteoporosis accompanied by stress fracture
(Figure 1). Joint aspiration was performed due to increased
synovial fluid in the hip junction. She received analgesic
treatment with paracetamol and nonsteroid anti-inflamma-
tory drugs during pregnancy. During the remainder of the
pregnancy she was prescribed bed rest and avoided weight
bearing. Cesarean section was recommended considering the
risk of hip fracture during normal vaginal delivery. Calcitriol 0.5
mcg and calcium 1000 mg were prescribed soon after delivery.
Whole body scintigraphy performed one month after delivery
also demonstrated osteoporosis. Calcium 1000 mg, vitamin
D3 880 IU and salmon calcitonin 200 IU/day, switched to alen-
dronate 70 mg/week, were started for six months according
to the scintigraphy findings. Her symptoms and MRI findings
regressed 6 months following delivery (Figure 2).
Physiotherapy, rheumatology and orthopedic consultations are
considered for persistent, moderate to severe hip, back and/or
groin pain during pregnancy. Pubic symphysiolysis, avascular
necrosis, ostemyelitis, neoplasm and TOP should be ruled out
in the differential diagnosis. Plain radiographs of the limb may
demonstrate severe osteopenia for advanced cases of TOP.
MRI is a more sensitive, safe and effective imaging technique
for detecting skeletal abnormalities including TOP and hip
fractures during pregnancy (5). Diffuse bone marrow edema
by MRI, normal levels of markers for inflammation, severe and
persistent groin and/or hip pain during the last months of preg-
nancy are positive findings for TOP.
Prevention or permission for only limited weight bearing is
essential in order to avoid complications in TOP. Atraumatic frac-
tures may also be observed. Hip fracture is reported during labor,
therefore cesarean section is preferred in cases with TOP (6).
The palliative approach to TOP includes use of non-weight bear-
ing measures such as bed rest, wheelchairs, crutches, analgesia
and physiotherapy. Hips are usually remineralized within 6-14
months postpartum (7). Antiresorptive therapy with biphospho-
nates, calcium and vitamin D are used as adjunctive measures
during the recovery period.
In summary, TOP should be considered for the differential diag-
nosis of severe hip pain during pregnancy. Early diagnosis and
treatment are essential in order to prevent its complications.
Conflict of interest
No conflict of interest is declared by authors.
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Figure 1. T2 weighted MRI demonstrates bone marrow edema
in the femur head and neck and increased synovial fluid in the
Figure 2. Fat suppressed T2 weighted sequences of the
control MRI postpartum demonstrated normalization of
bone marrow edema
J Turkish-German Gynecol Assoc 2010; 11: 163-4
Ergin et al.
Transient osteoporosis of pregnancy