cholecalciferol and Femoral-Neck-Fractures

The incidence of insufficiency fracture (IF) at femoral neck is low, accounting for about 5% of all insufficiency fractures, and IF at bilateral femoral neck is less common with more occurrence in athlete or serviceman. With the aging of populations, more cases of bilateral femoral neck IF have occurred recently, while the standard clinical treatment still remains lacking due to the complexity of these patients.. A 55-year-old male patient complained pain in his bilateral hip, with no history of trauma, glucocorticoid hormone consumption or radiotherapy, and imaging examination revealed fracture nonunion and shortening in his left femoral neck, and double fracture line on the right femoral neck. The patient received a cementless THA for the left femoral neck fracture and conservative treatment for the right side, followed by Elcatonin injection and oral administration of Carbonate D3 Granules. After 4 months of fellow-up, the patient presented improved functional scorings in bilateral hip joints, with no signs of prothesis infection or loosening.. We present a rare case of bilateral femoral neck IF in a middle-aged male and the treatment is successful. The timely CT and MRI examinations of bilateral hip joints for patients was necessary for orthopedists to select proper therapeutic regimen. In addition, the choice for therapeutic regimen of bilateral femoral IF should not only be based on the professional judgement of orthopedists, but also on the wishes of patients.

Topics: Adolescent; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Bone Screws; Calcitonin; Calcium-Regulating Hormones and Agents; Cholecalciferol; Conservative Treatment; Female; Femoral Neck Fractures; Femur Neck; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Stress; Fractures, Ununited; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Active vitamin D3 has been most widely used in Japan for the treatment of osteoporosis. Although it mildly increases bone mineral density, it has little consistent effect on bone metabolic markers, and clinical evidence for its efficacy as a fracture-preventing drug is rather weak. Recent reports suggest that (active) vitamin D3 may prevent fracture incidence not only by promoting intestinal calcium absorption but also by improving neuromuscular function to reduce the number of falls.

Topics: Bone Density; Bone Density Conservation Agents; Cholecalciferol; Clinical Trials as Topic; Evidence-Based Medicine; Femoral Neck Fractures; Humans; Meta-Analysis as Topic; Osteoporosis; Quality of Life; Spinal Fractures

Topics: Bone Density; Bone Density Conservation Agents; Calcium; Cholecalciferol; Diphosphonates; Evidence-Based Medicine; Femoral Neck Fractures; Humans; Meta-Analysis as Topic; Osteoporosis; Practice Guidelines as Topic; Raloxifene Hydrochloride; Randomized Controlled Trials as Topic; Selective Estrogen Receptor Modulators; Spinal Fractures

Recently, vitamin D metabolites have been internationally recognized to be effective for osteoporosis. The beneficial trend of the drugs for osteoporosis has been more in the prevention of fracture than in the increase of bone mineral density, and more in the prevention of fractures of four extremities compared to spinal fractures. The reason to reduce the fracture frequency of four extremities is due to increase the muscle power, the decrease of body sway and the reduction of falls by the action of the vitamin D. In the study of Japanese, it was declared that administration of active vitamin D significantly reduced the frequency of femoral neck fracture.

Topics: Accidental Falls; Aged; Aged, 80 and over; Cholecalciferol; Clinical Trials as Topic; Female; Femoral Neck Fractures; Humans; Middle Aged; Muscle Tonus; Muscle, Skeletal; Osteoporosis, Postmenopausal; Randomized Controlled Trials as Topic

Recent studies suggest that variations of the vitamin D receptor (VDR) gene are related to bone mineral density (BMD). In this study, we examined the effect of vitamin D3 supplementation on BMD at the femoral neck in relation to VDR genotype. We analyzed 81 women, age 70 years and over, who participated in a placebo-controlled clinical trial on the effect of vitamin D3 supplementation (400 IU daily for at least 2 years) on BMD and fracture incidence. VDR genotype was based on the presence (b) or absence (B) of the BsmI restriction site. Mean BMD of the right and left femoral neck was measured at baseline and after 1 and 2 years. Dietary calcium, body mass index, and years since menopause were assessed at baseline while biochemical markers were measured at baseline and after 1 year. There was no difference among the BB, Bb, and bb genotype for baseline measurements of BMD at the femoral neck (mean and SD, g/cm2: 0.70 (0.10), 0.71 (0.12), and 0.69 (0.10), respectively), nor for any of the biochemical indices. The mean increase of BMD in the vitamin D group relative to the placebo group, expressed as percentage of baseline BMD, was significantly higher (p = 0.03) in the BB (delta BMD: 4.4%, p = 0.04) and Bb genotype (delta BMD: 4.2%, p = 0.007) compared with the bb genotype (delta BMD: -0.3%, p = 0.61). No significant changes were found for any of the other measured parameters. The VDR genotype-dependent effect of vitamin D supplementation in these elderly subjects suggest a functional involvement of VDR gene variants in determining BMD.

