Transient regional osteoporosis

Cano-Marquina, A.; Tarı́n, Juan J.; Garcı́a-Pérez, Miguel A.; Cano, Antonio

doi:10.1016/j.maturitas.2014.01.012

Cited by 29 publications

(18 citation statements)

References 49 publications

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“…Transient osteoporosis of the hip in pregnancy (also known as bone marrow edema syndrome) is a rare condition of skeletal fragility. It appears to be a form of chronic regional pain syndrome 1 or reflex sympathetic dystrophy that most often involves the hips (112,147,335,351,571). When it occurs in association with pregnancy, its onset is usually during the third trimester or the puerperium with unilateral hip pain, limp, or a hip fracture; it can also be bilateral at presentation (112,272,301,335,573,688).…”

Section: Human Datamentioning

confidence: 99%

“…When it occurs in association with pregnancy, its onset is usually during the third trimester or the puerperium with unilateral hip pain, limp, or a hip fracture; it can also be bilateral at presentation (112,272,301,335,573,688). The femoral head and neck are osteopenic and radiolucent on plain radiographs (147,218,571), while DXA suggests that the hip BMD is quite low (301). The lumbar spine BMD is usually normal but if it is also low, it is usually substantially higher than the femoral neck BMD (31).…”

Section: Human Datamentioning

confidence: 99%

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Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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Section: Human Datamentioning

confidence: 99%

Section: Human Datamentioning

confidence: 99%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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“…The concrete case of hip fracture may have a mixed origin, because transitory processes have been described in the absence of systemic osteoporosis, or in non-pregnant women or men at midlife (84). The term transitory regional osteoporosis has been proposed to denominate these cases, whose pathophysiological mechanisms remain elusive.…”

Section: Clinical Presentationmentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Sanz-Salvador

Garcı́a-Pérez

Tarı́n

et al. 2015

European Journal of Endocrinology

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Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use.

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“…Sintigrafide kalçada aktivite artışı tespit edilebilir, bulgular erken saptanır ve semptomlar geriledikten sonra haftalarca devam eder. Ancak bu bulgular özgül değildir, enfeksiyonda, AVN'de, tümör veya diğer durumlarda görülebilir (6). Jeneralize osteoporozun ayırıcı tanıya girmesi nedeniyle kemik yoğunluğu ölçümleri de bu hastalarda değerlendirilebilir (4).…”

Section: Discussionunclassified

“…Muayenede yumuşak doku şişliği, effüzyon ve hatta kas atrofisi görülebilir. Klinik tablo giderek kötüleşir ve ağrı başlangıçta dinlenmekle azalırken, zamanla devamlı hale gelir (6). Günler içinde baston gerektirecek kadar şiddetli ağrı gelişir.…”

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Dual Etiologic Back Pain in Pregnancy: A Case Report with Lumbar Disc Herniation and Transient Osteoporosis of the Bilateral Hip

İzol¹,

Erhan²,

Rençber³

2017

Tod

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Gebelikte bel ağrısı, gebeliğe bağlı gelişen postural ve hormonal değişiklikler sonrası ortaya çıkan ve gebelikte en sık görülen kas iskelet sistemi semptomudur. Gebelikte bel ağrısına neden olan durumlar; pelvik relaksasyon, lomber diskopati, spondilolistezis, koksidini ve postüral bel ağrısı olarak sıralanabilir (1). Sıklıkla ikinci ve üçüncü trimesterde ağrı belirginleşir. Bel ağrısı ile başvuran gebede önemli olan ağrının lokalizasyonu ve yayılımıdır. Siyatalji, spinal sinir kökü basısına işaret eder ve siyatik sinir trasesine uyan ağrı ile başvuran gebede ilk akla gelmesi gereken patoloji lomber disk herniasyonu (LDH) olmalıdır (2). Semptomatik LDH 1-25/10,000 gibi daha nadir olarak karşımıza çıkmaktadır. Gebeliğin LDH için bağımsız bir risk faktörü olduğu ve var olan disk herniasyonunu kötüleştirebildiği bildirilmektedir (1).Kalçanın geçici osteoporozu (KGO) ise kalça ağrısının spontan başlayıp, zamanla ortadan kalktığı ve femur başında geç beliren osteoporoz görünümü ile karakterize nadir görülen bir klinik tablodur (3). İlk 1959'da üçüncü trimesterde olan üç gebede "kalçanın geçici demineralizasyonu" olarak Curtiss ve Kincaid tarafından tanımlanmıştır. 1967'de Duncan yük taşıyan eklemlerde ardı sıra gelişen poliartiküler artralji için "gezici bölgesel osteoporoz" tanımını kullanmış, 1968'de Lequesne tarafından "KGO" şeklinde isimlendirme yapılmıştır. İdiyopatik bölgesel osteoporoz, geçici ağrılı osteoporoz, geçici osteopeni, algodistrofi gibi tanımlamalar kullanılsa da günümüzde en yaygın kullanılan KGO ve geçici kemik iliği ödemi sendromudur (4 Summary AbstractLow back pain in pregnancy is a common complaint. It has been reported that the pregnancy is an independent risk factor for lomber disc herniation and may worsen the existing herniation. Transient osteoporosis of the hip (TOH), is a rare, self-limiting and gestational disease of unknown cause. In this article, we report a case of acute lomber disc hernia and later bilateral temporal osteoporosis of the hip that was treated with conservative methods during the same gestational period. With this pathologic case it is emphasized that, two pathological phenomenon can be seen in the same patient at the same time. It should be kept in mind TOH and radiculopathy should be considered in the differential diagnosis in pregnant patients who complains back and hip pain.

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Transient regional osteoporosis

Cited by 29 publications

References 49 publications

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Dual Etiologic Back Pain in Pregnancy: A Case Report with Lumbar Disc Herniation and Transient Osteoporosis of the Bilateral Hip

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