Chief Complaint: 72-year-old woman who fell onher right hip.

History: Margaret Donovan, a 72-year-old whitefemale, was brought to the emergency room by her son-in-law afterfalling in her bathtub. She was previously in good health, despiteleading a relatively sedentary lifestyle and having a 30-pack-yearhistory of cigarette smoking. The only medication she currentlytakes is Inderal (propranolol) for mild hypertension. She fell uponentering the bathtub when her right leg slipped out from under her;she landed on her right hip. There was no trauma to her head, nordoes she complain of right or left wrist pain. However, she reportssevere pain in the right hip and upper thigh, and was unable to getup after her fall. An injection of oxymorphone hydrochloride(Numorphan) helped relieve her pain and she was taken to theradiology department for an X-ray of her right leg and hip.

Physical Examination: The patient was alert,oriented to time, place, and date, and was responding appropriatelyto questions despite being in considerable pain. There were nosigns of trauma to the head, neck, torso, arms, or left leg. Theright thigh and hip were extremely tender and were immobilized by aleg splint. Heart and lung sounds were normal, and abdominal soundswere reduced.

Radiology Report: The X-ray of the right hiprevealed a complete, comminuted, intertrochanteric fracture of theright hip. No other fractures were noted in the right leg. Therewere also long-term osteoporotic changes in the femur, tibia, andfibula.

Questions:

1. What is meant by a “complete, comminuted, intertrochantericfracture of the right hip”
2. The radiologist reported signs of osteoporosis. Describe thecharacteristics of an osteoporotic femur as seen on an X-ray (Howdoes this differ in appearance from a normal fracture)

Treatment: Surgeons performed an open reductionof Margaret’s fracture, immobilizing the bones with internalpins

Questions:

1. Aside from any effect on the healing process, why else mightMargaret’s physician want her to avoid a prolonged period ofbed-ridden inactivity?
2. What risk factors does Margaret have for osteoporosis?
3. What parts of the skeleton (ie what bones) are most vulnerableto the ravages of osteoporosis?
4. Following her recovery, Margaret was placed on threemedications: A) oral calcium supplementation, B) oral estrogen, andC) oral alendronate sodium (Fosamax). Specifically describe howeach of these mediations works to treat Margaret’s condition.
5. Other treatments for osteoporosis include A) sodium fluorideand B) calcitonin. Describe how each of these medications works totreat osteoporosis