Is a certain degree of osteomalacia involved in femoral neck fractures of the elderly? Histological approach to the problem and practical applications.

A study was made in Geneva of 14 patients with femoral neck fractures (7 subcapital and 7 trochanteric) to determine whether a certain degree of osteomalacia might be involved (group I). No patients with risks factors for osteomalacia were used. For ethical reasons, double tetracycline labelling was not possible and osteomalacia criteria were based on osteoid tissue values determined in a histomorphometric study directly on cancellous bone samples of the femoral head. A comparison was made with femoral head bone tissue taken from 12 patients with hip osteoarthritis at a distance from the remodelled territory (group II) and with iliac crest bone tissue taken from 6 patients with clinically and biochemically determined osteomalacia (group III). The patients were part of a larger group of subjects used for a biochemical blood study in which levels of albumin, calcium and 25 OHD3 as an index of vitamin D content were determined. Based on the data of the literature and the results obtained for group II, slight signs of osteomalacia were diagnosed for only one case (group I), although 25 OHD3 deficiency was found in more than a third of the subjects in that group as well as in some subjects of group II and in some of the aged controls. Skeletal aging must be considered not only in terms of unavoidable physiological factors but also within the context of living conditions. Hence the necessity of controlling calcium and vitamin D intake in the elderly, and of a histological examination for signs of osteomalacia in surgical specimens from patients with femoral neck fractures.