Transient osteoporosis of the hip

Transient osteoporosis of the hip is an uncommon but probably underdiagnosed condition. There appears to be a predisposition for the condition in middle-aged males and in women in their third trimester of pregnancy. The etiology remains unclear, with theories that include vascular and neurologic disturbances. Clinical signs are usually pain in the hip area with functional disability of the affected limb. Plane film radiographs may be completely normal or show only minimal osteopenia. This report describes a 40-year-old male in whom transient osteoporosis of the hip was diagnosed. The patient's symptoms were initially interpreted as being due to sciatica; however, careful evaluation, further diagnostic work-up in the form of magnetic resonance imaging, and the clinical course of the disease ultimately led to the correct diagnosis. Resolution occurred gradually with non-steroidal anti-inflammatory drug therapy and rest. This case demonstrates the need for further evaluation of patients with hip-area pain who may have negative x-rays of the hip joint but continue to be symptomatic.