Transient osteoporosis of knees, ankles & feet in twin pregn
The following case has been reported in the Journal of Clinical Gynecology and Obstetrics.

The patient is a 36-year-old woman, 25 weeks pregnant with twins, who was admitted as an emergency with intense pain on the knees and ankles, without a previous record of trauma, associated with functional disability for standing and walking, which required hospitalization.

The physical examination revealed intense pain on palpation and on mobilization of knees and ankles. No joint effusion was observed and the meniscal maneuvers were negative. Muscle strength and sensitivity were normal.

The knee ultrasound was also normal, and the MRI of the right knee showed a slight joint effusion with bone edema on the subchondral region of the patella and the internal femoral condyle, with a small image of a microfracture. The analysis revealed hypercalcemia of 11.3 g/dL, vitamin D of 15 mg/dL, and hypercalciuria of 665 mg/day. Complementary tests were performed and a malignant process was ruled out.

After a diagnosis of osteoporosis of pregnancy (TOP), treatment was started with analgesics, topical capsaicin and rest. The patient did not report a clinical improvement and she presented with class IV functional capacity.

A programmed cesarean section was performed in week 35 of pregnancy. In the postoperative period, X-rays of knees, ankles and feet were obtained, as well as a bone scintigraphy. Given the findings and the clinical symptoms, which were resistant to the usual treatment, a 5 mg dose of intravenous zoledronic acid was administered, associated with calcium, vitamin D and rehabilitation.

After 8 months, the patient showed a clinical and radiological improvement, with functional class I.

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