Category: Clinical Sciences/Health Conditions
Case Diagnosis: The patient initially presented to the hospital complaining of diffuse burning sensation in the lower extremities. The patient was found to have a calcium level of 5.7 on admission. Endocrinology was immediately consulted and recommended IV calcium gluconate to replenish calcium. During the patient’s hospital stay, the patient endorsed bilateral hip pain. As a result, x-rays of the pelvis were obtained which illustrated a subacute fracture of the right inferior pubic ramus. A subsequent MRI-hip/pelvis revealed bilateral incomplete insuffiency fractures of each femoral neck. These findings were consistent with a diagnosis of “Hungry Bone Syndrome”. Orthopedic consultation recommended bilateral closed reduction percutaneous pinning (CRPP). The patient was admitted to rehabilitation service to complete physical/occupational therapy and maintaining calcium levels between 7.5-8.0.
At 2 weeks post-operation, the patient continued to demonstrate fluctuating calcium levels. Endocrinology suggested this was consistent with acute postsurgical hypoparathyroidism. Of note, previous level of function consisted of ambulation with straight cane for half a block. On entry to the rehabilitation unit, the patient required minimal assistance for transfers and ambulation with rolling walker for 20 feet. Orthopedic team recommended partial weight bearing to right lower extremity and weight bearing as tolerated to left lower extremity. Upon discharge, the patient improved to contact guard for bed mobility and 100 feet x 2 with rolling walker. Additional advances in function will be described.
An uncommon occurrence, Hungry Bone Syndrome relates to significant hypocalcemia in association with hypomagnesemia and hypophosphatemia as a result of decreased parathyroid hormone. This syndrome arises status post parathyroidectomy and results in pathological bone fractures if left untreated.
Pathological fractures may arise in patients suffering from “Hungry Bone Syndrome” and lead to a reduced level of function, surgical intervention and physical rehabilitation.