Transient osteoporosis of the hip and fatty liver disease: Case report and pathogenic hypothesis

Transient osteoporosis of the hip is a rare, temporary condition characterized by hip pain and functional limitations, which can significantly reduce the quality of life. Bone marrow edema of the proximal femur, identified through magnetic resonance imaging is the primary diagnostic feature of transient osteoporosis of the hip. While the exact cause of transient osteoporosis of the hip remains unclear, several potential pathophysiological mechanisms warrant further investigation to better understand this condition. In this case study, we present an unusual case of a patient with transient osteoporosis of the hip who was diagnosed with non-alcoholic fatty liver disease. A 42-year-old Caucasian man presented with left hip pain. After clinical and radiological evaluations, he was diagnosed with transient osteoporosis of the hip. Biochemical assessment revealed a persistent and isolated elevation of alanine aminotransferase. The patient underwent a treatment regimen involving 16 days of intramuscular neridronate along with physical therapy. At the 3- and 6-month follow-ups, he showed significant improvements in both clinical symptoms and radiological findings. In our study, we propose, for the first time, a potential association between liver disorders, specifically non-alcoholic fatty liver disease, and the onset of transient osteoporosis of the hip, exploring the possible pathophysiological mechanisms connecting these two conditions and discuss the rationale for both pharmacological and non-pharmacological treatments.