Bilateral Subtrochanteric Pseudofractures of the Femur Secondary to Osteomalacia: a case report

Abstract

Introduction: Nutritional osteomalacia is a metabolic bone disorder common among the Asian female immigrant population in the United Kingdom. It is often under diagnosed in the United Kingdom, although it has been highlighted in the literature since the 1960s.1 Patient may be asymptomatic in the early stages although signs of osteomalacia may be apparent on X-ray pictures or other diagnostic tests. As osteomalacia worsens, symptoms may include bone pain, decreased muscle tone and muscle weakness. Pathological fractures such as bilateral subtrochanteric pseudofractures of the femur are an uncommon complication of osteomalacia. This has been rarely reported. Case presentation: This case presents an interesting and unusual case of a 38year-old female of Asian origin with bilateral subtrochanteric pseudofractures of the femur secondary to osteomalacia. The patient was treated successfully with calcium and vitamin D supplement therapy without surgical intervention. The bone pain subsided and she was able to bear full weight within 2 weeks of treatment. Conclusion: There should be a high index of suspicion of this disease, particularly among Asian female immigrant population presenting with persistent and non-specific musculoskeletal pain and on strict vegetarian diet. This case reiterates the importance of considering insufficiency or stress fractures in this group of patient. Management of the underlying cause, osteomalacia proves vital to prevent further complications. Morbidity related to delayed treatment has been well documented, so a high level of clinical suspicion is imperative.