Blake Ryan J, Melemai Vincent K, Fitzpatrick Brody M, Hubbard David F, Dietz Matthew J, Watkins Colleen M
Department of Orthopaedics, West Virginia University, PO Box 9196, Morgantown, WV, 26506, USA.
Osteoporos Int. 2025 Feb;36(2):333-337. doi: 10.1007/s00198-024-07346-4. Epub 2024 Dec 24.
Atraumatic bilateral femoral neck fractures are rare, especially in younger patients and those without significant comorbidities. However, pregnant individuals appear to be at increased risk due to normal physiological changes in calcium balance, leading to transient osteoporosis of the hip. In these individuals, calcium and bone mineral density are generally decreased, reflecting the calcium demands of the developing fetus. Therefore, peripartum non-osteoporotic bilateral femoral neck fractures sustained remain a rare presentation. A 31-year-old patient presented with worsening hip pain; imaging studies revealed bilateral femoral neck fractures. A complicated birth requiring specialized maneuvers 11 months prior resulted in moderate hip pain, and a single step down from the bottom rung of a ladder approximately 7 months after the delivery initiated acute exacerbation of the hip pain. Orthopedic evaluation determined that the patient would benefit most from the surgical fixation of both femoral necks with an arthroplasty on the right and a dynamic hip screw on the left. Rheumatologic evaluation of the patient revealed no relevant risk factors for osteoporosis other than suboxone use, tobacco use, and low levels of vitamin D. A DXA scan was unremarkable, and interestingly, the only notable laboratory findings were markedly increased parathyroid hormone levels with a slight increase in calcium. Pregnant patients with high serum levels of parathyroid hormone might be at risk for atraumatic hip fractures regardless of serum calcium levels, particularly when maneuvers that put stress on the femoral neck are employed. This case demonstrates the importance of increased clinical suspicion of hip fractures and evaluation for hyperparathyroidism in a patient presenting with atypical hip pain immediately following labor.
非创伤性双侧股骨颈骨折很少见，尤其是在年轻患者和无明显合并症的患者中。然而，由于钙平衡的正常生理变化，孕妇似乎风险增加，导致髋部短暂性骨质疏松。在这些个体中，钙和骨密度通常会降低，这反映了发育中胎儿对钙的需求。因此，围产期非骨质疏松性双侧股骨颈骨折仍然是一种罕见的表现。一名31岁患者出现髋部疼痛加重；影像学检查显示双侧股骨颈骨折。11个月前一次需要特殊操作的复杂分娩导致中度髋部疼痛，分娩后约7个月从梯子最底层往下迈一步引发了髋部疼痛的急性加重。骨科评估确定，对该患者而言，双侧股骨颈手术固定，右侧采用关节成形术，左侧采用动力髋螺钉，将获益最大。对该患者的风湿科评估显示，除了使用丁丙诺啡、吸烟和维生素D水平低之外，没有其他与骨质疏松相关的危险因素。双能X线吸收法扫描结果无异常，有趣的是，唯一显著的实验室检查结果是甲状旁腺激素水平明显升高，钙略有升高。血清甲状旁腺激素水平高的孕妇可能有非创伤性髋部骨折的风险，无论血清钙水平如何，尤其是在采用对股骨颈施加压力的操作时。本病例表明，对于产后立即出现非典型髋部疼痛的患者，提高对髋部骨折的临床怀疑以及对甲状旁腺功能亢进进行评估非常重要。
