This patient has sustained a stress fracture in an unusual location near the lesser trochanter. She had a callus there, which you can detect on the DEXA scan as an abnormally bright area. This increased the bone density of the inter-trochanteric region, and therefore of the total hip, but the "real" value is seen in the femoral neck and trochanteric regions. She had multiple fractures and severe osteoporosis.
Usually I consider the total hip to be the most representative value, but in this case the femoral neck better reflects the underlying disease. The patient was treated with teriparatide and has had no further fractures.