Question

An 84-year-old G2P2 widow is seen in the Emergency Department because of a pain in her right arm. Her daughter, with whom she lives, states that her mother is always falling down and is becoming forgetful. She has a history of breast cancer treated by mastectomy 15 years ago and took tamoxifen for five years. The patient is on zolpidem (Ambien) 5 mg for sleep. She has been unable to afford the bisphosphonates needed for bone loss. Examination reveals a cachectic white woman, 5 feet 2 inches tall, weighing 94 pounds. She has tenderness in her right forearm with swelling. She is also noted to have old and new bruises on her chest and arms. An x-ray of the right arm reveals a spiral fracture. Which of the following is the most likely cause of the bone fracture?

A. Osteoporosis
B. Elder abuse
C. Bone metastasis from occult breast cancer
D. Malnutrition
E. Falls due to unsteadiness

Answer 1

The 84-year-old widow's forearm spiral fracture is most likely due to osteoporosis, given her risk factors including age, cachexia, untreated bone loss, and medication use that increases risk of falls.

Step-by-step explanation:

The most likely cause of the bone fracture in the 84-year-old G2P2 widow is osteoporosis. Osteoporosis is responsible for millions of fractures annually, especially among the elderly. It leads to a reduction in bone density and weakening of the bones, which may result in fractures from minimal or no trauma. In the context of the patient, factors such as insufficient treatment for bone loss (inability to afford bisphosphonates), cachexia (being underweight), and taking zolpidem (which may increase fall risk) likely contribute to the increased risk of an osteoporotic fracture.

Osteoporotic fractures are quite common in the long bones, such as the femur, and in this case, the right forearm. Histologically, osteoporosis is characterized by thinning of compact bone and reduction in the number and size of trabeculae in cancellous bone. Falls, malnutrition, and previous cancer treatment may contribute to the patient's condition; however, the pattern of injury and the clinical context suggest that osteoporosis is the primary cause for the fracture.