How does the parathyroid hormone assay relate to the differential diagnosis of the patient’s problem?

A thin, 60-year-old woman experienced sudden pain in her right hip while walking and fell to the ground. On admission to the emergency room, her only abnormality on physical examination was pain with motion of the right hip and an internally rotated and shortened right leg. Studies Results Routine laboratory values Within normal limits (WNL) X-ray of the right hip, p. 1006 Fracture of the neck of the hip. Significant bone thinning noted.
Diagnostic Analysis

The patient had a hip fracture, based on her clinical findings and X-rays. Her hip did not fracture because of the fall, but rather she fell because of her hip fracture. Her bones were very weak. In light of her thin body habitus and postmenopausal state, she probably had osteoporosis. The patient underwent an open reduction and fixation of the hip. She recovered well and later underwent an evaluation for her bone thinning.

Studies Results Bone densitometry, p. 1002 Bone density is <2.5 SDs below normal (normal: <1.0 SD below normal) Parathyroid hormone assay, p. 380 22 pg/mL (normal: 10-65 pg/mL) Bone turnover markers, p. 915 Elevated Diagnostic Analysis The patient had osteoporosis. She had no evidence of hyperparathyroidism, renal failure, or other problems. She was started on alendronate (Fosamax). She had no further bone fractures. Her bone turnover markers returned to normal, indicating reduced bone resorption. 2. Why was renal failure a consideration in this case situation?

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