J Bone Metab.  2017 Aug;24(3):197-200. 10.11005/jbm.2017.24.3.197.

Atraumatic Bilateral Fracture of the Femoral Neck in Young Male Patient with Suspected Osteomalacia

• Yoon BH
• Kwon MS

• KMID: 2415958
• DOI: http://doi.org/10.11005/jbm.2017.24.3.197

Abstract

In this report, we describe the case of a healthy 37-year-old male patient without a history of disease, who developed atraumatic bilateral fracture of the femoral neck. Radiological and blood investigations revealed osteopenia and severe vitamin D deficiency (7.42 ng/mL), respectively, but patient had no apparent risk factors for insufficiency fracture. Bilateral osteosynthesis was obtained using cannulated screws and laboratory findings improved after vitamin D supplementation. This case highlights the effect of vitamin D deficiency on demineralization in a young male patient.

Keyword

Femur neck; Fractures; Bone; Osteomalacia; Vitamin D deficiency

MeSH Terms

Adult
Bone Diseases, Metabolic
Femur Neck*
Fractures, Stress
Humans
Male*
Osteomalacia*
Risk Factors
Vitamin D
Vitamin D Deficiency
Vitamin D

Figure

• 

  Fig. 1 (A) Pelvic anteroposterior X-ray demonstrating the transcervical fracture of the neck of the left femur. (B) T2-weighted magnetic resonance imaging of both hips showing increased signal around the femoral necks in keeping with acute bilateral femoral neck fractures.

• 

  Fig. 2 At 6 months postoperatively, the radiograph showed complete union of the fractures.

Reference

1. Yoon DS, Lee YK, Ha YC, et al. Inadequate dietary calcium and vitamin D intake in patients with osteoporotic fracture. J Bone Metab. 2016; 23:55–61.

2. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008; 87:1080s–1086s.

3. Kwon YU, Kong GM, Park JH. Femur neck fracture in a young marfan syndrome patient. Hip Pelvis. 2016; 28:264–268.

4. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96:1911–1930.

5. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am. 2008; 90:2254–2266.

6. Malluche HH, Porter DS, Mawad H, et al. Low-energy fractures without low T-scores characteristic of osteoporosis: a possible bone matrix disorder. J Bone Joint Surg Am. 2013; 95:e1391–e1396.

7. Selek O, Memisoglu K, Selek A. Bilateral femoral neck fatigue fracture due to osteomalacia secondary to celiac disease: Report of three cases. Arch Iran Med. 2015; 18:542–544.

8. Rader CP, Corsten N, Rolf O. Osteomalacia and vitamin D deficiency. Orthopade. 2015; 44:695–702.

9. Desai M, Nadkarni S. Spontaneous bilateral fracture neck of femur secondary to vitamin D deficiency: a case report. Clin Cases Miner Bone Metab. 2015; 12:282–284.

10. Carter T, Nutt J, Simons A. Bilateral femoral neck insufficiency fractures secondary to vitamin D deficiency and concurrent corticosteroid use--a case report. Arch Osteoporos. 2014; 9:172.

11. Baki ME, Uygun H, Ari B, et al. Bilateral femoral neck insufficiency fractures in pregnancy. Eklem Hastalik Cerrahisi. 2014; 25:60–62.

12. Hanley DA, Davison KS. Vitamin D insufficiency in North America. J Nutr. 2005; 135:332–337.

13. Gordon CM, DePeter KC, Feldman HA, et al. Prevalence of vitamin D deficiency among healthy adolescents. Arch Pediatr Adolesc Med. 2004; 158:531–537.

14. Holick MF. The influence of vitamin D on bone health across the life cycle. J Nutr. 2005; 135:2726s–2727s.