Frequency of osteomalacia in elderly patients with hip fractures.

OBJECTIVE To determine the frequency of Osteomalacia and biochemical abnormalities in patients with hip fracture who presented at our Institution. METHODS All patients with operatively treated hip fractures (Aga Khan University Hospital, Karachi from June 1996 to June 2001) were included. The total number of patients was 168 with 59 males and 109 females. Eighty nine patients presented with intracapsular hip fracture and 79 had Intertrochanteric fractures. All fracture types and grade of osteoporosis were determined. Laboratory investigations included Serum Calcium, Phosphorus and Alkaline phosphatase. During surgery, small amount of curetted cancellous bone from fracture site was sent for histopathology. An elaborate questionnaire was completed for every patient. RESULTS The average age of patients with hip fractures was 61 years with 94.5% of the female patients being postmenopausal. Most of the patients (94%) had low velocity trauma. Singh's index for most of the fractures was grade II (n=48) and grade III (n=65). About one fourth of the patients showed abnormal values of serum Calcium, Phosphorus and Alkaline Phosphatase. Bone biopsy showed osteomalacia to be present in 13 patients (7.7 %). Among these 13 patients, 6 had abnormal values of Serum Calcium, Phosphorus and Alkaline phosphatase. Out of these 13 patients, 4 were male and eight out of nine females were postmenopausal. CONCLUSION Frequency of osteomalacia in cases of hip fractures was found with no association with known risk factors. Bone histopathology was the gold standard of diagnosis and biochemical markers like serum calcium, phosphorus and alkaline phosphates were not very helpful.