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Transient Osteoporosis of the Hip

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I have been suffering from a very painful condition affecting my inner hip (or groin) area. I finally went to the doctor two days ago. They took x-rays however the doctor could not see any type of fracture and he remarked that he wasn't very good at detecting arthritis and wanted to wait until the he got the radiologist report before he would suggest a diagnosis of arthritis as opposed to bursitis. I was given a presciption for naprosyn and sent home to wait for the radiologist report in the mail.

I have been doing some research, trying to find information about hip problems, injuries, and conditions. I believe that I discovered the name for this condition that I have, except that I do not fall into either of the two categories of patients with this condition, however I am experiencing every single symptom of this condition. It is called, "transient osteoporosis of the hip.

I am a 47 year old female who is not pregnant and I am experiencing the following symptoms which match this above condition exactly:

1. Sudden onset of pain, typically in the front of the thigh, the side of the hip, the buttocks or the groin.
2. No previous accident or injury to the joint that would trigger pain.
3. Limited motion; pain intensifies with turning movements.
4. Pain intensifies with weight bearing and may lessen with rest.
5. Pain gradually increases over a period of weeks or month and may be so intense that it is disabling.
6. A change in gait as the patient tries to protect the joint and ease the pain.

The following is the only description I can find about this condition:

"osteoporosis is generally a progressive and painless condition. But one type of osteoporosis is both reversible and painful. Because it isn’t permanent and is usually most obvious in the hip joint, this condition is called transient osteoporosis of the hip.

Who’s at risk?

Women in the late stages of pregnancy (after the sixth month)
middle-aged men (between 40 and 70 years old)

a diagnosis of transient osteoporosis of the hip is usually made by eliminating other possible causes of hip pain, such as a muscle injury or stress fracture. Your doctor will ask you whether you can remember any injury to the joint. You may also be asked to do certain range-of-motion tests to replicate the pain. Because x-rays may not show bone loss until the condition is well-advanced, your physician may request an mri (magnetic resonance image) or bone scan to confirm the diagnosis. If you are pregnant, your physician may elect to delay any imaging studies until the last stages of your pregnancy, or even until after the delivery.

Treatment

this condition generally resolves by itself over 6 to 12 months. Treatment focuses on preventing any damage while bones are weakened by osteoporosis. If you are pregnant, this condition increases your risk of a hip fracture.

Your physician may prescribe a mild pain reliever.
Using crutches, a cane, or other walking aids will help relieve the stress of weight bearing on the joint.
To help maintain strength and flexibility in the muscles, your physician may also recommend a series of flexibility and range-of-motion exercises that you can do as the pain subsides. Aquatic exercises may be helpful not only because they ease movement, but also because they relieve weight bearing. "

why couldn't a middle aged woman, such as myself, have this condition that apparently is known only to affect middle aged men or women in their third trimester of pregnancy?

Again, the symptoms of this condition are the exact symptoms I am experiencing.

How do I convince my doctor that I think I have this medical condition?

Any input is appreciated. Sad

thanks,


julie
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First Helper Bobo1
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replied October 28th, 2004
Extremely eHealthy
Hi there! I am sorry to hear about your problem. You can always go to another Dr. And get a second opinion or even a third or a fourth, just keep going until you get the answers you want, a naturopathic or herbal Dr. Is always a different thought. I am no Dr. But my sympathy is with you, as I live with a lot of pain 24/7, aquatic exercise does help but the main thing I have learned with my pain is to keep up the motivation and try not to get yourself stressed out(i know, easier said than done).
Keep us posted.
Hope you get some answers soon.
Sincerely,
sandy
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replied October 29th, 2004
Toph
Thanks, sandy. I usually do try to "keep a stiff upper lip".

Julie
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replied June 1st, 2010
Dear Jewelcat,

RE: TRIGGER POINT PAIN:

To me it sounds like your pain is caused by 'Trigger Points' in some of your muscles rather than some transient condition of the bone (bones do not have pain receptors in them so it's impossible to feel pain from within a bone). Trigger points cause 'Referred Pain,' often to seemingly unrelated parts of the body.

In your case I suspect the trigger points are in the Iliacus and Psoas muscles and possibly the Sartorius and lower Abdominal muscles as well. Intrapelvic muscles may also be involved.

