Primary hyperparathyroidism presenting as atraumatic bilateral hip fractures: a case report

Area of Science:

• Endocrinology
• Geriatrics
• Orthopedics

Background:

• Primary hyperparathyroidism (PHPT) affects up to 1.5% of older adults, increasing fracture risk.
• Atraumatic hip fractures are a rare but serious complication of PHPT.

Purpose of the Study:

• To report a case of atraumatic bilateral neck of femur fractures in an older female due to undiagnosed PHPT.
• To highlight the importance of investigating secondary causes of osteoporosis in elderly patients.

Main Methods:

• Case presentation of an 82-year-old woman with atraumatic hip fractures.
• Diagnostic workup including X-ray, CT, blood tests (calcium, PTH, vitamin D), and bone densitometry (DXA).

Main Results:

• The patient presented with displaced left and non-displaced right neck of femur fractures.
• Blood tests confirmed hypercalcemia, vitamin D deficiency, and elevated parathyroid hormone (PTH).
• DXA revealed severe osteoporosis with T-scores of -4.0 and -4.9.

Conclusions:

• Undiagnosed PHPT can lead to severe bone loss and rare atraumatic hip fractures.
• DXA screening and investigation for secondary osteoporosis causes are vital in older adults.