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The patient began maintenance hemodialysis at 22\u00a0years of age. The patient then underwent surgical parathyroidectomy (PTX) for secondary hyperparathyroidism at 43\u00a0years of age, which resulted in decreased levels of parathyroid hormone (PTH). Thereafter, this patient\u2019s serum 1,25(OH)<jats:sub>2<\/jats:sub>D<jats:sub>3<\/jats:sub>level was very low because active vitamin D<jats:sub>3<\/jats:sub>derivative was not administered. At 54\u00a0years of age, a transverse fracture of the femoral shaft equivalent to AFF occurred. Surgery with open reduction and internal fixation using intramedullary nailing was performed; however, the delay of postoperative healing continued for 16\u00a0months. A left iliac crest bone biopsy was performed and showed osteoid-like lesion and an increase of woven bone. The patient received active vitamin D<jats:sub>3<\/jats:sub>derivative and recombinant human PTH (1\u201334) derivative. Twenty-nine months after the first surgery, a reoperation was performed. Simultaneously, a right iliac crest bone biopsy was performed. Bone morphometrical improvement was confirmed. Six months after resurgery, the bone union was achieved.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>Severe vitamin D<jats:sub>3<\/jats:sub>deficiency and decreased levels of PTH may induce a higher osteoid state and an increase of woven bone, which may then attribute to the development of diaphyseal femoral fracture and impairment of postoperative bone healing. It is hypothesized that treatment with active vitamin D<jats:sub>3<\/jats:sub>and teriparatide acetate may be a therapeutic option via the accelerated formation of lamellar bone for refractory diaphyseal femoral fracture of long-term dialysis.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s11657-020-00849-7","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T16:10:35Z","timestamp":1605197435000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Diaphyseal femoral fracture due to severe vitamin D3 deficiency and low parathyroid hormone levels on long-term hemodialysis: a case report"],"prefix":"10.1007","volume":"15","author":[{"given":"Masaki","family":"Hatano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izuru","family":"Kitajima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuya","family":"Isawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Hirota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Suwabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junichi","family":"Hoshino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Sawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seizo","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihumi","family":"Ubara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"issue":"4","key":"849_CR1","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1053\/j.ajkd.2015.06.023","volume":"67","author":"SM Sprague","year":"2016","unstructured":"Sprague SM, Bellorin-Font E, Jorgetti V, Carvalho AB, Malluche HH, Ferreira A, D\u2019Haese PC, Dr\u00fceke TB, Du H, Manley T, Rojas E, Moe SM (2016) Diagnostic accuracy of bone turnover markers and bone histology in patients with CKD treated by dialysis. 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