Zoledronic acid for the treatment of pregnancy-associated fe
Osteonecrosis of the femoral head must always be taken into account in the differential diagnosis of hip pain in pregnancy. Conservative treatment of pregnancy-associated osteonecrosis may lead to hip replacement. Prompt treatment may be essential to prevent arthroplasty.
Here reported for the first time a case of femoral osteonecrosis treated with zoledronate in a primigravid woman. Zoledronic acid proved safe and effective and the outcome persisted throughout the duration of a second pregnancy.

A 40-year-old woman developed necrosis of the left hip during her first pregnancy. An MRI scan one month after delivery revealed a large necrotic area in the left femoral head and no signs of osteoarthritis. serum calcium was slightly elevated. DXA scans showed osteoporotic values at the lumbar spine (L2-L4 T-score −2.7 SD) as well as at the femoral neck and the proximal femur. Treatment with zoledronic acid three months after delivery resulted in a rapid reduction of the necrotic area. The patient's second pregnancy shortly afterward had no complications. A magnetic resonance scan three years later documented complete resolution.

Conclusively, femoral head necrosis should be suspected in the differential diagnosis of pain in pregnancy. Zoledronic acid given in the early stages prevented progression to hip arthritis in this case.

Source: https://www.sciencedirect.com/science/article/pii/S2214911220300205
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