Joan is a 77-year-old woman with heart failure with preserved ejection fraction, orthostatic hypotension, central adiposity, and chronic kidney disease stage 3B without albuminuria.

She has an atrophic left kidney and typical eGFR 30mL/min, which has been stable for six years.

Her current medications include aspirin, atorvastatin and glyceryl trinitrate patch. 

Joan presents with left groin and buttock pain and reduced mobility. She is referred for an MRI, which identifies sub-acute fractures of the left pubic rami and left inferior ala stress response.