Objective
To shorten the natural course of transient osteoporosis of hip (TOH), which is a self-limiting idiopathic condition and requires 6–12 months for the resolution of symptoms, various therapies including treatment with bisphosphonates have been attempted. There exist fewer case reports evaluating the effect of bisphosphonates in TOH and most of them lack radiographic evidence of resolution of disease. The present study was carried out with an aim to evaluate the clinical and radiological outcomes of TOH patients subsequent to treatment with a single dose of zoledronic acid.
Methods
Data of 19 adult male and non-pregnant female patients with TOH treated with zoledronic acid were included in the study. Efficacy was assessed using changes in clinical signs and symptoms, visual analogue scale pain score, and changes in bone marrow edema (BME) in magnetic resonance imaging (MRI).
Results
Mean age of the patients was 42.1 years, 17 being males. The mean time of onset of symptom was 4 weeks. Subsequent to treatment, the patients were pain-free and had no limp within an average of 2.8 weeks (range, 2–5 weeks) and remained asymptomatic at a mean follow-up of 35 months (range, 6–54 months). The post-treatment MRI showed resolution of BME in approximately 84% (16/19) of patients at 3 months. No major adverse events were reported. None of the patients progressed to avascular necrosis at their last follow-up.
Conclusion
Intravenous single dose administration of zoledronic acid provides early pain relief and complete reversal of TOH. Consequently, zoledronic acid is proposed as a new paradigm in the management of TOH.

Citations

• Вone marrow edema in the differential diagnosis of deases of the knee
  Alexander N. Torgashin, Alexander K. Morozov, Anna V. Torgashina, Ruslan M. Magomedgadgiev, Ivan A. Fedotov, Svetlana S. Rodionova
  N.N. Priorov Journal of Traumatology and Orthopedics.2024; 31(4): 647.     CrossRef
• Comparison of various treatment modalities for the management of bone marrow edema syndrome/transient osteoporosis in men and non-pregnant women: a systematic review
  Konstantinos Paraskevopoulos, Anthimos Keskinis, Ioannis S. Vasios, Konstantinos G. Makiev, Konstantinos Tilkeridis, Georgios I. Drosos, Athanasios N. Ververidis
  Osteoporosis International.2023; 34(2): 269.     CrossRef
• Clinical and Histopathological Aspects of MRONJ in Cancer Patients
  George Adrian Ciobanu, Laurențiu Mogoantă, Adrian Camen, Mihaela Ionescu, Daniel Vlad, Ionela Elisabeta Staicu, Cristina Maria Munteanu, Mircea Ionuț Gheorghiță, Răzvan Mercuț, Elena Claudia Sin, Sanda Mihaela Popescu
  Journal of Clinical Medicine.2023; 12(10): 3383.     CrossRef
• Management of transient bone osteoporosis: a systematic review
  Filippo Migliorini, Gianluca Vecchio, Christian David Weber, Daniel Kämmer, Andreas Bell, Nicola Maffulli
  British Medical Bulletin.2023; 147(1): 79.     CrossRef
• Osteonecrosis in Patients Recovering from COVID-19: Mechanisms, Diagnosis, and Treatment at Early-Stage Disease (Review)
  Alexander N. Torgashin, Svetlana S. Rodionova
  Traumatology and Orthopedics of Russia.2022; 28(1): 128.     CrossRef
• The Efficacy of Conservative Treatment of Bone Marrow Edema Syndrome: A Scoping Review of the Last Ten Years of Literature
  Francesco Roberto Evola, Riccardo Compagnoni, Arianna Pieroni, Alberto Tassi, Alessandra Menon, Pietro Randelli
  Journal of Clinical Densitometry.2022; 25(4): 506.     CrossRef
• Prevalence of Transient Osteoporosis of the Hip Among Patients Presenting With Hip Pain in a Major Tertiary Hospital in Saudi Arabia
  Asim S Aldhilan, Salma O Al-Amoudi, Sarah S Baabbad, Hamad M Al Jubair, Abdulmalik B Albaker, Yassir Edrees Almalki, Ali A Alamer, Sharifa Alduraibi, Ziyad A Almushayti, Suhayb Aldhilan
  Cureus.2022;[Epub]     CrossRef
• Bone marrow lesions: etiology and pathogenesis at the hip
  Maria A Munsch, Marc R Safran, Matthew C Mai, W Kelton Vasileff
  Journal of Hip Preservation Surgery.2021; 7(3): 401.     CrossRef
• Treatment of aseptic necrosis of the femoral head. Clinical guidelines
  A. N. Torgashin, S. S. Rodionova, A. A. Shumsky, M. A. Makarov, A. V. Torgashina, I. F. Akhtyamov, A. N. Kovalenko, N. V. Zagorodniy, S. P. Mironov
  Rheumatology Science and Practice.2021; 58(6): 637.     CrossRef
• Medikamentöse Therapie des primären Knochenmarködemsyndroms
  Maximilian M. Delsmann, Constantin Schmidt, Julian Stürznickel, Florian Barvencik
  Arthritis und Rheuma.2021; 41(04): 265.     CrossRef
• Efficacy and Safety of Oral Ibandronate versus Intravenous Zoledronic Acid on Bone Metabolism and Bone Mineral Density in Postmenopausal Japanese Women with Osteoporosis
  Masashi Uehara, Yukio Nakamura, Takako Suzuki, Masaki Nakano, Jun Takahashi
  Journal of Clinical Medicine.2021; 10(22): 5420.     CrossRef
• The efficacy and safety of bisphosphonates in patients with bone marrow edema syndrome/transient osteoporosis: A systematic literature review
  Athanasios N. Ververidis, Konstantinos Paraskevopoulos, Anthimos Keskinis, Georgios I. Petkidis, Konstantinos Tilkeridis
  Journal of Orthopaedics.2020; 22: 592.     CrossRef
• RANKL Blockade Reduces Cachexia and Bone Loss Induced by Non-Metastatic Ovarian Cancer in Mice
  Fabrizio Pin, Alexander J Jones, Joshua R Huot, Ashok Narasimhan, Teresa A Zimmers, Lynda F Bonewald, Andrea Bonetto
  Journal of Bone and Mineral Research.2020; 37(3): 381.     CrossRef
• Bisphosphonate Treatment Ameliorates Chemotherapy-Induced Bone and Muscle Abnormalities in Young Mice
  Alyson L. Essex, Fabrizio Pin, Joshua R. Huot, Lynda F. Bonewald, Lilian I. Plotkin, Andrea Bonetto
  Frontiers in Endocrinology.2019;[Epub]     CrossRef

