Bilateral Hip Fractures in an Elderly Man

Monique Bethel, MD; Laura D. Carbone, MD, MS


June 14, 2016

Physical Examination and Workup

Upon physical examination, the patient is pleasant and conversant. He is afebrile, his blood pressure is 141/75 mm Hg, his pulse 65 beats/min and body mass index (BMI) is 29.5. He is ambulating with a cane. He has crepitus in both knees and a well-healed scar over the area of his left hip, consistent with his recent hip replacement.

The following laboratory tests were obtained to assess secondary causes of osteoporosis:

  • Free testosterone level: 3.1 ng/mL (reference range, 1.9-8.4 ng/mL)

  • 25-OH vitamin D level: 33 ng/mL (reference range, 30-50 ng/mL)

  • Creatinine level: 1.2 mg/dL (reference range, 0.6-1.2 mg/dL)

  • Calcium level: 9.2 mg/dL (reference range, 8.5-10.2 mg/dL)

  • Ionized Ca2+ level: 4.2 mg/dL (reference range, 4.5-5.3 mg/dL)

  • Magnesium level: 2.1 mg/dL (reference range, 1.3-2.7 mg/dL)

  • Albumin level: 3.5 g/dL (reference range, 3.5-5 g/dL)

  • Thyroid-stimulating hormone level: 1.88 mIU/mL (reference range, 0.4-4.2 mIU/mL)

  • Alkaline phosphatase level: 65 IU/L (reference range, 44-147 IU/L)

  • Serum protein electrophoresis level: No monoclonal spike


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