24th July 2023

An 88-year-old lady is admitted to the acute medical unit with acute onset right hip pain overnight.

An 88-year-old lady is admitted to the acute medical unit with acute onset right hip pain overnight. X-ray pelvis showed a complete transverse fracture with a beaked appearance of the cortex. This was managed by the orthopaedics team with an intramedullary nail.

Post discharge, she is seen in the metabolic bone disease clinic. She informs the clinician; she has been taking alendronate for osteoporosis for 15 years due to being lost to follow up by her GP.

What is the most likely cause of her atypical fracture?

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