26th January 2024

A 71-year-old female is on the elderly care ward following a right hip fracture.

A 71-year-old female is on the elderly care ward following a right hip fracture. She had previously sustained a fracture to her right wrist after tripping over the pavement a few months ago. She has a past medical history of rheumatoid arthritis, hypothyroidism, cataract and COPD. Her medications include hydroxychloroquine, levothyroxine and salbutamol inhaler, and Trimbow inhaler (beclometasone/formoterol/glycopyrronium bromide. Her BMI is 26 kg/m². She does not drink any alcohol, but has a 35-pack-year smoking history. 

Routine bloods are carried out during her inpatient stay:

Hb 113 g/L (130-180)

MCV 93.5fL (80-96)

WCC 8.0 x 10⁹/L (4.0-11.0)

CRP 18 mg/L (<10)

Sodium 134 (133–146 mmol/L)

Potassium 4.3 (3.5–5.3 mmol/L)

Creatinine 73 (45–84 μmol/ L)

EGFR >90 

LFTs normal 

ESR 3

Rheumatoid factor 5 (0-20 u/mL)

Serum adjusted calcium level 2.8 (2.2-2.6 mmol/L)

Serum phosphate level 0.8 (0.74 – 1.4 mmol/L)

Serum albumin 37 (35–50 g/L)

Vitamin D 30 : (> 500 nmol/L)

She is commenced on oral vitamin D supplementation

In terms of assessing her fracture risk, what is the next best step in management? 

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