Bone marrow edema syndrome manifests itself through severe pain in the affected bone section, which is usually dependent on exertion. Bone marrow edema most commonly occurs in the hip joint, and more rarely in the knee. Possible causes of the disease are circulatory disorders and mechanical overloading or trauma to the bone.
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Bone marrow edema syndrome is usually accompanied by severe pain in the affected section of bone, usually dependent on exertion. Bone marrow edema, i.e. the increased accumulation of water in the bone, is the hallmark of the disease.
The term bone marrow edema syndrome describes the entire complex of
In principle, the disease can occur in all bones, but is most common in the hip joint, less frequently in the knee.
The first bone marrow edema syndrome was described by Curtiss and Kincaid in 1959. At that time, the authors reported on a woman in the last trimester of her pregnancy. She had a clinical syndrome with hip pain and reduced bone density on X-ray.
The pain syndrome was associated with a transient decrease in radiographic density in the corresponding bone areas. For this reason, Hunter and Kelly named the syndrome "transient osteoporosis" in 1968.
The term bone marrow edema was only introduced after magnetic resonance imaging(MRI) had found its way into the diagnosis of unclear bone and joint diseases. Wilson therefore replaced the term transient osteoporosis with the term transient bone marrow edema syndrome in 1988.
In 1989, one year later, Turner reported that this syndrome can be associated with avascular bone necrosis. Since then, many authors have assumed a disease continuum that begins with bone marrow edema and can end in avascular bone necrosis.
Bone marrow edema probably represents an early reversible phase of avascular bone necrosis. This hypothesis is based on similarities in the histologic examination of the bone, which is identical for early avascular necrosis and bone marrow edema. According to the Association Research Circulation Osseous (ARCO), four stages can be categorized:
The disease is usually accompanied by severe pain in the affected bone sections. Apart from the pain, which is usually load-dependent, there are few other symptoms.
The clinical course of the disease is characterized by position- or weight-bearing-dependent pain. The symptoms improve when lying or sitting. Immobilization or resting the extremity does not lead to a lasting improvement. Even medication cannot eliminate the pain in the long term.
Transient osteoporosis can be suspected if four of the five points apply:
The bone marrow edema is not visible on a normal X-ray. Only at a later stage does a temporary decrease in the X-ray density in the affected bone section become apparent. Bone scintigraphy can provide indications of transient osteoporosis.
Bone imaging using bone scintigraphy © agenturfotografin | AdobeStock
Bone marrow edema is almost exclusively diagnosed using magnetic resonance imaging. This shows hyperintense staining in the STIR and T2 images and hypointense staining of the bone marrow in T1-weighted MR images.
The disease occurs most frequently in the hip joint, less frequently in the knee. However, like avascular bone necrosis, it can in principle occur in all bones.
The syndrome can occur in three situations:
The circulatory disorder can be caused either by an impairment of the arterial inflow or the venous outflow. The arteries rarely show wall changes or thrombus formations in the biopsies. Therefore, the syndrome is probably more often caused by venous stasis than by arterial interruption of the blood supply.
Mechanical bone marrow edema is caused by overloading of the bone or trauma.
Reactive bone marrow edema is associated with e.g.
In summary, the following disorders and situations can trigger bone marrow edema:
The underlying disorder must be treated therapeutically. It is therefore essential to determine the cause. Depending on the cause and stage, various forms of therapy are then available.
Once a fracture and osteoarthritis have occurred, the only remaining option is often joint replacement with an endoprosthesis. This therapy is carried out by orthopaedic surgeons.
The syndrome is often only correctly diagnosed at an advanced stage of the disease. Then only surgical or even palliative treatment is possible.
Early detection of the disease and clarification of the causes makes it possible to intervene in the various aspects of the development of the disease. In this way, the course of the disease can be favorably influenced.
Transient osteoporosis is
It is not yet possible to predict the future course of the disease in advance. The disease usually lasts for about a year.
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