Chief Complaint: 75-year-old woman who fell on her left hip.

History: Judy Smith, a 75-year-old white female, was brought to the emergency room by her son after falling in her kitchen. She has had no major health problems in the past, but she has led an inactive lifestyle and has smoked cigarettes for over 40 years. Judy stated that she spilled water on the kitchen floor while making breakfast and forgot it was there, only minutes later to walk to the refrigerator and slip on the spilled water. When Judy fell, she landed on the left side of her body. She was given an injection to help relieve her pain and taken to the radiology department for an X-ray of her left leg and hip.

Physical Examination: The patient was alert but in pain, she was able to identify the time and day, and was responding appropriately to questions. Heart and lung sounds were normal, and abdominal sounds were reduced. There were no signs of trauma to the head, neck, torso, arms, or right leg. The left thigh and hip were extremely tender and were immobilized by a leg splint.

Radiology Report: The X-ray of the left hip revealed a complete, transverse fracture of the left proximal femur. No other fractures were noted in the left leg. There were also long-term osteoporotic changes in the femur and tibia.

1) Explain what is meant by a “complete, transverse fracture of the left proximal femur”.

2) Judy’s femur and tibia showed signs of osteoporosis. How do you think an osteoporotic bone would differ on an x-ray compared to a healthy bone? In one paragraph, explain the role of bone in calcium homeostasis.

3) As Judy’s bone heals and repairs over time, it will undergo many changes. Describe, in detail, the steps a bone must go through to repair.

4) Why is Judy a candidate for osteoporosis?

5) What bones are most commonly the site of osteoporosis? Relate this to why we often “shrink” as we age.