Arch Phys Med Rehabil. 2004 Sep;85(9):E30. Denise Chang (New York Presbyterian Hosp, New York, NY); David Lin; Julie Lin, e-mail: firstname.lastname@example.org. [No authors listed] DISCLOSURE: D. Chang, None; D. Lin, None; J. Lin, None.
SETTING: Acute rehabilitation unit in an urban area. Patient: A 27-yo white woman with a history of fibromyalgia and depression presented with right hip pain for 2mo leading to limited range of motion (ROM), difficulty ambulating, and left hip pain 4mo prior, which had resolved. There was no history of trauma. The patient had received several intra-articular cortisone injections without pain relief.
Case Description: Radiologic imaging revealed a displaced right femoral neck fracture, osteopenia, and a nondisplaced left femoral neck fracture. The patient was surgically treated with an open reduction and fixation of the right hip and percutaneous pinning of the left. Additional workup included a dual-energy x-ray absorptiometry scan, which revealed osteopenia (T score=-1.6) of the lumbar spine. Laboratory data revealed vitamin D deficiency with a 25-hydroxyvitamin D value of 16 and an elevated N-telopeptide value of 83.
Assessment/Results: The patient was started on high-dose vitamin D (150,000U) and calcium supplements as well as teriparatide (Forteo). She underwent bilateral surgical interventions and was admitted to the acute rehabilitation unit for intensive physical therapy. She was touch-toe weight bearing on the left lower extremity and weight bearing as tolerated on the right lower extremity. The patient responded well with significant improvements in ROM and ambulation with an assistive device, as reflected in improved motor FIM scores.
Discussion: Nontraumatic hip fracture in young women may be an indicator of osteopenia and bone mineralization disorder, which could be of varying etiology. The etiologic workup of this patient's vitamin D deficiency is ongoing, with the leading hypothesis being related to her use of the antidepressant medication bupropion (Wellbutrin).
Conclusions: Bilateral femoral insufficiency fractures are a unique presentation of vitamin D deficiency and osteopenia in young women. Recognition of this association can aid the accurate diagnosis and treatment for these patients. Key Words: Fractures; Metabolic diseases; Rehabilitation. PMID: 15376019 [PubMed – as supplied by publisher]