Best thing to do is to pick up a copy of a book entitled "The Trigger Point Therapy Workbook" by Clair Davies. It's a great book, and you will be able to determine whether or not you have Trigger Point pain AND be able to self-treat the Trigger Points.

One other thing: Do you tend to sit back on your tailbone when you're sitting in a chair? This incorrect sitting posture can cause muscle problems too. Be sure to rock your pelvis more forward so that 40% of your weight is supported by your legs and 60% by the triangle formed by your two 'sit bones' and the pubic bone--weight should be distributed evenly between the pubic bone and the sit bones. Your weight should rest on the back of your upper thighs, right in front of your sit bones. You'll notice that rocking the pelvis forward allows your low back to curve forward (which is what you want--you DON'T want your low back flat), lifts your chest, and makes it easier to breathe. [Another good book--"The New Rules of Posture" by Mary Bond].

Good luck!
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replied August 25th, 2010
Sounds like you do have Transient Osteoporosis of the hip as I have the same thing right now and am a 39 year old NON pregnant female. Although I do have Osteogenesis Imperfecta which could put me at higher risk of TOH per some studies I have come across. If you do have TOH the MRI will show bone marrow edema and that is what is causing the pain. There is fluid inside the bones causing expansion and pain. I had to go to a ton of doctors before getting the correct diagnosis as well. Try going to Boston! Also there are certain findings on the MRI that indicate TOH.
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replied October 21st, 2010
Osteoporosis can really slow an active lifestyle. One in four Canadian women over the age of 50 have osteoporosis. While it can strike at any age and at any time, it’s most common after menopause. The good news is you may be able to take action now to strengthen your bones

I'm here on the behalf of Novartis and their new Osteoporosis Awareness campaign, On The Go Women.
On The Go Women aims to educate women about the disease and stresses the importance of managing the condition with treatment and a healthy lifestyle. There are many factors that determine whether a woman is at risk of Osteoporosis. We’ve developed a risk assessment tool for you to use and share here:
At that link you’ll also find a Personalized Conversation Starter – to use when discussing Osteoporosis with a doctor.

These tools are invaluable health resources for any woman – even if they aren’t at a high risk for Osteoporosis themselves, they can be shared with mothers, sisters and friends who are.
We’ve also collected some recipes for Osteoporosis-fighting foods that might be of interest as well.
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replied May 4th, 2011
I'm a 54 year old male and I'm not pregnant either... anyway I was just diagnosed with TOH. Every article I've read describes symptoms exactly like jewelcatz2005 lists in the first post, and those are exactly the symptoms I have. You need to get an MRI to diagnose TOH, my x-rays showed absolutely nothing to suggest TOH but the MRI "lit up" (whatever that means) on the affected hip which made it an easy call for both the radiologist and the orthopedist.

It's a very rare disease, my orthopedist said this is only the 2nd case he's seen in his 30 years of practice! Which is probably one reason why it's hard to diagnose.

I read one medical study of about 50 people with TOH, and in every single one the symptoms disappeared after a year. So while TOH is very painful, the good news is that it's not permanent and doesn't require invasive treatment nor exotic medications with potent side effects.

