Transient Migratory Osteoporosis in Osteogenesis Imperfecta

Transient or transient migratory osteoporosis (TMO) is a painful and disabling disorder that occurs in patients with osteogenesis imperfecta. TMO is probably under-reported. TMO frequently affects men over the age of 40 or women in the late prenatal period of pregnancy or postpartum. In the individual with OI this diagnosis may be more difficult to determine because of bone deformity or pre-existent microfractures. T2-weighted MRI imaging may be diagnostic. Diagnostic confusion with other entities such as inflammatory arthropathy or avascular necrosis can lead to inappropriate treatment. The etiology of TMO is not defined; however, a cellular inflammatory response to microfractures may be causative. A limited number of studies, mainly involving single case reports, suggest that compared to conservative therapy, treatment with bisphosphonates may speed resolution and normalization of MRI changes. The prostaglandin analog ioprost may also be effective. TMO should be considered in the OI patient with rapid onset hip pain if fracture is excluded by radiologic procedures.