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- Title
Fulminant Skeletal Failure in a Centenarian: The Impact of Nutrition and Immobility.
- Authors
Brennan, M.; O'Flaherty, N.; O'Shea, P. M.; O'Keeffe, S.; Mulkerrin, E.
- Abstract
This case describes a 103-year-old lady who presented from home with an incidental diagnosis of a left femoral fracture. She had no history of trauma and denied pain. She had a known diagnosis of osteoporosis, and sustained a fracture of the contralateral femur aged 93 which was managed conservatively. She was bed-bound with fixed contractures, poor oral intake and was non-compliant with prescribed calcium/vitamin D supplementation. Clinical biochemical measurements showed severe vitamin D deficiency and mild hypocalcaemia. Secondary hyperparathyroidism in the setting of an inappropriately normal phosphate suggested concurrent renal bone disease. Biomarkers of bone turnover were also consistent with bone remodelling. The history of prior fragility fractures, severe vitamin D deficiency and immobility supports a diagnosis of osteoporotic fracture, however other causes of spontaneous fracture were also considered. This case highlights the complexity of interpreting clinical biochemistry results in the setting of multi-morbidity and addresses the challenges of bone health management in the frail older person.
- Subjects
TREATMENT of bone diseases; DIAGNOSIS of bone fractures; BONE remodeling; BIOCHEMISTRY; CENTENARIANS; FEMUR injuries; BONE fractures; FRAIL elderly; HYPERPARATHYROIDISM; HYPOCALCEMIA; MOVEMENT disorders; MUSCULOSKELETAL system; NUTRITION; OSTEOPOROSIS; VITAMIN D deficiency; COMORBIDITY; BONE density; DISEASE complications
- Publication
Journal of Nutrition, Health & Aging, 2019, Vol 23, Issue 8, p700
- ISSN
1279-7707
- Publication type
Article
- DOI
10.1007/s12603-019-1233-7