Fragile

A 47 year old lady is brought in after she slipped and fell on the ground. She was unable to get up due to severe pain in both hips.

Close questioning reveals the presence of nocturia and constipation for several months.

Her medical history is unremarkable and she is not on any drugs.

Select Relevant Investigations
X-Ray B/L lower limbs

Performed

Bilateral subtrochanteric fractures are noted. There is marked osteopenia of both femurs and the pelvic bones.
Biochemical profile

Performed

Na+, K+, Cl-: Normal
Ca++:13.3 mg/dl (8.5-10.5)
PO4--- 12.6mg/dl (15.3-27)
S. Creatinine: normal
ALT, AST: normal
ALP: 200 IU/l (44-147)
Serum PTH

Performed

The serum parathyroid hormone level is 121 pg/ml (range: 10-65)
Tc99 isotope scan

Performed

A single area of high uptake corresponding to the left superior parathyroid gland is noted.

Select Relevant Management
Parathyroidectomy
Bilateral hip screws
Bisphosphonates
Tamoxifen