Hip Fracture Due to Osteomalacia Secondary to Celiac Disease

Abstract

Background: Hip fracture is uncommon among younger patients but can have devastating consequences. Therefore, hip fracture caused by minimal trauma requires examinations on calcium metabolism to identify the primary cause. Methods: We present a clinical case of an 18-year-old male patient who suffered a subcapital fracture of the left hip due to minimal trauma while playing soccer. The patient immediately underwent surgery, which is closed reduction and internal fixation with two cancellous screws installed. Subsequently, metabolic tests showed severe vitamin D deficiency (27.1 nmol/L - normal above 75 nmol/L) and high levels of IgA anti-transglutaminase antibodies (2502.40 U/mL). Digestive biopsy confirmed the diagnosis of celiac disease, and he was treated with a gluten-free diet and calcium and vitamin D supplements. Results: After two years of follow-up, the patient is pain-free, with full hip mobility. There were no complications (osteosynthesis failure, avascular necrosis or pseudarthrosis) and serum levels of vitamin D, and IgA anti-transglutaminase antibodies had normalized. Conclusion: In young patients presenting with low energy trauma fractures, vitamin D deficiency should be considered as a possible etiology, and the reason for such osteomalacia, such as celiac disease, should be identified.