{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T06:39:04Z","timestamp":1789195144818,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Transient osteoporosis of the hip (TOH) is a rare, self-limiting disorder characterized by acute hip pain and reversible osteopenia. The aim of this study was to evaluate clinical outcomes following treatment with Neridronate, Clodronic Acid, Cholecalciferol, and pulsed electromagnetic field therapy (PEMF). Materials and Methods: A total of 45 patients presenting with non-traumatic hip pain were screened using a standardized diagnostic protocol. Magnetic resonance imaging (MRI) identified 8 patients (17.8%) with transient osteoporosis of the hip (TOH), who were subsequently enrolled in this analysis. Pain was evaluated using the Visual Analog Scale (VAS). Patients received a three-phase therapeutic protocol, including pharmacological therapy and PEMF. Clinical evaluations using the Harris Hip Score (HHS) were performed monthly, and follow-up MRI was conducted at the end of treatment. Results: We identified 8 cases of TOH (17.8%); the mean baseline HHS for these patients was 68.5 (range 51\u201383, SD 10.36). Pain reduction became evident within the first month of treatment. At the end of treatment, clinical improvement was observed in 7 patients, with mean HHS increasing to 88.0 (range 67\u201395, SD 8.84). Post-treatment MRI demonstrated complete resolution of bone marrow edema in all patients. One patient developed avascular necrosis despite therapy and required surgical intervention. Conclusions: TOH remains a controversial condition in terms of diagnosis and treatment. Early diagnosis and timely intervention are essential to progression to osteonecrosis. A combined therapeutic approach using bisphosphonates, vitamin D, and PEMF appears effective in reducing symptoms, promoting bone healing, and ensuring good patient compliance.<\/jats:p>","DOI":"10.3390\/jcm14217879","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T11:41:47Z","timestamp":1762515707000},"page":"7879","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Transient Osteoporosis of the Hip: Clinical and Radiological Outcomes After Combined Pharmacologic and Biophysical Therapy"],"prefix":"10.3390","volume":"14","author":[{"given":"Calogero","family":"Puma Pagliarello","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121 Piacenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5664-8066","authenticated-orcid":false,"given":"Vito","family":"Pavone","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Kory","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Costarella","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Buscema","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5246-9714","authenticated-orcid":false,"given":"Gianluca","family":"Testa","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, A.O.U. Policlinico Rodolico-San Marco, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7094-4344","authenticated-orcid":false,"given":"Corrado","family":"Ciatti","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121 Piacenza, Italy"},{"name":"Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.bonr.2016.10.004","article-title":"Transient osteoporosis: Not just the hip to worry about","volume":"5","author":"Berman","year":"2016","journal-title":"Bone Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1007\/s00296-010-1404-7","article-title":"Transient osteoporosis of the hip: Successful treatment with teriparatide","volume":"32","author":"Fabbriciani","year":"2012","journal-title":"Rheumatol. Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.injury.2017.02.020","article-title":"Denosumab is effective in the treatment of bone marrow oedema syndrome","volume":"48","author":"Rolvien","year":"2017","journal-title":"Injury"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s13224-013-0355-9","article-title":"Transient osteoporosis of hip and lumbar spine in pregnancy","volume":"62","author":"Pallavi","year":"2012","journal-title":"J. Obstet. Gynaecol. India"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"117535","DOI":"10.1016\/j.bone.2025.117535","article-title":"Clinical characteristics of patients with bone marrow edema syndrome, transient osteoporosis or migratory osteoporosis: A scoping review","volume":"198","author":"Hasvik","year":"2025","journal-title":"Bone"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1016\/S8756-3282(03)00164-9","article-title":"Biochemical markers of bone metabolism in bone marrow edema syndrome of the hip","volume":"33","author":"Berger","year":"2003","journal-title":"Bone"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00003086-200008000-00018","article-title":"Elevated levels of lipoprotein(a) in familial bone marrow edema syndrome of the hip","volume":"377","author":"Berger","year":"2000","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1007\/s00198-017-3952-0","article-title":"Transient osteoporosis of the hip: Review of the literature","volume":"28","author":"Asadipooya","year":"2017","journal-title":"Osteoporos. Int."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Moldovan, F., and Moldovan, L. (2025). A Modeling Study for Hip Fracture Rates in Romania. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093162"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0033-8389(03)00166-0","article-title":"Avascular necrosis and bone marrow edema syndrome","volume":"42","author":"Watson","year":"2004","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.injury.2014.01.023","article-title":"Intravenous bisphosphonates and vitamin D in the treatment of bone marrow oedema in professional athletes","volume":"45","author":"Simon","year":"2014","journal-title":"Injury"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s00198-007-0540-8","article-title":"Mechanisms of action of bisphosphonates: Similarities and differences and their potential influence on clinical efficacy","volume":"19","author":"Russell","year":"2008","journal-title":"Osteoporos. Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1093\/rheumatology\/ket370","article-title":"Bisphosphonates beyond their anti-osteoclastic properties","volume":"53","author":"Varenna","year":"2014","journal-title":"Rheumatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s10067-007-0766-z","article-title":"Oral bisphosphonates in treatment of transient osteoporosis","volume":"27","author":"Kibbi","year":"2008","journal-title":"Clin. Rheumatol."},{"key":"ref_15","first-page":"56","article-title":"Biophysical stimulation with pulsed electromagnetic fields in osteonecrosis of the femoral head","volume":"88","author":"Massari","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.7547\/8750-7315-105.1.27","article-title":"Treatment of bone marrow edema of the talus with pulsed electromagnetic fields: Outcomes in six patients","volume":"105","author":"Martinelli","year":"2015","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_17","first-page":"e29384","article-title":"Transient Osteoporosis of the Hip: A Radiologist\u2019s Perspective","volume":"14","author":"Khan","year":"2022","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e35475","DOI":"10.1097\/MD.0000000000035475","article-title":"The correlation between transient osteoporosis of the hip and pregnancy: A review","volume":"102","author":"Galanis","year":"2023","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2175659","DOI":"10.1080\/14767058.2023.2175659","article-title":"Transient osteoporosis of the hip in pregnancy\u2014A case series","volume":"36","author":"Eshed","year":"2023","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_20","first-page":"11","article-title":"Algodystrophy: Complex regional pain syndrome and incomplete forms","volume":"13","author":"Giannotti","year":"2016","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1302\/0301-620X.85B8.14673","article-title":"Complex regional pain syndrome","volume":"85","author":"Atkins","year":"2003","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"480","DOI":"10.5435\/00124635-200808000-00007","article-title":"Transient osteoporosis","volume":"16","author":"Korompilias","year":"2008","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ejrad.2008.01.056","article-title":"Histopathological perspective on bone marrow oedema, reactive bone change and haemorrhage","volume":"67","author":"Thiryayi","year":"2008","journal-title":"Eur. J. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s10067-003-0820-4","article-title":"Transient bone marrow edema syndrome progressing to avascular necrosis of the hip\u2014A case report and review of the literature","volume":"23","author":"Radke","year":"2004","journal-title":"Clin. Rheumatol."},{"key":"ref_25","first-page":"e75571","article-title":"Transient Osteoporosis of the Hip: A Case Report","volume":"16","year":"2024","journal-title":"Cureus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1053\/sarh.2002.50014","article-title":"Calcitonin in the treatment of transient osteoporosis of the hip","volume":"32","author":"Arayssi","year":"2003","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"329","DOI":"10.5301\/hipint.5000527","article-title":"MRI of the hip: Current concepts on bone marrow oedema","volume":"27","author":"Klontzas","year":"2017","journal-title":"Hip Int."},{"key":"ref_28","first-page":"97","article-title":"Clodronate: New directions of use","volume":"12","author":"Frediani","year":"2015","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_29","first-page":"15","article-title":"Bisphosphonates\u2014Anti-Inflammatory Properties","volume":"1","author":"Maksymowych","year":"2002","journal-title":"Curr. Med. Chem. Anti. Inflamm. Anti. Allergy Agents"},{"key":"ref_30","first-page":"7657982","article-title":"Recurrent Migratory Transient Bone Marrow Edema of the Knees Associated with Low Vitamin D and Systemic Low Bone Mineral Density: A Case Report and Literature Review","volume":"2018","author":"Alsaed","year":"2018","journal-title":"Case Rep. Rheumatol."},{"key":"ref_31","unstructured":"Maniscalco, P., Quattrini, F., Ciatti, C., Gattoni, S., Puma Pagliarello, C., Burgio, V., Di Stefano, G., Cauteruccio, M., Giovanelli, M., and Magro, A. (2020). The Italian Covid-19 Phase 2 in Piacenza: Results of the first semester of 2020 and future prospective of new orthopedics surgical procedures. Acta Biomed., 91."},{"key":"ref_32","unstructured":"Maniscalco, P., Ciatti, C., Gattoni, S., Quattrini, F., Puma Pagliarello, C., Patane\u2019, A.C., Capelli, P., Banchini, F., Rivera, F., and Sanna, F. (2021). Proximal humerus fractures in COVID-19 lockdown: The experience of three orthopedics and traumatology departments in the first ten weeks of the Italian epidemic. Acta Biomed., 92."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7879\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T11:56:10Z","timestamp":1762516570000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":32,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217879"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217879","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]}}}