Bisphosphonates are the most widely prescribed medications for the treatment of osteoporosis. However, bisphosphonate- related osteonecrosis of the jaw (BRONJ) is recently recognized as a serious complication among patients receiving bisphosphonate therapy. Most reports relate to BRONJ result from intravenous bisphosphonate or dental procedure. We report a case of mandible osteonecrosis related with oral bisphosphonate medication. A-63-year old woman suffered from toothache, cheek swelling and heating sense visited our dental clinic. She had taken oral alendronate and antihypertensive agents for 4 years because of osteoporosis and hypertension. Dental physical examination, radiologic study and pathologic study showed the severe inflammation and osteonecrosis of the mandible. Therefore we diagnosed the patient as having BRONJ and she stopped to take bisphosphonate and received surgical treatment with bone curettage. After surgical treatment and stopping bisphosphonate, her symptoms were improved. (J Korean Acad Rehab Med 2010; 34: 599-602)

Kümmell's disease is a rare disorder defined as delayed avascular necrosis of a vertebral body after minor trauma. Diagnosis is based on clinical presentation of delayed onset back pain and kyphosis after minor trauma, and on intravertebral vacuum cleft in radiologic examination. Vertebroplasty or surgical management is necessary to the patients with risks of vertebral collapse or cord compromise, but we experienced a successful result after active conservative management to a patient with severe vertebral collapse and mild spinal cord compression without myelopathy. A 76-year old woman had back pain and gait disturbance 7 weeks after fall down. X-ray and MRI showed a vacuum cleft in T12 vertebra. We treated her conservatively with bed rest and immobilization followed by gradual weight bearing with thoracic-lumbar-sacral orthosis. Back pain and gait disturbance was improved after conservative management, and the improvement was maintained until 8 months after fall down. (J Korean Acad Rehab Med 2007; 31: 776-780)