An Atypical Fracture
An 81-year-old female with a past medical history of osteoporosis, hypertension, hypercholesterolemia, and gastroesophageal reflux disease presented to her family practice office in hospital follow-up of a right leg injury she sustained six weeks prior. She had a mechanical fall at home and was taken to the emergency department by ambulance, and underwent x-ray imaging (See Figure 1, 2). Her medications included daily carvedilol, lisinopril, ranitidine, and simvastatin, as well as an eight-year use of weekly oral alendronate. The patient suffered a right diaphyseal (mid-shaft) fracture of the femur and subsequently underwent orthopedic repair with open reduction and internal fixation. The patient was diagnosed with fragility fracture secondary to a history of osteoporosis and fall from standing. Upon discharge, she was kept on alendronate. The patient completed inpatient rehabilitation and later brought the following images to her primary care physician.