This patient presents after minor trauma. She provides a history of total thyroidectomy many years ago. On physical exam, there was a palpable left neck mass. Lab findings show an increase in serum calcium and parathyroid hormone (PTH).

The diffuse decrease in bone density, multiple bone fractures which are out of proportion to the severity of the trauma, the characteristic Looser zone fracture and the right mandible osteolytic bony lesion (most likely a brown tumor), are highly suggestive of osteomalacia.

With correlation of the clinical setting and radiology, this lesion most likely parathyroid adenoma with a secondary brown tumor.

Surgery was performed, and pathology confirmed parathyroid adenoma.