Sleeping fracture is a very rare condition found among patients with hyperparathyroidism; to the best of our knowledge this is the first case. The patient was a 54 years old man that had pain and swelling in right femur at waking up after a diurnal sleep. The patient has experienced weakness and fatigue with a general pain and tenderness for 16 years. The patient had difficulty with walking during this long period.
Radiographic findings revealed subperiosteal bone resorption in fingers, pepper appearance in skull X-RAY, loozer zones in humerus and sever osteopenia in all bones. Laboratory findings presented that total serum calcium was normal, serum parathyroid hormone was mildly elevated, and alkaline phosphatase was highly elevated. The patient underwent total parathyroidectomy and then fixation of the femur. Hyperparathyroidism with sever bone disorders is still existing in Iran. In conclusion, it is reasonable that when the serum calcium is usually in normal range and the pathologic fracturs result from severe osteopenia, the attention should be paid to primary hyperparathyroidism with calcium normal range.