Transient osteoporosis of the hip in pregnancy – a case series

Figures & data

Figure 1. Coronal T2-W sequences of the pelvis of a 32 years old female, 1 week after vaginal delivery, with severe bilateral hip pain (A) and a follow-up image performed after 3 months (B). On presentation, there is bilateral bone marrow edema of the femoral head and neck (more severe on the right) compatible with bilateral transient osteoporosis (A). After 3 months there is almost complete resolution of the bone marrow edema with minor residual bone marrow edema on the right femoral head (B).

Table 1. Demographic variables.

Variables	n = 34
Maternal age (years)	34.18 ± 4.75
Height (cm)	165.25 ± 7.32
Weight pre pregnancy (kg)	59.97 ± 7.35
BMI pre pregnancy	22.03 ± 3.18
Weight at term (kg)	75.22 ± 13.07
BMI at term	27.60 ± 5.02
Smoking	16 (47.1)
Alcohol	1 (2.9)

Data are presented as n (%) for categorical variables and mean ± SD for continuous variables.

BMI: Body Mass Index (kg/m²).

Table 2. Medical history.

Variables	n = 34
Family history of osteoporosis	10 (29.4)
Previous TOH	1 (2.9)
Exercise before puberty
Less than normal	9 (26.5)
Normal	15 (44.1)
Above normal	10 (29.4)
Dental problems in childhood
Less than normal	13 (38.2)
Normal	12 (35.3)
Above normal	9 (26.5)
Breastfeeding until disease	0 (0)
Hypercoagulation disorder	1 (2.9)
Pregestational diabetes	0 (0)
Rheumatic disease	0 (0)
Neurologic disease	1 (2.9)
Trauma to hip area	1 (2.9)
Hypothyroidism	1 (2.9)
Hyperparathyroidism	1 (2.9)
IBD	0 (0)
Renal disease	1 (2.9)
Celiac	0 (0)
Asthma	3 (8.8)
Osteogenesis imperfecta	0 (0)
Other chronic disease	12 (35.3)
Chronic medications	7 (20.6)
Escitalopram	3 (8.8)
Levothyroxine	1 (2.9)
Budesonide/Formoterol	1 (2.9)
Steroids	2 (5.9)

Data are presented in n (%).

TOH: Transient osteoporosis of hip; IBD: Inflammatory bowel disease.

Hypercoagulation disorder – One case of Factor V Leiden.

Table 3. Obstetric and neonatal variables.

Variables	n = 34
Gravity	2.17 ± 1.38
Parity	0.67 ± 1.37
Past CD	2 (5.9)
Past abortions	0.50 ± 0.86
Mode of conception
Spontaneous	22 (64.7)
IUI	1 (2.9)
IVF	11 (32.4)
Multigestation pregnancies	2 (5.8)
GDM
GDMA1	2 (5.9)
GDMA2	0 (0)
Gestational HTN disease	0 (0)
Immobilization during pregnancy	18 (52.9)
Mode of delivery
Termination of pregnancy	2 (5.8)
NVD	12 (35.3)
VE	4 (11.8)
CD	16 (47.1)
Elective CD	10 (29.4)
Urgent CD	6 (17.6)
Reason for CD
TOH	5 (31.2)
Malpresentation	3 (18.8)
NRFHR	4 (25.0)
Failed induction	1 (6.2)
Other	3 (18.8)
Trial of birth	16 (47.1)
Birth weight	3052.17 ± 530.65
Neonatal complications	0 (0)

Data are presented in n (%), mean ± SD.

CD: Cesarean delivery; IUI: Intrauterine insemination; IVF: In-vitro fertilization; GDM: Gestational diabetes mellitus; NVD: Normal vaginal delivery; VE: Vacuum extraction; TOH: Transient osteoporosis of hip; NRFHR: Non-reassuring fetal heart rate.

Table 4. TOH clinical status.

Variables	n = 34
TOH Rt. Grade	14 (41.2)
Head only	6 (42.8)
Head and neck	8 (57.2)
TOH Lt. Grade	20 (30.0)
Head only	6 (30.0)
Head and neck	14 (70.0)
Unilateral or bilateral
Unilateral	25 (73.5)
Bilateral	9 (26.5)
MRI timing
During pregnancy	17 (50.0)
Post-partum	17 (50.0)
MRI gestational age (weeks)	29.00 ± 7.32
Treatments
Physiotherapy	23 (67.6)
Acupuncture	15 (44.1)
Analgesics	24 (70.6)
Anti-coagulants	10 (29.4)
Vitamin D	18 (52.9)
Calcium	13 (8.2)
Bisphosphonates	0 (0)
Other medications	1 (2.9)
Length of treatment during pregnancy (months)	1.18 ± 1.53
Length of treatment after pregnancy (months)	2.91 ± 3.21
Resolution of symptoms (months)	3.56 ± 4.44
Follow up MRI (with resolution findings)	8 (23.5)
Complications	11 (32.4)
VTE	1 (2.9)
Edema/inflammation	9 (26.5)
Hairline fracture	2 (5.9)
Pregnancy after TOH	15 (44.1)
TOH in following pregnancy	2 (13.3)

Data are presented in n (%), mean ± SD.

TOH: Transient osteoporosis of hip; MRI: Magnetic resonance imaging; VTE: Venous thromboembolism. Complications: At least one of VTE, Edema/inflammation, Hairline fracture.

Table 5. Comparison between normal vaginal delivery and cesarean delivery.

Variables	NVD (n = 16)	CD (n = 16)	p value
Maternal age	36.14 ± 30.47	32.0 ± 5.44	.897
BMI pre-pregnancy	20.9 ± 1.88	22.9 ± 2.05	.299
BMI at term	25.18 ± 2.18	31.11 ± 4.73	.086
Unilateral TOH	14 (87.5)	10 (62.5)	.220
MRI timing
During pregnancy	7 (43.8)	7/15 (7.7)	>.999
Post-partum	9 (56.2)	8/15 (53.3)	>.999
MRI gestational age (weeks)	30.86 ± 6.33	30.71 ± 5.49	.902
Treatments
Physiotherapy	9 (56.3)	12 (75.0)	.458
Acupuncture	4 (25.0)	11 (68.7)	.032
Analgesics	12 (75.0)	12 (75.0)	>.999
Anti-coagulants	2 (12.5)	8 (50.0)	.054
Vitamin D	5 (31.2)	12 (75.0)	.032
Calcium	4 (25.0)	9 (56.2)	.149
Bisphosphonates	0 (0)	0 (0)	>.999
Length of treatment during pregnancy (months)	2.43 ± 1.27	2.29 ± 1.79	.897
Length of treatment after pregnancy (months)	1.29 ± 1.70	2.71 ± 3.04	.254
Resolution of symptoms (months)	3.71 ± 3.81	3.00 ± 2.31	.926
Complications	5 (31.2)	5 (31.2)	>.999
VTE	1 (6.2)	0	.310
Edema/inflammation	7 (43.8)	2 (12.5)	.113
Hairline fracture	0	2 (12.5)	.484
Pregnancy after TOH	4 (25.0)	10 (62.5)	.073
TOH in following pregnancy	0	2/10 (20.0)	.484

Data are presented in n (%), mean ± SD.

TOH: Transient osteoporosis of hip; MRI: Magnetic resonance imaging; VTE: Venous thromboembolism. Complications: At least one of VTE, Edema/inflammation, Hairline fracture.