Saturday, August 8, 2009

Hip Pain

By Shawn Vuong

According to, osteoporosis is a condition where bones become weak and brittle due to low calcium levels. Osteomalacia on the other hand is a condition where the bones soften do to low Vitamin D. In children this condition is called rickets.

This week Dr. Holm give a very common medical story about the nice elderly lady who fell and broke a hip, due to these hiding conditions. But what does this have to do with us young people you may ask? Dr. Holm's story is more than just a description of a common clinical picture of osteoporosis or osteomalacia, it's about bone health. These days more and more people are sitting in front of the computer all day at the office, or maybe in the dorm room skipping class and playing WOW (World of Warcraft). We are not getting enough Vitamin D and we are not leading lives conducive to good bone health.

So some suggestions for those of us who do not want to break a hip include:

- 30 minutes a day of weight bearing exercise
- Drink more milk and get a little sun
- Take a multivitamin


By Richard P. Holm MD

Osteoporosis is a condition of thinning and porous bone, while osteomalacia is about soft protein-poor bone. To understand the difference, listen to this common and real story.

The eighty year-old woman arrives in the emergency room by ambulance with a new hip fracture. She would be writhing in pain, but if she moves it hurts even more, so she is lying perfectly still in pain.

After injecting pain reliever, the doctor notes the right leg is shortened, turned outward, and the X-Ray indicates a fracture of the hip. More specifically the break is in the neck between the ball and the body of the thighbone, also called the femur.

The doctor listens carefully to her story and discovers that she is a widow still living in her own home, still doing some gardening, still driving her friends around town to club meetings, still cooking and cleaning for herself. But all of that changed when she lost her balance on the back stoop, couldn’t find a rail to catch herself, and down she came striking hard on the cement sidewalk.

Her daughter-in-law says that it is a miracle she hadn’t tripped before what with the loose rugs scattered through the rooms, the electrical cords running everywhere, and the hand-knitted slippery foot warmers she wears after supper while shuffling around the darkened house.

The diagnosis of osteomalacia is suspected, as she describes generalized fatigue and aching over the last five years, and on exam she has a remarkable arching back and now this fractured hip. Later a very low Vitamin D level confirms the diagnosis, and the doctor suspects it’s been low the last half of her life, resulting from working inside the house most of the day, with little exposure to the sun. Vitamin D supplement becomes part of the patient’s treatment.

It is interesting to point out that there is no real clinical difference between osteoporosis and osteomalacia.

This was a story about home safety and prevention of falls, about bone building and bone maintenance, and how much more important vitamin D is than we used to think.

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