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CHAPTER
39
Transient Migratory Osteoporosis in
Ost
eogenesis Imperfe
cta
Jay R. Shapiro
Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD, USA
INTRODUCTION
by bone edema and limited to a single joint occurs in
approximately 50% of cases. In the remainder it has a
migratory pattern which may or may not be ipsilateral,
with individual involvement of several joints either
simultaneously or in sequence.
TMO is a disorder of adults. Its occurrence in chil-
dren or in children with OI is not established. The inci-
dence of transient osteoporosis is not known at this
time but it is substantially less common than avascu-
lar necrosis of a joint. Transient osteoporosis occurs
more frequently in healthy middle-aged men, usually
between the fourth and sixth decades of life.
3
Women
are rarely affected, although when they are affected it
predominantly occurs during the last trimester of preg-
nancy or shortly after delivery. The ratio of male to
female cases is 3:1.
4
Transient and migratory osteoporosis affecting the
hip during pregnancy or as a new occurrence has been
reported in several individuals with OI. These are listed
in
Table 39.1
.
Transient migratory osteoporosis (ICD-9 code 733.09,
Other Osteoporosis) is included in this text as a clinical
entity because: (1) the literature contains several reports
of the disorder in individuals with osteogenesis imper-
fecta (OI) and (2) because when transient osteoporo-
sis occurs in the OI patient it is frequently a source of
misdiagnosis and a potential cause for mistreatment. In
particular, early differentiation of transient osteoporosis
from avascular necrosis will avoid unnecessary surgical
intervention.
The current recommendations for the treatment of
transient osteoporosis are not well defined. The objec-
tive of this chapter is to review the disorder and its rela-
tionship to OI, to consider pathogenetic mechanisms
and to evaluate current treatments applicable to indi-
viduals with OI.
The term “transient osteoporosis” was first applied
to involvement of the hip. Here, transient osteoporosis
and transient migratory osteoporosis (TMO) are used
synonymously because of frequent overlap in presen-
tation seen clinically. A current definition of transient
osteoporosis would include the following: transient
migratory osteoporosis is the occurrence of a localized
decrease in bone mass in a weight-bearing joint associ-
ated with edema of the bone, frequently affecting the
hips, knees or ankles, which is painful, transient over a
period of months, and migratory but which is eventu-
ally reversible.
Transient osteoporosis of the hip was initially
reported by Curtis and Kincaid in 1959 in three women
during the third trimester of pregnancy.
1
In 1968,
Levesque first applied the term transient osteoporo-
sis of the hip.
2
Transient osteoporosis characterized
C
LINICAL FEATURES OF TM
O
Patients experiencing TMO have pain of relatively
immediate onset in one or more joints. The hip is most
commonly affected although TMO can occur in the
ankle, foot and less commonly in the lumbar spine,
shoulder, elbow, wrist and hand (
Figure 39.1
). Although
one joint is usually symptomatic, bilateral hip involve-
ment may occur which is more often seen in women.
3
A migratory pattern may ensue, usually 1-2 months
after the initial event and rarely at longer time inter-
vals, up to a year.
5
Pain due to TMO first appearing in
the hip or knee may migrate to involve ipsilateral joints
