Hip Pain in Late Pregnancy and Middle-Aged Men: Transient Osteoporosis of the Femoral Head

Hip pain is often blamed on muscle strain, back problems, or “wear and tear.” But in some people—especially men aged 30–60 or women in late pregnancy—a suddenly developing, steadily worsening groin/hip pain can point to a less common (but important) condition: Transient Osteoporosis of the Hip (TOH).

TOH is closely related to what many doctors call Bone Marrow Edema Syndrome (BMES). The reassuring part is that, with the right diagnosis, it is usually self-limiting and improves over time. The key is to distinguish it from conditions that can progress and damage the joint, such as avascular necrosis (AVN).

What is Transient Osteoporosis of the Hip?

TOH is a temporary condition where the femoral head (the “ball” of the hip joint) develops bone marrow swelling (edema) and a temporary drop in bone density. Symptoms typically resolve gradually, most often within 6–12 months.

Who is most at risk?

• Middle-aged men: One of the most commonly affected groups.
• Late pregnancy / early postpartum: Symptoms often start in the third trimester or shortly after delivery.

The exact cause is not always clear. Factors like low vitamin D, smoking/alcohol, or long periods of standing may play a role in some cases.

Common symptoms

• Sudden onset: Pain may start “out of the blue.”
• Groin pain is typical: It may also be felt on the outer hip or the front of the thigh.
• Worse with weight-bearing: Walking, standing, stairs, and prolonged activity make it worse.
• Limping: An antalgic limp is common.
• Night pain may occur: Not in every patient, but it can happen.

Why MRI matters (and X-rays can be misleading early on)

One challenge is that early X-rays may look normal. The “temporary bone loss” may become visible only weeks later.

MRI is the most useful test because it can detect bone marrow edema early and helps your doctor differentiate TOH from AVN. This distinction matters because AVN can be progressive and may lead to collapse of the femoral head, while TOH usually improves.

Treatment goals

Treatment is mainly focused on:

• Reducing pain
• Protecting the bone during the temporary weakness phase to lower the risk of fracture (especially in the femoral neck region)

1) Conservative treatment (first-line for most patients)

• Reduced weight-bearing: Crutches or a walker may be advised for a period of time.
• Pain control: Anti-inflammatory medication or other pain relief options as guided by your doctor.
• Vitamin D & calcium: Especially if blood tests show deficiency.
• Safe, guided activity: The goal is not complete bed rest, but protecting the hip while keeping the body conditioned.

2) Medications (selected cases)

In some patients, medications may be considered to reduce pain faster and potentially shorten the course. However, medication choices are limited in pregnancy and must be coordinated with obstetrics and orthopedics. Do not self-medicate during pregnancy.

3) Procedural options (rare)

If pain is severe and persistent despite appropriate care, some patients may be evaluated for procedures designed to reduce bone pressure and improve symptoms. This is not a routine first choice—decisions are case-specific.

Can it “move” to another joint?

Rarely, similar symptoms may later appear in the other hip or even a different joint (like the knee). If a new joint pain develops after recovery, early reassessment is helpful.

When to seek prompt evaluation

• Rapidly worsening groin/hip pain that makes weight-bearing difficult
• Night/rest pain that disrupts sleep
• New significant hip pain in late pregnancy
• MRI findings suggesting AVN or structural risk