Letter to the Editor
Transient Osteoporosis of Both Hips in Pregnancy
Osteoporosis transitoria de ambas caderas en el embarazo
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"documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2014;10:56-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5077 "formatos" => array:3 [ "EPUB" => 51 "HTML" => 4649 "PDF" => 377 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Infectious Tenosynovitis of the Foot Extensors" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "56" "paginaFinal" => "57" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tenosinovitis infecciosa del aparato extensor del pie" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 875 "Ancho" => 879 "Tamanyo" => 136641 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI of the foot in two cross sections: distal third in the upper image and middle third in the lower image. 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In this case, it often develops in the last trimester and, to a lesser extent, before or after labor. It is usually unilateral and most likely to occur on the left side.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Because it is uncommon, we present the case of bilateral TOH, with greater involvement of the right side, during the fifth month of pregnancy.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 34-year-old woman undergoing her first pregnancy with a history of idiopathic left hip TO, which occurred six years earlier. During the fifth month of pregnancy and with no other known trigger, she began to have pain in the right buttock which was attributed to a pyramidal bone syndrome. Afterwards, the pain was located on the outside of the right hip and was classified as a probable trochanteritis. In the absence of improvement, she was referred to rheumatology during the seventh month of pregnancy. She complained of pain on the lateral side of both hips, more markedly on the right, accompanied by significant functional impairment. This pain was compounded by weight burden and gait, forcing her to use crutches. The examination revealed pain and limitation in abduction and external rotation of the right hip, without alterations in other areas of the musculoskeletal system. Otherwise, laboratory data did not see an increase in acute phase reactants, with negative rheumatoid factor, citrullinated peptide antibodies and HLAB27. There was no radiological or scintigraphic study performed due to the pregnancy. Suspecting a TOH, she was treated with paracetamol, physiotherapy and unloading of the joint. During the postpartum period, we performed an X-ray which showed no abnormalities, and an MRI in which “intraspongy cephalic and intertrochanteric right and left marrow edema, with no signs of osteonecrosis or sacroiliitis, all of this indicating a bilateral TOH” (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). After the birth, she had progressive improvement and the symptoms disappeared after 2 months. In a second imaging control, at eighth months postpartum, there was a restoration of normalcy in the MR images (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Prevalence of TOH due to pregnancy is difficult to assess. It usually occurs in the last third of pregnancy and to a lesser extent, before or postpartum. Its pathogenesis is unclear and, therefore, involves several factors: microtrauma, trabecular microfractures by decreased bone mass during pregnancy, circulatory changes characteristic of pregnancy and compression of the obturator or pelvic sympathetic nerve by the gravid uterus. Clinically, it usually presents with groin pain or pain adjacent to the hip, of a mechanical rhythm, accompanied by functional impairment. The preference for the left hip is allegedly due to cephalic presentation of the fetus, which could lead to repeated microtrauma in that area. Bilateral involvement is exceptional. Similarly, migratory forms have been described affecting the knee, ankle or foot. Laboratory changes only relate to those seen during pregnancy. Initially, X-rays are normal and later (1–2 months), a homogeneous demineralization, that does not affect the joint line may be seen. Early on scintigraphy shows increased uptake of isotope in the acetabulum and femur. MRI is essential for diagnosis, showing edema in the affected area and ruling out osteonecrosis, as in the present case. It is convenient to make a differential diagnosis with other hip problems (osteonecrosis, inflammatory rheumatic disease, infectious disease, metabolic disease, synovial disease, neoplasia, osteomalacia and trauma) or surrounding area disorders (lumbar, sacroiliac, symphysis pubis, uro-genital and digestive). Treatment is based on the joint unloading, analgesia and physical therapy. It usually has a favorable outcome and recovery without sequelae in variable periods of time (2 months to 1 year). However, some cases leading to osteonecrosis or femoral neck fracture have been described.