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JAMA Clinical Challenge
December 7, 2011

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

Author Affiliations

Author Affiliations: Department of Pathology, University of Alabama at Birmingham, and UAB Center for Metabolic Bone Disease, Birmingham.

JAMA. 2011;306(21):2385-2386. doi:10.1001/jama.2011.1748

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 1). 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.