Topics: Absorptiometry, Photon; Aged; Aged, 80 and over; Biomarkers; Body Mass Index; Bone Density; Calcium, Dietary; Cholecalciferol; Female; Femoral Neck Fractures; Femur Neck; Genotype; Humans; Longitudinal Studies; Osteoporosis, Postmenopausal; Receptors, Calcitriol

Bilateral femoral neck insufficiency fracture due to osteomalacia in pregnancy is an extremely rare condition. In this article, we report a 22-year-old female case with bilateral femoral neck fractures in whom the diagnosis was delayed due to the avoidance of ionising radiation and managing hip complaints by conservatively in pregnancy. She was treated surgically with internal fixation using cannulated screws and received medical treatment for vitamin D deficiency.

Topics: Adult; Bone Density Conservation Agents; Calcium Compounds; Cholecalciferol; Delayed Diagnosis; Female; Femoral Neck Fractures; Femur Neck; Fracture Fixation, Internal; Fractures, Stress; Humans; Magnetic Resonance Imaging; Osteomalacia; Pregnancy; Pregnancy Complications; Treatment Outcome; Vitamin D Deficiency

A 28-year-old woman was referred to hospital with a spontaneous femoral neck fracture. Dual energy X-ray absorptiometry showed severe osteoporosis without apparent cause or risk factors. The basic endocrinologic evaluation revealed hypercortisolism, and the diagnosis of Cushing's disease could be made following biochemical test and magnetic resonance imaging. A transsphenoidal resection of the pituitary gland tumor was performed and led to a cure of the disease. The patient received calcium and vitamin D substitution as well as biphosphonates.. Glucocorticoid-induced osteoporosis is the most frequent cause of secondary osteoporosis. Only few cases with occult endogenous Cushing's syndrome and osteoporosis as the main manifestation of the disease have been reported. Nevertheless, hypercortisolism should be excluded whenever osteoporosis without apparent cause is diagnosed.

Topics: ACTH-Secreting Pituitary Adenoma; Adult; Bone Density Conservation Agents; Calcium; Cholecalciferol; Combined Modality Therapy; Cushing Syndrome; Diagnosis, Differential; Female; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Hypophysectomy; Magnetic Resonance Imaging; Osteoporosis; Pituitary ACTH Hypersecretion; Pituitary Function Tests; Pituitary Neoplasms

Topics: Calcium; Calcium, Dietary; Cholecalciferol; Drug Combinations; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Osteoporosis

Topics: Aged; Aged, 80 and over; Bone Density; Calcium Phosphates; Cholecalciferol; Drug Therapy, Combination; Female; Femoral Neck Fractures; Follow-Up Studies; Hip Fractures; Humans; Lumbar Vertebrae; Risk Factors

Topics: Aged; Aged, 80 and over; Calcium; Cholecalciferol; Female; Femoral Neck Fractures; Humans

Two patients with moderate renal failure sustained spontaneous bilateral hip fractures during treatment with fluoride, calcium, and vitamin D for osteoporosis. They had been taking sodium fluoride (40-60 mg/day) for 11 and 21 months, respectively. Histological examination of a specimen of the bone showed severe fluorosis in the first case, and quantitative analysis of bone showed osteomalacia and skeletal fluorosis in the other case. These abnormalities were considered to be the consequence of excessive retention of fluoride due to renal insufficiency. As bilateral femoral neck fractures are very rare these data suggest a causal link between fractures and fluoride in patients with renal failure. Thus fluoride should be given at a lower dosage, if at all, to patients with even mild renal failure.

Topics: Aged; Bone and Bones; Calcium; Cholecalciferol; Drug Therapy, Combination; Female; Femoral Neck Fractures; Fractures, Spontaneous; Humans; Kidney Failure, Chronic; Osteomalacia; Osteoporosis; Sodium Fluoride

Topics: Aged; Cholecalciferol; Femoral Neck Fractures; Humans; Osteomalacia; Ozone; Ultraviolet Rays; Vitamin D Deficiency