Bilateral Transient Osteoporosis of the Hip in Pregnancy: Diagnostic Challenges, MRI-Based Approach, and Multidisciplinary Management

Background: Pregnancy-related transient osteoporosis of the hip (PR-TOH) is a rare and often underdiagnosed condition presenting with acute hip pain in late pregnancy or postpartum. Due to its nonspecific clinical presentation, it is frequently misinterpreted as common musculoskeletal or pelvic girdle pain, leading to delayed diagnosis and suboptimal management. Case Presentation: We report a rare case of bilateral PR-TOH in a 35-year-old primigravida diagnosed at 31+6 weeks of gestation. The patient presented with progressively worsening hip pain leading to severe mobility impairment. Initial investigations, including ultrasound and laboratory testing, were inconclusive. Definitive diagnosis was established by magnetic resonance imaging (MRI), demonstrating characteristic bone marrow oedema in both femoral heads. The patient was managed conservatively with analgesia, restricted weight bearing, and multidisciplinary care involving obstetrics, endocrinology, and orthopaedics. Pregnancy was successfully prolonged until 37+4 weeks, when caesarean section was performed due to clinical deterioration. Postpartum management included calcium and vitamin D supplementation and rehabilitation. Follow-up demonstrated significant improvement in bone mineral density on DEXA and complete clinical recovery at 12 months. Conclusions: PR-TOH should be considered in pregnant or postpartum women presenting with persistent hip pain and progressive functional limitation. Early use of MRI is essential for accurate diagnosis and differentiation from more common pregnancy-related conditions. Prompt recognition and multidisciplinary management are crucial to prevent complications and optimize maternal and obstetric outcomes.