title: Bilateral non-traumatic hip fractures in a heavy smoker COPD patient on inhaled steroids.
abstract: BACKGROUND
  Bilateral proximal femoral fractures without trauma are very rare conditions. They have been reported in connection with osteoporosis, renal osteodystrophy, parathyroid disease, tumors, epileptic seizures, electroconvulsive therapy, and postirradiation.
  
  
  METHODS
  We present a case of a 75-year-old man with bilateral hip fractures. No trauma, neurological, endocrinological disorder, or malignancy was reported in his history. He had a background of chronic obstructive pulmonary disease (COPD) and had been taking inhaled steroids (budesonide) 800 µg per day for 10 years. He was a heavy smoker with a smoking history of 120 packs/year. His complaints had initially started as pain on the left hip and groin and then had progressed to the right in 10 days. Plain x-rays of the pelvis showed left femoral neck and right subtrochanteric femoral fractures. Fixation with proximal femoral nail of the right hip and partial arthroplasty of the left hip was performed on the following day after his admission. Pathological examination revealed osteoporosis in bone samples from both hips.
  
  
  RESULTS
  COPD and osteoporosis have some common risk factors. Smoking, decreased exercise capacity, inhaled, or oral steroid therapy may increase osteoporosis and risk of bone fractures by decreasing bone mineral density. Non-traumatic femoral fractures may occur in patients on long-term inhaled steroid treatment for chronic airway diseases such as asthma and COPD.
  
  
  CONCLUSIONS
  History of COPD with corticosteroid use may be used as a diagnostic tool to identify patients having osteoporosis. Preventive measures can be performed by monitoring high-risk patients with bone mineral densitometry, WHO fracture risk assessment tool (FRAX tool), serum calcium, and vitamin D levels to prevent bone fractures. Treating those patients with the lowest effective dose of corticosteroids should be targeted.
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Maltepe University, Maltepe, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Sanel
authors.affiliation: Department of Internal Medicine, Medical Faculty, Maltepe University, Maltepe, Turkey.
authors.forename: Gulbuz
authors.initials: G
authors.lastname: Sezgin
authors.affiliation: Department of Pulmonary Diseases, Medical Faculty, Maltepe University, Maltepe, 34758, Istanbul, Turkey. nessariman@yahoo.com.
authors.forename: Nesrin
authors.initials: N
authors.lastname: Sarıman
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Maltepe University, Maltepe, Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Ugutmen
authors.affiliation: Department of Orthopaedics and Traumatology, Medical Faculty, Maltepe University, Maltepe, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Solakoglu
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D015519:Bone Density / Q000187:drug effects; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects*; D005265:Femoral Neck Fractures / Q000139:chemically induced; D006620:Hip Fractures / Q000209:etiology*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
chemical_list: D000305:Adrenal Cortex Hormones; D019819:Budesonide
keywords: Bilateral; COPD; Hip fracture; Inhaled corticosteroids; Osteoporosis