case_images: PMC11058989_01
case_images: A 49-year-old woman presented consistent bone pain with limb weakness for more than 2 years. (A) The pelvic AP radiograph presented grossly normal hips in June 2020. (B) Magnetic resonance imaging revealed low-signal intensity bands in the bilateral femoral head. (C, D) Images presented blurred bilateral hips with insufficiency femoral neck fracture in June 2022 (indicated by white arrow). (E) Severe osteomalacia was found in the femoral head sample. (F, G) A well-circumscribed lesion of about 13x18-mm in size was observed in the T11 by PET/CT( white arrow in F) and MRI with long T1 and T2 signals (white arrow in G) in August 2022. (H) Radiographs obtained in September 2022 demonstrated the narrow space and coxa vara of the left hip, and proper prosthetic placement without loosening in the right hip. (I) Radiographs obtained in March 2023 showed proper bilateral prosthetic positions without signs of loosening.
case_images: fendo-15-1373794-g001.jpg
case_images: PMC11058989_01_fendo-15-1373794-g001.jpg
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case_images: She first sought treatment at our hospital because of bilateral hip pain in June 2020, with normal hip radiograph findings ( Figure 1A ), although low signal intensity were noted in the bilateral femoral heads on magnetic resonance imaging ( Figure 1B ). Plain pelvic radiograph obtained in June 2022 showed bilateral hip blur with insufficient femoral neck fractures ( Figure 1C ), and bilateral hip transverse computed tomography (CT) confirmed bilateral femoral neck fractures ( Figure 1D ). Severe osteomalacia of the acetabulum and femoral head was observed intraoperatively, with a variation in the shape of the cortical bone as the external force was applied, whereas a nearly normal trabecular appearance was observed despite the lack of rigidity ( Figure 1E ). Moreover, 18F-FDG PET/CT was conducted as a supplementary search, and an osteolytic bone lesion with increased radioactivity in the right side of the T11 vertebral body and adnexa was found, which proved to be a well-circumscribed lesion of approximately 13x18 mm in the T11 with long T1 and T2 signals and an SUVmax of 5.5. on MRI ( Figures 1F, G ). However, she continued to experience persistent pain and limited mobility of the left hip, with a narrow space and coxa vara deformity of the left hip was revealed on radiography ( Figure 1H ). By May 2023, the patient returned to normal gait with satisfactory hip movement function without recurrence of PMT-associated osteomalacia or loosening of the prosthesis ( Figure 1I ).