Young Man Develops Disuse Osteoporosis at 39 After Leg Fracture and Prolonged Immobilization

Disuse osteoporosis is commonly associated with aging or hormonal changes in postmenopausal women, but it can also develop in younger individuals due to prolonged immobilization. This case highlights a 39-year-old male who developed significant bone density loss in his lower leg and ankle following a severe tibial fracture that led to extensive bone defect and over a year of bed rest. Without regular mechanical stress on the bones, his skeletal structure weakened dramatically—leading to disuse-induced osteoporosis. With timely surgical intervention, targeted rehabilitation, and medical support, he regained near-normal mobility and showed marked improvement in bone health.

Patient Overview

Age & Gender: 39-year-old maleDiagnosis: Disuse osteoporosis secondary to long-term immobilization and tibial bone defectHospital: The First Affiliated Hospital of Harbin Medical UniversityDate of Treatment: April 2021Treatment Plan: Bone transport surgery, progressive physical therapy, calcium supplementation (Calcium Carbonate D3 tablets)Treatment Duration: 10-day hospitalization, followed by 3-month follow-up evaluationOutcome: Significant recovery in muscle strength, joint function, and bone integrity; patient resumed nearly normal walking ability

Initial Assessment: A Year of Immobility Takes Its Toll

The patient sustained a crushing injury to his lower leg one year prior, resulting in a comminuted tibial fracture with a large segmental bone defect. Multiple surgeries failed to fully resolve the issue, leaving him confined to bed without weight-bearing activity for over 12 months. During this time, he experienced progressive muscle atrophy and joint stiffness.

Upon clinical examination, his right calf appeared visibly thinner than the left, covered with multiple surgical scars. His ankle mobility was significantly restricted, indicating soft tissue contracture and neuromuscular deconditioning. Imaging studies—including X-ray and CT scans—revealed dramatic thinning of the cortical bone in the tibia, fibula, and foot bones. Additionally, scattered radiolucent areas within the trabecular bone suggested active bone resorption, classic signs of disuse osteoporosis.

These findings confirmed that prolonged absence of mechanical loading had triggered accelerated bone loss—a well-documented phenomenon where lack of use leads to reduced osteoblastic activity and increased osteoclastic resorption.

Comprehensive Treatment Approach

To address both the structural defect and its consequences, a multidisciplinary strategy was implemented. Preoperative evaluations included lower limb vascular Doppler ultrasound, complete blood count, inflammatory markers (ESR, CRP), liver and kidney function tests, and coagulation profile—all performed to rule out infection or systemic complications before surgery.

Surgical Intervention: Bone Transport Procedure

The patient underwent an Ilizarov-based bone transport surgery, a technique designed to gradually regenerate missing bone segments using external fixation. This method allows controlled distraction osteogenesis—where new bone forms as the gap is slowly closed over weeks to months.

Concurrent Management of Osteoporosis

Even during the initial phase of non-weight-bearing, anti-osteoporotic measures were initiated:

Daily intake of Calcium Carbonate D3 tablets to enhance mineral absorption
Nutritional counseling focusing on high-protein, calcium-rich foods such as dairy, leafy greens, fatty fish, and fortified products
In-bed exercises including isometric muscle contractions and passive range-of-motion movements assisted by caregivers
Active use of the unaffected (contralateral) leg for mobility to maintain overall circulation and prevent secondary complications like deep vein thrombosis

After 10 days of postoperative monitoring and stabilization, the patient was discharged with clear instructions for home care and scheduled for a follow-up visit in three months.

Recovery Milestones and Clinical Outcomes

By the four-month mark, imaging confirmed complete union of the bone defect. More importantly, functional improvements were evident:

Muscle volume and strength in the affected leg increased significantly
Knee and ankle joints regained full range of motion
One month after bone healing, the patient began partial weight-bearing with crutches—reporting no pain or discomfort, only mild residual swelling
Four months post-healing, disuse osteoporosis showed substantial reversal on repeat X-rays, with visible thickening of cortical layers and denser trabecular patterns

Ultimately, the patient achieved independent ambulation with minimal assistance and returned to most daily activities—marking a successful outcome after a challenging recovery journey.

Ongoing Care and Rehabilitation Guidelines

Given the extended nature of this condition, long-term commitment to recovery is essential. Key recommendations include:

Gradual Progression in Physical Activity

During the early stages of recovery, focus should remain on strengthening the healthy limb while safely engaging the injured side through non-weight-bearing exercises. As bone consolidation progresses, transition to partial then full weight-bearing must be gradual to avoid re-injury.

Consistent Nutritional Support

Continued supplementation with Calcium D3 remains critical throughout rehabilitation. Dietary sources of vitamin D (sunlight exposure, eggs, fortified cereals) and calcium (dairy, broccoli, almonds, sardines) should be emphasized to sustain bone remodeling.

Regular Monitoring

Patients are advised to undergo X-ray assessments every three months to monitor bone regeneration and alignment. Annual dual-energy X-ray absorptiometry (DEXA) scans help track bone mineral density changes and guide further interventions if needed.

Clinical Insights: Addressing the Root Cause First

Disuse osteoporosis falls under the category of secondary osteoporosis—meaning it arises as a consequence of another medical condition rather than primary aging or hormonal shifts. In cases like this, treating the underlying cause—in this instance, the bone defect—is paramount.

Only once structural stability is restored can effective osteoporosis management take place. Early initiation of preventive strategies—even during immobilization—can significantly reduce the severity of bone loss. Combining surgical correction with proactive rehabilitation and pharmacological support offers the best chance for full functional restoration.

This case underscores the importance of early interdisciplinary planning in trauma-related orthopedic conditions. It also serves as a reminder that even young, otherwise healthy individuals are vulnerable to rapid bone deterioration when normal biomechanical forces are absent for prolonged periods.