Osteomalacia and osteoporosis in femoral neck fracture

L. D. Hordon, Munro Peacock

Research output: Contribution to journalArticle

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Abstract

Iliac crest bone histomorphometry, plasma and urine biochemistry and clinical history were examined in 78 unselected patients (68 women, 10 men) at the time of femoral fracture. Histological abnormalities occurred in 56 of the 78 biopsies. The commonest of these was a low bone volume of less than 15% which, irrespective of other abnormal histological features, was present in 37 ot the biopsies. On the basis of the histomorphometry, patients could be classified into four main groups. Normal histomorphometry (bone volume > 15%, osteoid surfaces < 24%, mineralising surface > 60%) was present in 22 patients, 23 had osteoporosis as the only abnormality (bone volume < 15%, osteoid surface < 24%, mineralising surface > 60%), nine had osteomalacia (osteoid surfaces > 24%, mineralising surface < 60%, osteoid width > 13μm) and 13 had decreased mineralising surfaces. Of the remainder, five had increased osteoid surface and six had insufficient osteoid to assess mineralising surface. Plasma and urine biochemistry in the four groups showed that, compared to age-matched controls, all groups had reduced plasma albumin. In comparison to the group with normal histomorphometry, patients with osteoporosis had a higher plasma calcium (P < 0.01), tubular reabsorption of calcium (P < 0.05) and plasma vitamin D binding protein (P < 0.01); patients with osteomalacia had a higher plasma creatinine (P < 0.02) and parathyroid hormone (P < 0.02) and lower plasma 24,25-dihydroxyvitamin D (P < 0.02), urinary calcium/ creatinine ratio (P < 0.02) and tubular reabsorption of phosphate (P < 0.02). The biochemistry in patients with decreased mineralising surface was no different from patients with a normal biopsy. The prevalence of both osteoporosis and osteomalacia increased with age and, in subjects over the age of 90, osteoporosis occurred in 71% of patients and osteomalacia occurred in 29% of patients. The osteomalacic group were significantly older than the other three groups (P < 0.05). The histomorphometry did not relate to the site of fracture (subcapital or intertrochanteric). A history of stroke, gastrectomy, rheumatoid arthritis, steroid treatment, thyroid disease, alcohol abuse and anti-convulsant therapy was present in patients with femoral fracture but did not relate to any particular histomorphometric classification.

Original languageEnglish
Pages (from-to)247-259
Number of pages13
JournalBone and Mineral
Volume11
Issue number2
DOIs
StatePublished - 1990

Fingerprint

Osteomalacia
Femoral Neck Fractures
Osteoporosis
Plasmas
Biochemistry
Biopsy
Bone
Calcium
Bone and Bones
Creatinine
Femoral Fractures
Vitamin D-Binding Protein
Convulsants
Dihydroxycholecalciferols
Urine
Parathyroid Hormone
Serum Albumin
Thyroid Diseases
Steroids
Phosphates

Keywords

  • 1,25(OH)D
  • Bone histomorphometry
  • Femoral neck fracture
  • Osteomalacia
  • Osteoporosis

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology
  • Surgery

Cite this

Osteomalacia and osteoporosis in femoral neck fracture. / Hordon, L. D.; Peacock, Munro.

In: Bone and Mineral, Vol. 11, No. 2, 1990, p. 247-259.

Research output: Contribution to journalArticle

Hordon, L. D. ; Peacock, Munro. / Osteomalacia and osteoporosis in femoral neck fracture. In: Bone and Mineral. 1990 ; Vol. 11, No. 2. pp. 247-259.
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abstract = "Iliac crest bone histomorphometry, plasma and urine biochemistry and clinical history were examined in 78 unselected patients (68 women, 10 men) at the time of femoral fracture. Histological abnormalities occurred in 56 of the 78 biopsies. The commonest of these was a low bone volume of less than 15{\%} which, irrespective of other abnormal histological features, was present in 37 ot the biopsies. On the basis of the histomorphometry, patients could be classified into four main groups. Normal histomorphometry (bone volume > 15{\%}, osteoid surfaces < 24{\%}, mineralising surface > 60{\%}) was present in 22 patients, 23 had osteoporosis as the only abnormality (bone volume < 15{\%}, osteoid surface < 24{\%}, mineralising surface > 60{\%}), nine had osteomalacia (osteoid surfaces > 24{\%}, mineralising surface < 60{\%}, osteoid width > 13μm) and 13 had decreased mineralising surfaces. Of the remainder, five had increased osteoid surface and six had insufficient osteoid to assess mineralising surface. Plasma and urine biochemistry in the four groups showed that, compared to age-matched controls, all groups had reduced plasma albumin. In comparison to the group with normal histomorphometry, patients with osteoporosis had a higher plasma calcium (P < 0.01), tubular reabsorption of calcium (P < 0.05) and plasma vitamin D binding protein (P < 0.01); patients with osteomalacia had a higher plasma creatinine (P < 0.02) and parathyroid hormone (P < 0.02) and lower plasma 24,25-dihydroxyvitamin D (P < 0.02), urinary calcium/ creatinine ratio (P < 0.02) and tubular reabsorption of phosphate (P < 0.02). The biochemistry in patients with decreased mineralising surface was no different from patients with a normal biopsy. The prevalence of both osteoporosis and osteomalacia increased with age and, in subjects over the age of 90, osteoporosis occurred in 71{\%} of patients and osteomalacia occurred in 29{\%} of patients. The osteomalacic group were significantly older than the other three groups (P < 0.05). The histomorphometry did not relate to the site of fracture (subcapital or intertrochanteric). A history of stroke, gastrectomy, rheumatoid arthritis, steroid treatment, thyroid disease, alcohol abuse and anti-convulsant therapy was present in patients with femoral fracture but did not relate to any particular histomorphometric classification.",
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