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Transient Osteoporosis Of The Hip In Pregnancy Complicated By Spontaneous Bilateral Femoral Neck Fracture

*C. Dieme, A. Dansokho, A. Sane, M. M. Niane, A. Ndiaye, S. Seye

*Department of Orthopaedic and Trauma Surgery CHU A. Le Dantec Dakar Sénégal

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Dr Charles DIEME
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Femoral neck fracture is a serious complication of transient osteoporosis of the hip during pregnancy. A case of spontaneous bilateral femoral neck fracture is presented. The healing is observed on the right hip spontaneously. On the left a femoral non union is observed, surgery will be necessary. Characteristics of transient osteoporosis of the hip during pregnancy are reviewed and the mechanism is discussed.
Keys words: Transient osteoporosis
; Pregnancy; Femoral neck fracture

J.Orthopaedics 2006;3(3)e14


Transient osteoporosis during pregnancy is an uncommun diagnosis. The hip is the most frequent localisation of this disease and femoral neck fracture an exceptional critical situation.

Case Report

A 41 years old primigravida was admitted in Orthopaedics unit two months after a succesful uncomplicated vaginal delivery. She is crippled and presented with bilateral pain of the hip. These symptoms started at 28 weeks of her pregnancy, without hip trauma. Physical examination showed lameness and external rotation of the legs with no length disparity. The patient is walking with the assistance of arthritic crutch. X-ray showed bilateral fracture of the femoral neck (fig. 1).

Medical laboratory investigations were normal (F.B.C., sedimentation rate, calcium, phosphorus, total protein, albumin and hydroxyprolin). The diagnosis of bilateral spontaneous bilateral fracture of the femoral neck   was done. It is a complication of transient osteoporosis of the hip during pregnancy. After two months rest and medication (calcitonin) the healing was complete on the right neck femoral (fig. 2). On the left, non-union of the femoral neck was observed. 


About a hundred cases of transient osteoporosis during pregnancy or post-partum has been published with a preferencial localization to the hip [1]. However the real frequency of this disease is under estimated [2] [3]. Most of the time, women present during pregnancy various painfull syndroms, so called lumbago or sciatalgia and are not well investigated. In fact, even the available investigations allowing the diagnosis (X-Rays, Scintigraphy) are limited during pregnancy. The biology is normal; only the sedimentation rate and hydroxyproliuria are elevated and have no pathological signification during pregnancy [4].

The pathogenesis is not well known even though some risks factors were involved :

  • increase weight

  • microtrauma owe to foetal movement

  • compression of the pelvic sympathetic nerves by gravid uterus [5]

  • compression of the pudental nerve [6]

  • compression of the inferior vena cava leading to venus stasis [7]

  • hypertriglyceridemia

Transient osteoporosis during pregnancy is a self-limiting disorder that resolves over the course of six to eight months [8]. The femoral neck fracture is an exceptional [9] and dangerous complication. The first cases were reported by Curtiss et Kincaid [6]. This complication is presenting insidiously. However a high suspicion should permit the use of magnetic resonance imaging (MRI). MRI may an early diagnosis and shows a diffuse bone – marrow – eodema – pattern signal with an increased signal intensity on T2 – weighted images and a decreased on T1 – weighted images [10, 11]. The neck femoral fracture find its explanation in the weakening of the bones during pregnancy related to osteoporosis and rarefiante osteopathy [12] ; most of calcium from the mother for the benefit of the foetus is also involved [13]. 

Our observation is peculiar :

  • the neck femoral fracture is spontaneous (there is no trauma)

  • the discovery of the fracture is fortuitous

  • the fracture is bilateral. A review of the literature found three observations concerning spontaneous bilateral femoral fracture of the neck during transient osteoporosis of the hip [14] [15] [16]

  • the healing is observed in one side after few weeks rest, without surgery. In the other side, osteosynthesis with bone graft or arthroplastic will be necessary.


The transient osteoporosis of the hip during pregnancy is a disease that should not be under estimated. The occurence of the fracture of femoral neck is the most serious complication. In non displaced case the outcome is good without surgery: rest and some medication (calcitonine). Surgery is advocated in displaced cases.

