A 22-year-old woman is referred for further evaluation of a fractured left femur, sustained after she slipped and fell on a flat floor yesterday. X-rays showed a transverse subtrochanteric fracture, with markedly dense cortical boundaries and a reduced intramedullary diameter.
Her medical and surgical histories are unremarkable, and she is not on any medications. Her mother experienced a foot fracture and a Colles fracture at the ages of 32 and 55 years respectively. These were treated individually, without further evaluation.
She is a student at the local community college, has never smoked, and only drinks socially.
A complete blood count is significant for a Hb of 10.5 g/dL (normal: 12-18), with normal MCV, MCH and MCHC values. Peripheral smears confirm normochromic normocytic anemia. A reticulocyte count is 0.5% (normal: 0.5-1.5).
Her ESR, CRP, and renal and liver profiles (including serum alkaline phosphatase levels) are all within normal parameters.