Abstract
Introduction
Transient osteoporosis or the bone marrow oedema syndrome is described as a self-limiting disorder. Transient osteoporosis usually affects only one bone, predominantly the proximal femur. Involvement of the foot is rare and often overlooked. A disorder of the navicular bone of the foot can be found twice in the literature.
Materials and methods
We report a case of transient osteoporosis of the navicular bone of the foot in a 20-year-old, female, top-level track athlete (400 m sprinter) treated with alendronate, and a review of the literature.
Results
The therapeutic options are limited, frequently consisting of non-specific, symptomatic therapy. Some authors report favourable results with core decompression, while others have reported good results with a conservative regime of symptomatic treatment and avoidance of weight-bearing until the clinical and radiological changes have resolved. In the described case, the patient had a favourable result after a short course of treatment with alendronate. She experienced almost immediate pain reduction and presented a complete resolution of the abnormal signal intensity on MRI.
Conclusion
This rapid result makes the use of alendronate seem promising in athletes with transient osteoporosis, permitting an early return to high-level activities.
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References
Aigner N, Petje G, Steinboeck G, Schneider W, Krasny C, Landsiedl F(2001) Treatment of bone-marrow oedema of the talus with prostacyclin analogue iloprost. J Bone Joint Surg Br 83:855–858
Berenson JR, Lichtenstein A, Poerter L, Dimopolous MA, Bordoni R, George S, Lipton A, Keller A, Ballester O, Kovacs MJ, Blacklock HA, Bell R, Simeone J, Reitsma DJ, Heffernan M, Seaman J, Knight RD (1996) Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. N Engl J Med 334:488–493
Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer C, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541
Bramlett KW, Killian JT, Nasca RJ, Daniel WW (1987) Transient osteoporosis. Clin Orthop 222:197–202
Calvo E, Alvarez L, Fernandez-Yruegas D, Vallejo C (1997) Transient osteoporosis of the foot: bone marrow edema in 4 cases studied with MRI. Acta Orthop Scand 68:577–580
Curtiss PH, Kincaid WE (1959) Transitory demineralisation of the hip in pregnancy: a report of three cases. J Bone Joint Surg Am 41:1327–1333
Diel IJ, Solomayer EF, Costa SD, Gollan C, Goerner C, Wallwiener D, Bastert G (1998) Reduction in new metastases in breast cancer with adjuvant clodronate treatment. N Engl J Med 339:357–363
Doury P(1980) Regional osteoporosis of the hip treated with calcitonin continued. J Rheumatol 7:114–116
Ducan H, Frame B, Frost HM (1967) Migratory osteolysis of the lower extremities. Ann Intern Med 66:1165–1173
Dunn CJ, Galinet LA, Wu H, Nugent RA, Schlachter TS, Staite ND, Aspar DG, Elliott GA, Essani NA, Rohloff NA (1993) Demonstration of novel anti-arthritic and anti-inflammatory effects of diphosphonates. J Pharmacol Exp Ther 266:1691–1698
Felix R, Bettex JD, Fleisch H (1981) Effect of diphosphonates on the synthesis of prostaglandins in cultured calvaria cells. Calcif Tissue Int 33:549–552
Frohberg PK, Braunstein EM, Buckwalter KA (1996) Osteonecrosis, transient osteoporosis and transient bone marrow oedema: current concepts. Radiol Clin North Am 34:273–291
Gallant GG, Fischer RL, Sziklas J (1994) Transient regional osteoporosis of the ankle and foot. A report of four cases and review of the literature. Orthop Rev. 23:405–409
Guerra JJ, Steinberg ME (1995) Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Surg Am 77:616–624
Hauzeur JP, Perlmutter N, Appelboom T, Pasteels JL (1991) Medullary impairment at an early stage of non traumatic osteonecrosis of the femoral head. Rheumatol Int 11:215–217
Hofmann S, Kramer J, Plenk H (1993) Bone marrow oedema syndrome and transient osteoporosis of the hip. An MRI controlled study of treatment by core decompression. J Bone Joint Surg Br 75:210–216
Hofmann S, Kramer J, Schneider W, Plenh H (1997) Transient osteoporosis may represent a reversible early form of avascular necrosis of the hip joint. Curr Orthop 11:164–172
Hofmann S, Schneider W, Breitenseher M (2000) Transient osteoporosis as a reversible subtype of osteonecrosis of the hip joint. Orthopaede 29:411–419
Hortobagyi GN, Theriault RL, Porter L, Porter L, Blayney D, Sinoff C, Wheeler H, Simeone JF, Seaman JJ, Knight RD, Heffeman M, Mellars K, Reitsman DJ (1998) Efficiacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. N Engl J Med 335:1785–1791
Judd DB, Kim DH, Hrutkay JM (2000) Transient osteoporosis of the talus. Foot Ankle Int 21:134–137
Lakhanpal S, Ginsburg WW, Luthra HS, Hunder G (1987) Transient regional osteoporosis. Ann Intern Med 106:444–450
Lequesne M (1968) Transient osteoporosis of the hip: a non traumatic variety of Sudeck atrophy. Ann Rheum Dis 27:463–467
O`Mara RE, Pinals RS (1970) Bone scanning in regional migratory osteoporosis. Case report. Radiology 97:579–581
Radke S, Vispo-Seara J, Walther M, Ettl V, Eulert J (2001) Transient bone marrow oedema of the foot. Int Orthop 25:263–267
Reade B, Atlas G, Distazio J, Kruljac S (1998) Mueller-Weiss syndrome: an uncommon cause of midfoot pain. J Foot Ankle Surg 37:535–539
Rogers MJ, Chilton KM, Coxon F, Lawry J, Smith MO, Suri S, Russell RG (1996) Bisphosphonates induce apoptosis in mouse macrophage-like cells by a nitric-oxide-independent mechanism. J Bone Miner Res 11:1482–1491
Rosen RA (1970) Transitory demineralisation of the femoral head. Radiology 94:509–512
Samdani A, Lachmann E, Nagler W (1998) Transient osteoporosis of the hip during pregnancy: a case report. Am J Phys Med Rehabil 77:153–156
Scheinberg MA, Aristides RSA, Svartman C (1978) Transient regional osteoporosis of the hip treated with calcitonin. J Rheumatol 5:236–238
Sharp M, Noble S, Spencer CM (2001) Alendronate: an update of its use in osteoporosis. Drugs 61:999–1039
Swezey RL (1970) Transient osteoporosis of the hip, foot and knee. Arthritis Rheum 13:858–868
Vande Berg BE, Malghem JJ, Labaisse MA, Noel HM, Maldague BE (1993) MR imaging of avascular necrosis and transient marrow oedema of the femoral head. Radiographics 13:501–520
Vande Berg BE, Malghem JJ, Lecouvet FE, Jamart J, Maldague BE (1999) Idiopathic bone marrow edema lesions of the femoral head. Predictive value of MR imaging findings. Radiology 212:527–535
Wilson AD, Murphy WA, Hardy DC, Totty WC (1988) Transient osteoporosis: transient bone marrow oedema. Radiology 167:757–760
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Miltner, O., Niedhart, C., Piroth, W. et al. Transient osteoporosis of the navicular bone in a runner. Arch Orthop Trauma Surg 123, 505–508 (2003). https://doi.org/10.1007/s00402-003-0532-x
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DOI: https://doi.org/10.1007/s00402-003-0532-x