Osteoporosis, osteomalacia, and hip fracture: A case study from the Terry collection

OBJECTIVE: This case study describes a perimortem hip fracture in a documented individual from the Robert J. Terry Skeletal Collection. The purpose of this paper is to comprehend how co-occurring conditions contributed to fracture risk and to understand the effect of the injury on this individual. MATERIALS AND METHODS: A 73-year-old female from the Terry Collection with a fracture of the left proximal femur was assessed macroscopically, and images were taken with a Keyence VHX-2000 digital microscope. Documentation concerning the individual's history and contemporary treatment of hip fractures was explored. RESULTS: Assessment demonstrated impaction of fractured elements occurred as a result of the inferior displacement of the femoral head into the femoral neck. Eburnation and hinge fractures are present on the fracture margins. Bending deformities of the sacrum, sternum, and ribs indicate underlying osteomalacia. No evidence of surgical intervention was observed. CONCLUSIONS: Both osteomalacia and osteoporosis contributed to overall fracture risk in this case, which demonstrates how complex underlying factors can interact to increase the probability of fracture, and influence post-fracture mortality. SIGNIFICANCE: This report is the first case study, to date, of a healing hip fracture in which the circumstances of the fracture and the medical history of the individual are known. LIMITATIONS: To fully investigate osteoporosis, bone mineral density for this individual should be compared with others in the collection. SUGGESTIONS FOR FURTHER RESEARCH: The effect of co-occurring conditions on fracture risk should be explored in the wider Terry Collection, and in other skeletal collections.