A 72-Year-Old Woman Is Brought to the Emergency Department for Right

A 72-year-old woman is brought to the emergency department for right hip pain 1 hour after she fell while walking around in her house. She has been unable to stand or walk since the fall. She has hypertension and gout. Her sister died of multiple myeloma at the age of 55 years. Current medications include amlodipine and febuxostat. She does not smoke cigarettes. She drinks a glass of wine daily. Her temperature is 37.3°C (99.1°F) , pulse is 101/min, and blood pressure is 128/86 mm Hg. Examination shows right groin tenderness. Range of motion of the right hip is limited by pain. The remainder of the examination shows no abnormalities. A complete blood count and serum creatinine concentration are within the reference range. An x-ray of the hip shows a linear fracture of the right femoral neck. Which of the following changes in bone structure is most likely responsible for this patient's condition?

A) Lamellar bone structure resembling a mosaic
B) Osteoid matrix accumulation around trabeculae
C) Persistence of primary spongiosa in the medullary canal
D) Subperiosteal bone resorption and cystic degeneration
E) Trabecular thinning with fewer interconnections