Resident Physician Emory University Atlanta, Georgia, United States
Case Diagnosis: Bilateral Hip Fractures, Osteomalacia
Case Description: 39-year-old female with longstanding recurrent falls presented as an OSH transfer for bilateral hip fractures. Fall frequency increased in 2022 secondary to “clumsiness”. May 2023 BL hip XRs showed no fractures. In October 2023 she experienced a GLF, severely injuring her left hip though she did not seek medical attention. May 2024 experienced another fall, injuring her right hip, prompting an OSH visit after days of painful ambulation. Exam showed an obese female with benign BLE livedo reticularis, limited range of motion, and BL hips TTP. XR showed displaced right subtrochanteric femur fracture and left proximal angulated basicervical femur fracture. Labs Vitamin D < 4, Ca 8.5, PTH 618, and Hgb 7.9. Received right femur ORIF on 5/21 and left anterior THA on 5/23, bone biopsy showed CD138 plasma cells. Arranged outpatient hematology follow-up for anemia and osteomalacia. She was then cleared for discharge to an acute rehabilitation facility
Discussions: Over 500 hip fractures per 100,000 women occur annually in the US, primarily due to falls in osteoporotic elderly or high-energy trauma in younger adults. Risk factors include osteoporosis, age, gait impairment, debility, and malignancy. Mortality ranges from 18% to 31% within one year, depending on comorbidities. Prolonged Vitamin D deficiency leads to abnormal bone mineralization, increasing fracture risk. These injuries are typically treated with THA or intramedullary nails. Complications include infection, PE/DVT, and MI. Rehabilitation is as crucial as surgery for restoring mobility and functional status.
Conclusions: Hip fractures, particularly bilateral fractures, pose significant threats regarding morbidity and mortality. This presentation is unique due to the chronicity of symptoms and the presence of bilateral hip fractures in a younger, ambulatory woman. Recognizing and addressing potential risk factors, alongside initiating high-quality rehabilitation, can help mitigate the consequences associated with hip fractures, promote faster recovery, and improve long-term outcomes.