Reference :

  1. Lecoq J, Boohs PM, Gaultier – Streith S and al. L’algodystrophie au cours de la grossesse.

  2. In Herisson C, Lopez S, Simon L. Entretiens de Rééducation et de Réadaptation fonctionnelle : Grossesse et Appareil locomoteur (1998), Masson, Paris, pp 63-74.

  3. Brocq O, Simon E, Bongain A, Gillet JY, Euller-Ziegler L (1999)Fracture du col fémoral compliquant une algodystrophie au cours de la grossesse.Press Med ; 28 : 1165 - 1166

  4. Cayla J, Chaouat D, Rondier J, Guérin K, Frugier JC (1978)Les algodystrophies réflexes des membres inférieurs au cours de la grossesse.Rev. Rhum Mal Ostéoartic., 45, 89-94. 

  5. Beaulieu JG, Razzano CD, Levine RB (1976)Transient osteoporosis of the hip in pregnancyClin Orthop, 115, 165-168. 

  6. Acquaviva P, Schiano A, Harnden P, Cros D, Serratria F (1982)Les algodystrophies : terrain et facteurs pathogéniques. Résultats d’une enquête multicentrique portant sur 765 observations Rev Rhum, 49 : 761-766. 

  7. Curtiss PH, Kincaid WE (1959) Transitory demineralisation of the hip in pregnancy. J Bone Joint Surg; 41 A: 1327-1333. 

  8. Junk S, Ostrowski M, Kokoszczynski L. (1996) Transient osteoporosis of the hip in pregnancy complicated by femoral neck fracture. Acta Orthop Scand ; 67 : 69-70. 

  9. Montella BJ, Nunley JA, Urbaniak JR (1999) Osteonecrosis of the femoral head associated with pregnancy. A preliminary report. J Bone Joint Surg ; 81 A : 790-798.

  10. Doury P (1996) L’algodystrophie de la grossesse ou du post partum Sem Hôp. Paris ; 72 : n°3-4, 117-124

  11. Montané de la Roque Ph., Cornu JL, Boyer M, Roy J (1993)Fracture spontanée du col fémoral compliquant une algodystrophie de hanche de la grossesse. Aspect en imagerie par résonance magnétique. Rev Rhum, 7-8 : 544-555

  12. Mitchell DG, Kressel HY, Arger PH, Dalinka M. and al (1986) A vascular necrosis of the femoral head : morphologic assessment by MR imaging with CT correlation. Radiology, 161 : 739-742.

  13. Billey Th, Dromer C, Pageo M, Caulier M, Lassoued S, Fournié B (1992) Fracture spontanée du col fémoral au cours d’une algodystrophie de hanche pendant la grossesse. A propos d’un ces et revue de la littérature. Rev. Rhum, Mal. Ostéoartic, 59 (7-8), 494-496

  14. Koeger A, Camus JP (1988) Métabolisme phosphocalcique normal et pathologique. In Weschler B, Janse-Marec J, Pechère JC Pathologie maternelle et grossesse (1998). Paris, Medesi Mac Graw Hill, pp 261-267.

  15. Jund D, Reinhardt W, Jagla J (1978) Bilateral spontaneous femoral neck fracture in severe pregnancy osteoporosis. Chirurg. ; 49(8): 523 - 4  

  16. Wattanawong T, Wajanavisit W, Larhacharrensombat W. (2001) Transient osteoporosis with bilateral fracture of the neck of the femur during pregnancy : a case report. J Med Assoc Thai ; 84 Suppl 2 : S 516 – 9

  17. Leistedt S, de Marneffe P, Burette JL, Cornette M (2004) Image of the month. Spontaneous bilateral fracture of the femoral neck resulting from transitory osteoporosis of pregnancy. Rev Med Liege : 59 (11) : 622-3.


This is a peer reviewed paper 

Please cite as : C. Dieme:Transient Osteoporosis Of The Hip In Pregnancy Complicated By Spontaneous Bilateral Femoral Neck Fracture

J.Orthopaedics 2006;3(3)e14





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