title: Rapid osteolysis of the femoral neck: consequence of an insufficiency fracture of the hip?
abstract: OBJECTIVE
  To describe the imaging and clinical features of rapid osteolysis of the femoral neck in an attempt to better understand this uncommon pathology.
  
  
  METHODS
  We retrospectively reviewed the files of 11 patients (six women and five men) aged 53-78 years diagnosed with rapid osteolysis of the femoral neck. Available imaging studies included radiographs, CT, MRI, and bone scintigraphy. Histopathological evaluations were available for seven cases.
  
  
  RESULTS
  All patients presented with complaints of hip pain, six of whom had acute symptoms, while the rest had progressive symptoms and impairment. All but one case were found to have bone deposition in adjacent hip muscles. CT confirmed bone deposition in adjacent tissues and true osteolysis of the femoral neck with relative sparing of the articular surfaces. Bone scintigraphy and MRI were useful to exclude underlying neoplastic disease.
  
  
  CONCLUSIONS
  Rapid osteolysis of the femoral neck tends to occur in patients with underlying comorbidities leading to bone fragility and may actually represent a peculiar form of spontaneous insufficiency fracture. Recognition of its imaging features and clinical risk factors may help distinguish this process from other more concerning disorders such as infection or neoplasm.
authors: Department of Radiology, Musculoskeletal division, University of Montreal Hospital Center, Hôpital Notre-Dame, 1560, rue Sherbrooke Est, Montréal, Quebec, H2L 4M1, Canada. etienne.blainpare@mail.mcgill.ca
authors: Etienne
authors: E
authors: Blain-Paré
authors: Matthieu
authors: M
authors: Ehlinger
authors: Jean-Claude
authors: JC
authors: Dosch
authors: Thomas
authors: T
authors: Moser
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications* / Q000175:diagnosis*; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology; D015775:Fractures, Stress / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000175:diagnosis* / Q000209:etiology*; D011859:Radiography; D011877:Radionuclide Imaging
references: Skeletal Radiol. 2000 Jan;29(1):40-4
references: 10663588
references: Skeletal Radiol. 2012 Sep;41(10):1213-21
references: 22664859
references: Skeletal Radiol. 1981;7(2):129-30
references: 7330663
references: AJR Am J Roentgenol. 2002 Sep;179(3):657-63
references: 12185038
references: Arthritis Rheum. 2000 Nov;43(11):2423-7
references: 11083264
references: AJR Am J Roentgenol. 1980 Dec;135(6):1317-8
references: 6779553
references: AJR Am J Roentgenol. 1980 Jun;134(6):1243-4
references: 6770636
references: J Bone Joint Surg Am. 2004 Jul;86(7):1534-7
references: 15252106
references: AJR Am J Roentgenol. 1999 Feb;172(2):489-91
references: 9930809
references: AJR Am J Roentgenol. 1994 Mar;162(3):651-4
references: 8109516
references: J Bone Joint Surg Am. 1955 Oct;37-A(5):985-1004
references: 13263344
references: J Bone Joint Surg Am. 1982 Sep;64(7):1053-8
references: 7118971
references: Ann Rheum Dis. 1974 May;33(3):196-203
references: 4843126
references: Ann Rheum Dis. 1986 Apr;45(4):272-6
references: 3486638
references: J Bone Joint Surg Am. 1984 Jan;66(1):121-6
references: 6690433
references: AJR Am J Roentgenol. 1992 Aug;159(2):245-52
references: 1632335
references: J Bone Joint Surg Br. 1985 Jan;67(1):88-93
references: 3968152