Anatomy Msk · Year 1 · from Anatomy Msk
Case 1: Osteoporotic Hip Fracture
Clinical Image
Source: Wikimedia Commons - Osteoporotic Hip Fracture - CC BY-SA 3.0
Case Presentation
A 78-year-old postmenopausal woman presents to the emergency department after a fall from standing height onto her right side. She reports severe pain in her right hip and is unable to bear weight. Past medical history includes hypertension, hypothyroidism, and she has been taking proton pump inhibitors for chronic GERD. She went through menopause at age 50 and has never received hormone replacement therapy or osteoporosis screening. Physical examination reveals the right lower extremity held in external rotation and shortened compared to the left. There is significant tenderness over the right hip with any attempted movement. Radiographs demonstrate a displaced femoral neck fracture (Garden type III). DEXA scan confirms osteoporosis with a T-score of -3.2 at the femoral neck. The patient undergoes hemiarthroplasty and is started on bisphosphonate therapy with calcium and vitamin D supplementation. This case illustrates how decreased bone mineral density from trabecular bone loss leads to fractures with minimal trauma.
Key Learning Points
- Osteoporosis primarily affects trabecular (cancite) bone, which has greater surface area for osteoclastic resorption
- The femoral neck is composed predominantly of trabecular bone, making it vulnerable to osteoporotic fractures
- Risk factors include postmenopausal estrogen deficiency, advanced age, PPI use, and low body weight
- Bone remodeling imbalance (increased resorption over formation) leads to decreased bone mass
- DEXA scanning measures bone mineral density and identifies patients at fracture risk