The Orthopaedic view of Transient Osteoporosis of the Hip in Pregnancy

  • Anastasios Daras
  • Nikolaos Markeas
  • Andreas Efstathiou
  • Konstantina Kourou
  • Fotini Georgakopoulou
Keywords: Transient osteoporosis of the hip, Pregnancy, Orthopaedic


Scope. The analysis of Transient Osteoporosis of the Hip, which invades the 3rd trimester of pregnancy (TOHP) and arouses the interest of the Orthopedist in its treatment. It is a rare, unknown disease that presents with localized osteoporosis in the neck and femoral head, often bilateral and resolved spontaneously after 4-8 months. The reduction of the mechanical strength of the femoral neck carries the risk of fragility fracture. The diagnosis is made with the information from the history and the objective examination and is documented with Magnetic Resonance Imaging (MRI).

Material and Methods. During the last 25 years (1998-2023), out of a total of 85,000 deliveries, 18 cases of TOHP were diagnosed (0.021%).  The symptoms of the onset of the disease were pain in the affected hip with lameness that limited daily activities. 

Results. Treatment was conservative and included rest, discharge of the affected hip, analgesics and anti-osteoclastic drugs after childbirth. After 6-8 months, there was a complete remission of the manifestations of the disease, and only in one woman, the diagnosis was made after a fracture of fragility of the femoral neck that was treated surgically.

Conclusions. This rare disease (TOHP) has a benign progression and requires early diagnosis, with awareness of Obstetricians Gynecologists and Orthopedic Surgeons, for the immediate initiation of therapeutic measures. Protection from a possible femoral neck fragility fracture, as well as surgical repair if it occurs, are critical issues for the successful final outcome of pregnancy.


Download data is not yet available.

Author Biographies

Anastasios Daras

Orthopaedic Head, in Orthopaedic dept of “LETO General, Maternity & Gynecology Clinic”, and “Euroclinic Children Hospital”

Nikolaos Markeas

Orthopaedic Head, “Euroclinic Children Hospital”

Andreas Efstathiou

2nd Orthopaedic Department University of Athens, School of Medicine, “Konstantopoulio” Hospital.

Konstantina Kourou

Orthopaedic Department, “Errikos Dynan Hospital”. Linguist (ESP Medicine) Cambridge University Associate.


Curtiss P. and Kincaid W., 1959: “Transitory Demineralization of the Hip in Pregnancy, A Report of Three Cases”. The J.B.J.S. 41(7):p 1327-1333, October 1959. Departments of Orthopaedic Surgery and Radiology, University Hospitals, Western Reserve University School of Medicine, Cleveland.
2. Beaelieu J. et al, 1976: “Transient osteoporosis of the hip in pregnancy”, Clin Orthop Relat Res. 1976 Mar-Apr;(115):165-8.
3. Lequensne M., 1968: “Transient Osteoporosis of the Hip”, Ann. Reum. Dis. (1968), 27, 463. Title name: given at a meeting if the Heberden Society in November 1967.
4. Asadipooya Κ. Et al, 2017: “Transient osteoporosis of the hip: review of the literature”, Review, Osteoporos, International Osteoporosis Foundation and National Osteoporosis Foundation 2017.
5. Hadji P. et al, 2017: “Pregnancy-associated transient osteoporosis of the hip: results of a case-control study”, Arch. Osteoporos, International Osteoporosis Foundation and National Osteoporosis Foundation 2017.
6. Quaresima P. et al, 2021: “Pregnancy associated transient osteoporosis of the hip (PR-TOH): A non–obstetric indication to caesarean section. A case report with literature review”, European Journal of Obstetrics & Gynecology and Reproductive Biology. Review article, ELSEVIER.
7. Takanobu A., et al, 2012: “Transient Osteoporosis of the Hip in Pregnancy Associated with Generalized Low Bone Mineral Density – A Case Report”, School of Nursing, Faculty of Medicine, University of Oita, b Angelic Clinic Urata, and Okamoto Clinic, Oita, Japan. Gynecol Obstet Invest.
8. Uldbjerg N., et al 1983: “Ripening of the human uterine cervix related to changes in collagen, glycosaminoglycans, and collagenolytic activity. Am J Obstet Gynecol 1983;147: 662–666.
9. Bruinsma B., LaBan M., 1990: “The ghost joint: transient osteoporosis of the hip”, Arch Phys Med Rehabil, Apr;71(5):295-8.
10. Hayes C., et al, 1993: “MR Imaging of Bone Marrow Edema Pattern: Transient Osteoporosis, Transient Bone Marrow Edema Syndrome, or Osteonecrosis”, Radiografics, Vol 13, No 5.
11. Curtis W. et al, 1993: “MR Imaging of Bone Marrow Edema Pattern: Transient Osteoporosis, Transient Bone Marrow Edema Syndrome, or Osteonecrosis” Radio Graphics 1993; 13:1001-1011
12. Vante Berg B., et al, 2008: “Bone marrow edema of the femoral head and transient osteoporosis of the hip” Department of Radiology and Medical Imaging, Universit´e Catholique de Louvain, University Hospital, Brussels, Belgium, 2008, Journal of Radiology 67 (2008) 68–77.
13. Bloem J.L., 1988: “Transient osteoporosis of the hip: MR imaging”, Radiology VOL. 167, NO. 3.
14. Schapira D., 1992: “Transient Osteoporosis of the Hip”, Semin Arthritis Rheum, Oct;22(2):98-105.
15. Butscheidt S. et al, 2018: “Mutational analysis uncovers monogenic bone disorders in women with pregnancy-associated osteoporosis: three novel mutations in LRP5, COL1A1, and COL1A2”. Osteoporos Int. 2018 Jul;29(7):1643-1651.
16. Janet L. et al, 1995: “Transient osteoporosis of the hip in pregnancy: natural history of changes in bone mineral density”, Clinical Endocrinology.
17. Toussia S. et al, 2023: “Transient osteoporosis of the hip in pregnancy – a case series”, The Journal of Maternal-Fetal & Neonatal Medicine, Published online: 08 Feb 2023, Available via
18. WHO 2015: Health Organization Human Reproduction Programme. WHO statement on Caesarean section rates 10 April 2015. Reprod Health Matters 2015;23 (May (45)):149–50.
19. Tejwani N., 2017: “Treatment of Pregnant Patients With Orthopaedic Trauma”, Review Article, NYU Hospital for Joint Diseases, New York, NY and the Philadelphia College of Osteopathic Medicine, Philadelphia, PA (Dr. K. Klifto). MDJ Am Acad Orthop Surg 2017; 0:1-12.
20. Smith M.W. 2008: “Orthopedic Issues in Pregnancy” Medical Education Program, Ft. Wayne, Indiana University School of Medicine, Indianapolis, Indiana, Obstetrical and Gynecological Survey, CME REVIEW ARTICLE 4, Vol 63, No 3.
21. Matzon JL. et al, 2015: “Considerations in the radiologic evaluation of the pregnant orthopaedic patient”. J Am Acad Orthop Surg 2015;23(8):485-491.
22. Oqueh O. et al, 2009: “A longitudinal study of the effect of heparin thromboprophylaxis during pregnancy on maternal bone metabolism”, Obstet Med. 2009 Dec; 2(4): 157–160.