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In sum, we consider it necessary to rule out the presence of primary TOH when there is groin or hip pain in a pregnant woman. Similarly, early diagnosis is important using scintigraphy and MRI when circumstances permit. In addition, early treatment is essential for a quick recovery. Finally, it is important to monitor a possible progression toward osteonecrosis or fracture of the femoral neck.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please, cite this article as: Bruscas Izu C, San Juan de la Parra S. Osteoporosis transitoria de ambas caderas en el embarazo. Reumatol Clin. 2014;10:58–59.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 951 "Ancho" => 958 "Tamanyo" => 112925 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">MRI Indicative of a Bilateral TOH.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 951 "Ancho" => 990 "Tamanyo" => 94923 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Restoration of Normality on MRI.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transitory demineralization of the hip in pregnancy. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 19 | 18 | 37 |
| 2024 October | 87 | 26 | 113 |
| 2024 September | 143 | 23 | 166 |
| 2024 August | 157 | 35 | 192 |
| 2024 July | 144 | 29 | 173 |
| 2024 June | 137 | 37 | 174 |
| 2024 May | 128 | 36 | 164 |
| 2024 April | 106 | 16 | 122 |
| 2024 March | 103 | 36 | 139 |
| 2024 February | 80 | 31 | 111 |
| 2024 January | 86 | 19 | 105 |
| 2023 December | 62 | 37 | 99 |
| 2023 November | 84 | 21 | 105 |
| 2023 October | 110 | 30 | 140 |
| 2023 September | 89 | 31 | 120 |
| 2023 August | 99 | 20 | 119 |
| 2023 July | 87 | 27 | 114 |
| 2023 June | 108 | 31 | 139 |
| 2023 May | 101 | 36 | 137 |
| 2023 April | 86 | 7 | 93 |
| 2023 March | 96 | 31 | 127 |
| 2023 February | 98 | 28 | 126 |
| 2023 January | 112 | 28 | 140 |
| 2022 December | 114 | 31 | 145 |
| 2022 November | 92 | 19 | 111 |
| 2022 October | 74 | 33 | 107 |
| 2022 September | 63 | 35 | 98 |
| 2022 August | 84 | 40 | 124 |
| 2022 July | 73 | 44 | 117 |
| 2022 June | 106 | 30 | 136 |
| 2022 May | 101 | 43 | 144 |
| 2022 April | 102 | 56 | 158 |
| 2022 March | 107 | 45 | 152 |
| 2022 February | 87 | 29 | 116 |
| 2022 January | 71 | 39 | 110 |
| 2021 December | 69 | 38 | 107 |
| 2021 November | 73 | 46 | 119 |
| 2021 October | 121 | 59 | 180 |
| 2021 September | 86 | 46 | 132 |
| 2021 August | 91 | 40 | 131 |
| 2021 July | 81 | 42 | 123 |
| 2021 June | 63 | 34 | 97 |
| 2021 May | 58 | 42 | 100 |
| 2021 April | 174 | 82 | 256 |
| 2021 March | 115 | 45 | 160 |
| 2021 February | 74 | 20 | 94 |
| 2021 January | 54 | 24 | 78 |
| 2020 December | 46 | 23 | 69 |
| 2020 November | 315 | 16 | 331 |
| 2020 October | 221 | 14 | 235 |
| 2020 September | 39 | 23 | 62 |
| 2020 August | 36 | 18 | 54 |
| 2020 July | 39 | 14 | 53 |
| 2020 June | 40 | 18 | 58 |
| 2020 May | 27 | 16 | 43 |
| 2020 April | 26 | 13 | 39 |
| 2020 March | 12 | 9 | 21 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 14 | 1 | 15 |
| 2018 April | 81 | 9 | 90 |
| 2018 March | 76 | 5 | 81 |
| 2018 February | 58 | 3 | 61 |
| 2018 January | 59 | 6 | 65 |
| 2017 December | 65 | 2 | 67 |
| 2017 November | 57 | 6 | 63 |
| 2017 October | 58 | 5 | 63 |
| 2017 September | 59 | 3 | 62 |
| 2017 August | 96 | 9 | 105 |
| 2017 July | 67 | 10 | 77 |
| 2017 June | 69 | 8 | 77 |
| 2017 May | 90 | 6 | 96 |
| 2017 April | 93 | 12 | 105 |
| 2017 March | 80 | 6 | 86 |
| 2017 February | 64 | 6 | 70 |
| 2017 January | 71 | 6 | 77 |
| 2016 December | 103 | 17 | 120 |
| 2016 November | 98 | 0 | 98 |
| 2016 October | 125 | 9 | 134 |
| 2016 September | 166 | 11 | 177 |
| 2016 August | 121 | 14 | 135 |
| 2016 July | 59 | 12 | 71 |
| 2016 April | 1 | 0 | 1 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 56 | 0 | 56 |
| 2015 June | 67 | 8 | 75 |
| 2015 May | 76 | 13 | 89 |
| 2015 April | 51 | 9 | 60 |
| 2015 March | 45 | 4 | 49 |
| 2015 February | 96 | 6 | 102 |
| 2015 January | 73 | 8 | 81 |
| 2014 December | 66 | 7 | 73 |
| 2014 November | 40 | 6 | 46 |
| 2014 October | 48 | 14 | 62 |
| 2014 September | 36 | 11 | 47 |
| 2014 August | 47 | 9 | 56 |
| 2014 July | 45 | 12 | 57 |
| 2014 June | 57 | 14 | 71 |
| 2014 May | 52 | 16 | 68 |
| 2014 April | 76 | 20 | 96 |
| 2014 March | 76 | 22 | 98 |
| 2014 February | 43 | 23 | 66 |
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