604 - Bilateral Transient Osteoporosis of the Hips in Late Pregnancy: A Case Report and Multidisciplinary Management Approach

Bilateral Transient Osteoporosis of the Hips in Pregnancy

Case Description:

This case details a 33-year-old primigravida with severe, acute bilateral hip pain and functional decline in the absence of a traumatic injury. MRI revealed extensive bone marrow edema in the bilateral femoral heads and necks, consistent with TOH. An interdisciplinary management plan was implemented involving physiatry, orthopedics, endocrinology, obstetrics and gynecology, and physical therapy. Conservative treatment included activity modification, calcium and vitamin D supplementation, a carefully designed physical therapy program, and a planned cesarean section at 37 weeks due to hip mobility limitations. Follow-up MRI at 14 weeks postpartum showed near-complete resolution of bone marrow edema and clinical recovery.

Discussions:

Transient osteoporosis of the hip (TOH) is a rare condition that may present in the third trimester of pregnancy. Characterized by sudden-onset hip pain and bone marrow edema on MRI, it poses diagnostic and management challenges due to its potential for serious complications, including fracture and avascular necrosis. TOH should be considered in the differential diagnosis of severe hip pain in pregnant patients, particularly in the absence of trauma. Given the rarity of this condition, especially in a bilateral presentation, and the important implications for maternal safety and mobility, early diagnosis and interdisciplinary management are essential to prevent complications and facilitate functional recovery.

Conclusions:

This case highlights the importance of a thorough evaluation of pregnant patients with new onset pain and demonstrates the value of a coordinated, conservative approach to optimize maternal musculoskeletal outcomes. Physiatrists play a crucial role in this evaluation and care coordination, as they may be one of the first providers to encounter and evaluate a patient with hip complaint. While many causes of pregnancy related discomfort are benign, it is important to maintain a high index of suspicion for potentially serious conditions, such as TOH.