Regional migratory osteoporosis

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Abstract

Regional migratory osteoporosis (RMO) is an uncommon disease characterised by a migrating arthralgia involving the weight bearing joints of the lower limb. The typical imaging findings on radiographs, magnetic resonance imaging, computed tomography and bone scintigraphy are described and illustrated. Men in their fifth and sixth decades of life are most commonly affected. The most common presentation is with proximal to distal spread in the lower limb. The world literature has been reviewed which has revealed 63 documented cases of regional osteoporosis or bone marrow oedema with migratory symptoms. Most of these cases have not been labelled as RMO and therefore the condition is probably under-diagnosed.

The radiology of RMO is indistinguishable from transient osteoporosis of the hip (TOH) except for the migratory symptoms and the two conditions are likely to be part of the same spectrum of disease. Systemic osteoporosis is a more recently recognised accompanying feature that hints at an underlying aetiology and an approach to the management of this condition.

Introduction

Regional migratory osteoporosis (RMO) is a rare condition characterised by migrating arthralgia of weight bearing joints in the lower limb. It was first described in 1967 [1] and occurs most commonly in middle-aged men [2], [3], [4]. The pathogenesis remains unclear, early plain radiographic assessment is often unhelpful and there are no specific biochemical or serological markers [5]. Despite the rarity of the disease, and the difficulty in securing the diagnosis, it is probably more common than would be suggested by a superficial glance of the literature. Transient osteoporosis of the hip (TOH) was first described in 1959 as a disease of the hip in pregnant women that resolves without sequelae [6]. Since then it has been described many times but careful examination of published case histories reveals that many of these patients went on to develop similar symptoms in adjacent joints. It is therefore probable that RMO has been under represented in the literature because it has been labelled as TOH or transient bone marrow oedema syndrome (TBME).

The first aim of this paper is to review the contemporary understanding of the aetiology, investigation and treatment of RMO. The second aim is to perform a systematic review of all published cases reports of RMO, TOH and TBME in which migratory symptoms have been described.

Section snippets

Materials and methods

Published articles were selected by searching the National Library of Medicine and National Institute of Health database Pubmed. The terms used for the search were “transient osteoporosis”, “bone marrow oedema/edema” and “migratory osteoporosis/oedema/edema”. Further publications were identified from the references in these papers. The inclusion criteria for this study included any patient presenting with focal joint pain that progressed to complete resolution, documented imaging findings of

Conventional radiography

Plain radiographic changes often lag behind the clinical symptoms by 3–6 weeks [3], [26]. Therefore, it is not uncommon for radiographs to be normal at presentation [30]. A significant amount of trabecular mineral loss must occur before it can be detected on radiographs [46]. Therefore, early changes are often subtle and difficult to appreciate particularly if there is no normal contralateral joint for comparison. This may explain the variations in the reported incidence of regional

Conclusion

RMO is an uncommon condition and can be diagnosed when there has been an episode of transient osteoporosis and then the typical migratory features with involvement of another joint. It occurs more commonly in men than women and the hips are the most commonly affected primary joint. Involvement of secondary joints typically occurs within 6 months of presentation. The radiology of RMO is the same as TOH and TBME but with multiple sequential joint involvement. There may be systemic osteoporosis

Acknowledgement

The authors would like to thank Angela Britcher for her help in the preparation of this manuscript.

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