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JAMA Clinical Challenge

A 23-Year-Old Woman With a Right Femoral Neck Fracture


Computed tomography scan showing multiple lytic bony lesions in the pelvis and proximal femurs and a right femoral neck fracture.

Shi Wei, MD, PhD
Gene P. Siegal, MD, PhD
A 23-year-old woman was referred for evaluation of a right femoral neck pathologic fracture. Review of her pelvic computed tomography (CT) scan from the referring hospital revealed multiple lytic bony lesions in her pelvis bilaterally and in both proximal femurs and a right femoral neck fracture (Figure). On admission, she had an elevated serum calcium level (14.8 mg/dL; normal range, 8.5-10.1 mg/dL [to convert to mmol/L, multiply by 0.25]), decreased serum phosphorus level (2.3 mg/dL; normal range, 2.5-4.9 mg/dL [to convert to mmol/L, multiply by 0.323]), serum creatinine within normal limits, and an undefined anemia (hemoglobin, 7.8 g/dL; normal range, 11.3-15.2 g/dL). She was treated with intravenous fluids, pamidronate for her hypercalcemia, and a blood transfusion for her anemia. She then underwent a hemiarthroplasty.

See the full article for an explanation and discussion.

Author Affiliations: Dr Wei (swei{at}uab.edu) is affiliated with the Department of Pathology, University of Alabama at Birmingham. Dr Siegal is affiliated with the UAB Center for Metabolic Bone Disease, Birmingham.