USMLE Forums banner

fracture in elderly

2K views 6 replies 6 participants last post by  DocSikorski 
#1 ·
A 66-year-old woman picks up a bag of groceries out of the supermarket cart to place it in the trunk of her car. As she does so, she feels sharp, sudden pain in the middle of her arm, and her humerus suddenly breaks. She arrives at the emergency department cradling her arm; the deformity leaves no doubt that the bone is broken. Which of the following is the most likely reason for the fracture?

A. Bony metastasis to the humerus from breast cancer
B. Osteitis fibrosa cystica from parathyroid disease
C. Osteomalacia from nutritional deficiency
D. Osteoporosis
E. Primary malignant bone tumor
 
#6 ·
The correct answer is
A. A fracture from such trivial strain signifies a very weakened bone. In this age and gender, the most likely cause would be a lytic lesion from metastatic breast cancer. In a man, we would have suspected metastatic lung cancer (not prostate, because prostatic metastases are blastic rather than lytic). The bony reabsorption of parathyroid disease (choice B) is mostly seen as cystic lesions in the bones of the hand. In very advanced cases, bones may be deformable, but parathyroid hormone does not weaken major bones to the point at which they break. Osteomalacia (choice C), and its counterpart in children, rickets, deforms bones, but they would not break as described here. Osteoporosis (choice D) is indeed likely to be present in this woman. However, even with advanced osteoporosis, the only spontaneous fractures seen are compression fractures of vertebral bodies. Osteoporotic bones break easily, but there has to be more trauma than lifting a bag of groceries. Primary malignant bone tumors (choice E) occur in young people. They do not occur at this age.
 
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.
Top