Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism. However, little information is available regarding early skeletal manifestations of primary hyperparathyroidism.
A 30-year-old Japanese male presented with pain in his left wrist, and was diagnosed with a distal radius fracture. During surgery, we noticed decreased bone strength of the fracture site. Further investigation found osteoporosis and primary hyperparathyroidism owing to a solitary parathyroid adenoma, which was resected without significant complications. History revealed that the patient suffered a metacarpal bone fracture of his right fifth bone 6 months earlier. Although serial x-rays at that time had shown rapidly developed cortical bone erosion around the fractured finger, the possibility of primary hyperparathyroidism was overlooked because of poor awareness of the condition, leading to a 6-month delay in the diagnosis of primary hyperparathyroidism.
Clinicians should be aware that finger fractures may be an early skeletal manifestation of primary hyperparathyroidism that can help achieve a prompt diagnosis of the condition, especially when they occur in young adults in the absence of major trauma.
From the Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma (AO, MT, TS, HO); Department of Internal Medicine, Jyoban Hospital of Tokiwakai Group, Iwaki (TT); Department of Orthopaedic Surgery, Iwase General Hospital, Sukagawa (EY); Department of Orthopaedic Surgery (SS); Department of Research, Minamisoma Municipal General Hospital, Minamisoma, Fukushima (CL); Department of Hematology and Reumatology, Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan (KT); Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo (TA); Department of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma (MT); Research Institute of Innovative Medicine, Jyoban Hospital, Iwaki, Fukushima (SK); and Medical Governance Research Institute, Tokyo (MK), Japan.
Correspondence: Akihiko Ozaki, Department of Surgery, Minamisoma Municipal General Hospital, 2–54–6 Takamicho, Haramachi, Minamisoma, Fukushima 975–0033, Japan (e-mail: email@example.com).
Abbreviations: BMD = Bone mineral density, DXA = Dual-energy x-ray absorptiometry, PHPT = primary hyperparathyroidism.
Author contributions: AO, EY, SS, TS, MT, MT, and HO treated the patient. AO wrote the manuscript. All authors conceptualized and designed the study, and revised the article.
Institutional review board statement: Ethical approval for this study was granted by the Minamisoma Municipal General Hospital Institutional Review Board.
The authors report no conflicts of interest.
Informed consent statement: The study participant provided informed written consent before the submission of this article.
This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
Received February 19, 2016
Received in revised form April 16, 2016
Accepted April 21, 2016