30th April 2024

A 72-year-old lady is brought to the emergency department after a fall at home

A 72-year-old lady is brought to the emergency department after a fall at home. She has a history of Parkinson’s disease and is taking Madopar. On examination, there is tenderness in the lower lumbar spine area. Otherwise, the systemic examination is unremarkable. Lumbar spine X-ray shows compression fractures at L3 and L4 lumbar spine. Blood results are as listed below:

Haemoglobin: 122 g/L (115-165)

White cell count: 10.6 x 10⁹/L (4.0–11.0)

Platelet count: 360 x 10⁹/L (150-400)

Serum urea: 6.5 mmol/L (2.5-7.0)

Serum creatinine: 108 μmol/L (60–110)

Serum corrected calcium: 2.5 mmol/L (2.20-2.60)

Serum phosphate: 1.20 mmol/L (0.80-1.45)

Serum alkaline phosphatase: 126 U/L (45-105)

Serum 25-OH-cholecalciferol: 64 nmol/L (>50)

What is the most likely cause of the compression fracture?

Select the SINGLE most appropriate option from the list below. Select ONE option only.