TOPLINE:

A population-based German study found that pelvic MRI signs of osteitis pubis, specifically parasymphyseal bone marrow oedema (BME; present in 11.1% of participants) and interpubic disc cleft signs (present in 6.0% of participants), were common incidental findings in the general population and were not associated with self-reported lower abdominal pain or leg pain.

METHODOLOGY:

• Researchers analysed data from 1000 randomly selected participants (mean age, 51.5 years; 52% women) in the Study of Health in Pomerania-Trend-0 cohort, a population-based study in Germany conducted between 2008 and 2012.
• All participants underwent standardised pelvic MRI using a 1.5-Tesla scanner with a coronal turbo inversion recovery magnitude (TIRM) sequence; after excluding 14 non-diagnostic examinations, 986 participants were included in the final analysis.
• Parasymphyseal BME was assessed for presence, laterality, extent (maximum lateral distance from the symphyseal cleft in millimetres), and signal intensity ratio; cleft signs were classified as present or absent.
• Associations of BME or cleft signs with potential determinants, including age, sex, BMI, sports activity, occupation, number of pregnancies, and self-reported lower abdominal pain or leg pain (assessed using a numeric rating scale based on pain experienced during the previous 7 days), were analysed using appropriate statistical tests.

TAKEAWAY:

• Parasymphyseal BME was detected in 109 of 986 participants (overall prevalence, 11.1%; 95% CI, 9.2%-13.2%), with a bilateral distribution in 5.5%, left-sided distribution in 2.5%, and right-sided distribution in 3.0%; in 99.1% of cases, the oedema extended to the immediate vicinity of the symphyseal cleft.
• Cleft signs were present in 59 of 986 participants (overall prevalence, 6.0%; 95% CI, 4.7%-7.6%); a significant association was observed between BME and cleft signs (P < .01), with cleft signs present in 18.3% of participants with BME vs 4.4% of those without BME.
• The number of pregnancies showed a borderline exploratory association with BME, with the odds of BME increasing by 23.8% per pregnancy (odds ratio, 1.238; 95% CI, 1.008-1.521; P = .042); cleft signs were more frequent in women than in men (7.9% vs 4.0%; P = .015).
• No significant associations were noted between BME or cleft signs and lower abdominal pain, leg pain, sports activity, occupation, age, or BMI; neither the extent of BME nor the signal intensity ratio was associated with pain variables.

IN PRACTICE:

"Parasymphyseal bone marrow oedema (BME) and interpubic disc cleft signs were observed on pelvic MRI in the general population, with prevalences of 11.1% and 6.0%, respectively. No association was detected with available self-reported pain, sports activity, or occupation variables; however, these findings should be interpreted cautiously given the non-specific pain assessment and exploratory analyses," the authors wrote.

"Pregnancy history showed a borderline association with BME, whereas cleft signs were more frequent in women. These background prevalences should be considered when evaluating suspected osteitis pubis and correlated with clinical presentation," they added.

SOURCE:

The study was led by Thomas Beyer, Rostock University Medical Center, Rostock, Germany. It was published online on May 21, 2026, in the European Journal of Radiology.

LIMITATIONS:

The study was limited by the indirect assessment of groin pain using lower abdominal and leg pain variables within a 7-day symptom window, its cross-sectional design, and the use of a single coronal TIRM sequence without T1-weighted or multiplanar high-resolution imaging. Additional constraints included a 5-mm slice thickness, moderate-to-fair interreader agreement, exploratory and univariable statistical analyses that were unadjusted for multiple comparisons, and a cohort restricted to a single geographic region in northeastern Germany.

DISCLOSURES:

The research did not receive any specific grant from public, commercial, or not-for-profit funding sectors. The authors reported having no conflicts of interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.