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Old 09-11-2012
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Rheumatology/Orthopedics fracture in elderly

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
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  #2  
Old 09-11-2012
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May be D
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Old 09-11-2012
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its A or E.......
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Old 09-11-2012
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ans E ..... theres no h/o of breast Ca so .......
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Old 09-11-2012
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pathological fracture......bony malignancy---the most common cause is secondaries not primary bone cancer..would go for A
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Old 09-11-2012
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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.
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Old 09-11-2012
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Was thinking between A and E.

Chose A,
as osteoporosis is likely to be in lumbar area + neck of the femurin postmenopausal...Breast ca metastases though are likely to be seen in the ribs, but maybe they are there - we are not told.
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