Symptoms

The main symptom of transient osteoporosis is the spontaneous onset of hip pain in otherwise healthy adults, particularly in the musculoskeletal area. Pain classically increases during exertion and occurs only very rarely at night or at rest. Sometimes the pain radiates into adjacent parts of the body such as the groin, buttocks and lower leg. In addition to the pain symptoms, transient osteoporosis can also provoke a limping gait pattern. Affected persons also complain of a restriction of hip joint mobility.

Therapy

Fortunately, transient osteoporosis is a disease with good prognosis, which is self-limiting and almost never chronic. Therefore, conservative therapeutic approaches should be given priority. These include drug treatment and protection with consequent relief of the hip joint.

Common painkillers are drugs from the group of so-called “non-steroidal anti-rheumatic drugs” (NSAIDs), such as Ibuprofen or Diclofenac.These are mainly used in pain therapy but also in orthopedic diseases, including transient osteoporosis, due to their pain-relieving (analgesic) and anti-inflammatory (antiphlogistic) effects. In addition to painkillers, bisphosphonates are also established in the treatment of transient osteoporosis, as they inhibit bone-destroying cells and thus stand for bone preservation. A third medication targets circulatory disorders as a possible cause: the prostacyclin analogue iloprost.

However, this has so far only been prescribed “off-label use”, i.e. it is used in excess of the marketing authorization. Crutches are often prescribed to relieve the hip joint. A speedy start of treatment and close monitoring are always important, since in addition to the outcome of complete etiology, the transition to femoral head necrosis is always possible.

In addition to pain relief, the aim of the therapy is to prevent possible bone fractures caused by the more unstable bone under further strain. On the one hand, the small bone fractures could increase the pain and on the other hand, the risk of a larger fracture such as a fracture of the femoral neck could increase. It is important to know that 3 to 6 months may pass before the relief leads to a noticeable symptom relief or improvement.

It is therefore essential that patients consistently follow the therapy and spare their hips, as this is the only way to achieve the desired therapeutic effect. If conservative measures are not sufficient, a surgical procedure may be indicated. The aim is to drain the bone marrow edema by “core decompression” of the bone and thus reduce the pressure, resulting in immediate symptom relief.

In general, the cause of the occurrence of transient osteoporosis must of course be considered in order to be able to treat any underlying or concomitant diseases in a secondary form of transient osteoporosis or to adjust the medication accordingly. The bisphosphonates belong to a group of drugs used in the treatment of osteoporosis. By inhibiting the so-called osteoclasts, bone-destroying cells, bisphosphonates reduce bone resorption.

Since the bone substance is also disturbed in transient osteoporosis due to the formation of bone marrow edema, they are used in the drug therapy of this disease. It is important to know that bisphosphonates are contraindicated in pregnancy, during which transient osteoporosis or pregnancy-associated osteoporosis may also occur. In addition, bisphosphonates should be taken at least half an hour before meals, as otherwise, due to complex formation with calcium ions from food, undesirable effects such as mineralization disorders with hypocalcemia and the risk of kidney failure may occur.

Currently, the most commonly prescribed drugs are alendronate, ibandronate and zoledronate. It is difficult to make an exact statement about the duration of transient osteoporosis. In general, fortunately, it is a self-limiting and healing disease.

How quickly the body can ultimately fight off the disease and how well the respective therapeutic measures work varies from person to person. On average, one can expect a healing time of 6 to 8 months. Even up to a 12-month persistence of symptoms, the chances that the transient osteoporosis will heal are still good. It is also important to know that there is never a transition to a chronic form.