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Background: Primary hyperparathyroidism may mimic osteoporosis and lead to pathological fractures. Case report: We report a case of 35-year-old female who sustained left distal tibia-fibula fracture after a trivial fall, later diagnosed to have left inferior parathyroid adenoma. The fracture was managed conservatively and left inferior parathyroidectomy for the adenoma. At four years follow-up, there are no clinical or biochemical signs of recurrence. Conclusion: Pathological fracture in a case of parathyroid adenoma is extremely rare and require a multidisciplinary approach for optimal outcome. A combination of clinical, biological, radiological and biochemical markers with a high index of suspicion in an isolated bone fracture is required to diagnose parathyroid adenoma.