Spontaneous Bilateral Femoral Neck Fracture Rare Presentation of a Metabolic Bone Disease

Abstract

A 50 year old woman was observed at the emergency department after falling from her own height after sudden failure of the lower limbs, which led to bilateral femoral neck fracture. She has had multiple repeated urinary tract infections, nephrolithiasis with several admissions in urology department and extracorporeal lithotripsy episodes with shock waves. She also had history of surgical removal of kidney stones. The Laboratory tests revealed high calcemia (13.2 mg/dl) and alkaline phosphatase (445); normal phosphate and magnesium, normal Calcitonin; high parathyroid hormone(> 2500 pg / ml). Hyperparathyroidism caused by a parathyroid adenoma was diagnosed after ultrasound, biopsy and scintigraphy were performed. Radiographs revealed classic and severe bone findings in PHPT, features which were common in the past but are thought to be rare at this modern age. Parathyroidectomy was performed at the same time as a bilateral cemented total hip arthroplasty. She developed the hungry-?bone syndrome 5 days postoperatively, which resolved with administration of bisphosphonates, calcium and D vitamin.