Frequency of Osteomalacia in Elderly Patients With Hip Fracture

Background: Osteomalacia represents a risk factor for hip fracture (HF), which is one of the most common and costly injuries in elderly. Objectives: This study was performed to determine the frequency of histopathologic and laboratory osteomalacia in elderly patients with HF. Patients and Methods: Totally, 87 patients with HF, admitted to Imam Khomeini hospital, Tehran, Iran, from 2005 to 2006, were studied. Laboratory investigations included serum calcium, phosphorus, alkaline phosphatase (ALP), albumin and 25-hydroxy vitamin D₃ [25 (OH) D₃]. Open biopsy from ipsilateral iliac crest was performed during the same surgery. Results: The average age was 78.06 ± 8.4 years. Bone biopsy showed osteomalacia in eight patients (9.2%), hypocalcaemia in 42.5%, hypophosphatemia in 17.2%, hypoalbuminemia in 66.6% and 25 (OH) D₃ deficiencies in 66.6%. Concomitant hypophosphatemia and hypovitaminosis [25 (OH) D₃ < 10 ng/mL] was detected in 13 patients (14.6%). An increased level of serum ALP was found in 52.8%. Five (38.5%) patients had only laboratory osteomalacia, when histopathological findings were negative. Conclusions: Elderly patients with femoral neck or intertrochanteric fractures may have osteomalacia, as a treatable cause for osteopenia, and laboratory tests may not be precise criteria for diagnosis in HF patients.