Bone and Osteoporosis

Mrs. Patricia Holt, 72, retired teacher. Presents following a mechanical fall from standing height onto her right hip. She has been on prednisolone 10 mg daily for the past 3 years for rheumatoid arthritis and has not previously been prescribed bone protection. Plain radiograph confirms a right subcapital neck of femur fracture. Her bloods show a haemoglobin of 9.8 g/dL, corrected calcium of 2.95 mmol/L, and creatinine of 180 µmol/L. A serum protein electrophoresis is sent. She undergoes a right total hip arthroplasty but on the first post-operative day is found unresponsive with oxygen saturations of 78% on air.