I can't help but wonder... most osteoporosis is "progressive" (meaning, incurable and it gets worse with time), whereas TOH is reversible. If people in their 40s and 50s with TOH can regain lost bone, is there something that can be learned from us that can be used to help people with the progressive type of osteoporosis?
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replied June 7th, 2011
Update: About 4 months after I first noticed the condition, and about 1 month after I finally got the diagnosis, the pain disappeared... almost overnight. I just remember one day thinking, "gee, I haven't felt my hip all day..." and the pain never returned. I do have a bit of "awareness" of the hip occasionally, but the pain is very minor and not limiting in any way. So to those of you with the TOH diagnosis, don't worry, your "parole" will come.
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replied January 3rd, 2012
Hey bobo1 thanks for this after being incorrectly diagnosed with osteo necrosis I have now been told I have ton thanks for the light at the end of the tunnel
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replied July 26th, 2011
Can somebody tell me if it's normal to feel soreness around the knee joints after getting off crutches? I've had Transient osteoporosis of the hip for several months. The DR. put me on crutches for 5 weeks. Now that I got off the crutches, ofcourse my leg feels all dead and numb from the lack of activity in the last month and I don't feel the pain in the upper leg that I felt months ago, but I feel some soreness around the knee now. Not all the time. Only when I walk.
Before I got on the crutches, the pain kinda shifted around. sometimes the upper leg, sometimes around the knee, and sometimes the ankle. So I was just wondering if somebody could tell me if the soreness around the knee joints was a normal symptom of getting off crutches due to inactivity of the knee joints, or if this is a sign that maybe I should go back on the crutches. The doc said not to be nervous if I see some of the same symptoms pop up that I had before, but only be concerned if it gets worse and then get back on the crutches for a few days and then try again doing without the crutches.
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replied October 22nd, 2011
36 year old Female Transient Osteoporosis of the Right Hip
I was 36 yrs old...had severe hip/groin pain..couldn't walk. I'm a female, never been pregnant. Had an X-ray of my hip and there was a huge shadow. (Which appeared to be the size of an orange) I ended up getting diagnosed with Transient Osteoporosis of the Hip. I was told that it'd take 12-18 mths for me to recover. I was able to recover within 6 mths. (Thank God!) I had to go thru extreme pain and physical therapy. The Drs. say my case is so unusual. Usually, it's in the left hip and mine was in the right hip. I had a bone density test done. My calcium and vitamin D levels were within normal limits. However, I was told I have bones of a 70 year old. I'm at osteopenia stage..next is osteoporosis. I spoke with someone recently who told me to get my parathyroid checked. Sometimes, if that's off, it can throw everything off. Once and a while, I get a "toothache" feeling that comes and goes, but, I'm so blessed to be able to be walking again.
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replied November 2nd, 2011
I'm an active 45 year old male and was diagnosed with TOH in early August of this year. After 6 weeks of thinking I had severely pulled a groin muscle, I went to the doctor and after several Xrays and an MRI I was told first I had I had a stress fracture of the femur near femoral head. A week later I was told I had TOH and would be on crutches for 6-12 months. Needless to say, I was bummed.

I went on crutches at 7 weeks and the pain worsened and and peaked in intensity at about 9 weeks. The only pain relief I took was 800mg of ibuprofen 2-3 times per day. I started taking glucosamine, chondroitin, calcium and vitamin D right away. I had to change my exercise regimen to an exercise bike and swimming laps in the pool. The bike was 40 to 60 minutes daily and swimming for an hour once or twice per week.

At 11 weeks from the first sign of pain, over the course of a couple of days, the pain diminished to about 10% of what it had been during the last 14 days or so. I did have one quick, severely painful jolt about this time while suddenly moving the afflicted leg, but other than that, since week 11 I have been relatively pain free. I experience slight tinges of pain a couple times a day but these mild and faint. It's more of a gentle reminder that I am not completely healed.

I also experienced soreness in my knee while on crutches but this is completely gone at this point. I really believe the exercise bike made a difference. Initially, the pain after exercise intensified. After a week, there would be a reprieve in the pain for a couple of hours. Every day after exercise, it seemed like the pain would disappear for a little longer, though it very well could have been psychosomatic. I am at 12 weeks now, and am continuing the supplements and exercise bike routine until I can resume my normal activities.

I should also add when I drank beer, wine, coffee the pain would intensify regardless of what level it was currently at. I hope this helps anyone else who to go through this condition. It was very frustrating to read that recovery time is 6 to 12 months on all the websites I found while researching this condition. Recovery time really seems to vary, and while I am not scheduled to have another MRI for 6 weeks or so, I will be contacting my doctor to see if I can get off the crutches sooner than that.
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replied January 8th, 2013
Hi everyone! I am a 41 year old female and a week ago I was diagnosed with Toh on the left hip. I had TOH on the right hip 9 years ago on the right hip. Back then I used crutches for about one month and my doctor gave me fosamax for 6 months. 6 years ago I got operated to remove my thyroid glad and since then I am taking everyday the thyrohormone supplent and for the past year I am taking calcium tablets because I also have osteopenia. Although the doctors do not really know why the TOH is happening to me again this time they are suggesting to me to do one intravenus injection called Boniva 3mg which will help me for the next 3 months and then perform an MRI again to see the progress. Has anyone tried this Boniva? And does anyone know if I choose not to take any medication and suffer the pain will this go away or will it destroy my bones more? Thanks for reading me!
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