Page 25 - Delaware Medical Journal - November/December 2020

CASE REPORT
is not indicative of a bone disorder or osteomalacia.9 While DEXA scanning is the gold standard for diagnosis
of osteopenia and osteoporosis, it is better utilized as only one of several tools in the diagnosis for osteomalacia. The diagnosis of osteomalacia can
be made via blood or urine tests to detect the presence of low vitamin D, calcium, and/or phosphorus, as well
as the presence of plain film x-rays showing slight cracks or structural change.10 Bone biopsy can also be used accurately in detecting osteomalacia; however, it's rarely needed to make the diagnosis.7
Delayed or misdiagnosed insufficiency and stress fractures of the femoral
neck increase the risk of complete fracture with displacement, nonunion, as well as the development of avascular necrosis. In turn, these problems
can then result in the inability to be able to fix the fracture, failure of the surgical fixation, need for multiple
REFERENCES
surgeries including hip replacement, and overall an increased likelihood
of complications with a suboptimal outcome. Therefore, timely and accurate diagnosis of femoral neck insufficiency and stress fractures is of the utmost importance, particularly in the young patient population.
CONCLUSION
In young patients with atraumatic fractures and no significant medical history, thorough evaluation of laboratory values, including vitamin D and calcium, may help discover undiagnosed malabsorption issues and prevent long-term complications and medical conditions. Upon review of the literature, there are other studies, although limited, which document atraumatic fractures secondary to celiac disease-induced osteomalacia. Treatment of these patients includes primary treatment of the fractures,
including both nonsurgical and surgical interventions. Treatment of nutritional deficiencies should be managed by
an endocrinologist, with diet and nutrient supplementation. Delayed or misdiagnosed atraumatic femoral neck fractures require early diagnosis and management in order to ensure the best possible outcome.
CONTRIBUTORS
■ THOMAS R. MERRING, PA-C is a physician assistant with Delaware Orthopaedic Specialists. He graduated summa cum laude from the Physician Assistant Program at Long Island University in 2012.
■ JAMES J. RUBANO, MD, MBA is a board- certified orthopedic surgeon with Delaware Orthopaedic Specialists. He is fellowship- trained in joint replacement surgery of the hip and knee, including complex/revision surgery.
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8. Bone densitometry in patients with osteomalacia: Is it valuable? (2013, September). PubMed Central (PMC). https://www.ncbi.nlm.nih. gov/pmc/articles/PMC3917579/
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10. Osteomalacia - Diagnosis and treatment - Mayo Clinic. (2020, March 6). Mayo Clinic - Mayo Clinic. https://www.mayoclinic.org/ diseases-conditions/osteomalacia/diagnosis-treatment/drc-20355520
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