Stress Fracture Along with Transient Osteoporosis in a 72-Year-Old Female with Hip Pain: A Case Report

Khalil Kargar Shooraki,1 Arash Aris,1,2 Masih Rikhtehgar3 1Bone and Joint Reconstruction Research Center, Department of Surgery, Shafa Yahyaeian Orthopedic Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; 2Department of Orthopedics, School of Medicine, Orthopaedic Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran; 3Bone and Joint Reconstruction Research Center, Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, IranCorrespondence: Arash Aris, Department of Orthopedics, School of Medicine, Orthopaedic Research Center, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran, Tel +98 1333542460, Email [email protected]: Transient hip osteoporosis (THO) is a rare, self-limiting condition characterized by acute hip pain and bone marrow edema. Although typically benign, THO may coexist with or predispose to femoral neck stress fractures, creating critical diagnostic and therapeutic challenges. We report a case of concurrent THO and femoral neck stress fracture in an elderly patient and discuss implications for management.Patients and Methods: A 72-year-old female presented with an eight-month history of persistent right hip pain. Initial radiographs suggested synovial chondromatosis; however, symptoms persisted despite conservative treatment. Repeat radiographs demonstrated subtle sclerotic change and a cortical fracture line at the medial/inferior femoral neck. MRI revealed mild-to-moderate joint effusion and diffuse bone marrow edema involving the femoral head and neck consistent with THO, along with a linear low-signal fracture line consistent with an established femoral neck stress fracture. The patient was initially managed with protected weight-bearing and analgesics.Results: Symptoms persisted after conservative management, and prophylactic fixation with proximal femoral nail antirotation (PFNA) was performed. The patient experienced complete pain resolution by four months. At 18-month follow-up, radiographs demonstrated healing of the stress fracture with full return to weight-bearing.Conclusion: Diffuse marrow edema suggestive of THO does not exclude a clinically meaningful femoral neck stress fracture, particularly in older adults with persistent atraumatic hip pain. Early MRI and close follow-up are essential for detecting occult fractures, guiding weight-bearing recommendations, and preventing progression to displacement.Keywords: osteoporosis, hip joint, fractures, stress, femoral neck fractures, fracture fixation, intramedullary