Thyrotoxicosis, though an established cause of osteoporosis, rarely presents with bone fracture. The authors report 2 cases of thyrotoxicosis presenting as fracture of the femoral neck without other clinical features. Both patients presented with fracture of the femoral neck and, though having no clinical features of thyrotoxicosis, were found to have biochemical evidence of the disease. Both had cortical and trabecular osteoporosis and evidence of increased bone resorption with a high fasting urinary hydroxyproline:creatinine ratio. On treatment with carbimazole this ratio returned to normal long after the patient had become biochemically euthyroid, suggesting that the effect of excess thyroid hormone on bone is prolonged. These 2 cases show that even in the absence of the usual clinical features of thyrotoxicosis this diagnosis should be considered in patients with fracture of the femoral neck.
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