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Old 06-26-2012
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Rheumatology/Orthopedics back pain with tenderness . most likely diagnosis ?

A 65-year-old woman comes to the emergency department complaining of back pain. The pain started two days prior to her visit and has been progressively worsening. She denies any fever or history of cancer. The physical examination is
significant for point tenderness over the lower spine. The neurologic examination is negative. Serum chemistries obtained
in the emergency department are as follows: calcium 8.7 mg/dL, phosphorus 3.2 mg/dL, and alkaline phosphatase 73 U/L.

What is the most likely diagnosis?

(A) Osteoporosis
(B) Osteomalacia
(C) Paget's disease
(D) Multiple myeloma
(E) Metastatic bone disease

btw, what are causes of vertebral tenderness? as far i know, these are osteomyelitis and compression fracture. is there any other ?
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Old 06-26-2012
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I think its A, lab results are normal which is consistent with osteoporosis, also her age is clearly a risk factor seeing she didnt receive any hormonal treatment after menopause (assuming it ocurred around age 51) so she missed the 10 year window.
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Old 06-26-2012
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in this question.. would you consider an 8.7 calcium as normal or low?
also what about the alk phos level? withing normal range.. but higher normal.


in pagets disease there is isolated increase in alk phos.

and in osteroporosis the lab values for calcium etc are all within normal range.

so im a little confused between these two.

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Old 06-26-2012
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Quote:
Originally Posted by mbbs2010 View Post
in this question.. would you consider an 8.7 calcium as normal or low?
also what about the alk phos level? withing normal range.. but higher normal.


in pagets disease there is isolated increase in alk phos.

and in osteroporosis the lab values for calcium etc are all within normal range.

so im a little confused between these two.

Yeah i also noticed that

If I remember correctly, in the USMLe the lower limit for Ca++ is given as 8.5, and she has 8.7 so i think i would consider it normal, but i cannot rule out Paget disease 100% for sure
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Old 06-28-2012
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It seems like A - osteoporosis... The age fits; normal calcium/phosphorus/ALP (normal range is up to 70, so 73 is generally normal)... Acute onset lower back pain and tenderness fits compression fracture. Compression fracture is characteristic for osteoporosis and NOT characteristic for Paget disease; in Paget disease there is long bone pain, which she doesn't have, bone deformities which she doesn't have, and so on... Of course we can't 100% exclude Paget disease, but osteoporosis seems definitely MORE likely.... What would you say?
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Old 06-29-2012
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(A) Osteoporosis
Postmenopausal with normal labs. (alkaline phosphatase normal range 35 to 104)
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Old 07-08-2012
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Quote:
Originally Posted by tyagee View Post
A 65-year-old woman comes to the emergency department complaining of back pain. The pain started two days prior to her visit and has been progressively worsening. She denies any fever or history of cancer. The physical examination is
significant for point tenderness over the lower spine. The neurologic examination is negative. Serum chemistries obtained
in the emergency department are as follows: calcium 8.7 mg/dL, phosphorus 3.2 mg/dL, and alkaline phosphatase 73 U/L.

What is the most likely diagnosis?

(A) Osteoporosis
(B) Osteomalacia
(C) Paget's disease
(D) Multiple myeloma
(E) Metastatic bone disease

btw, what are causes of vertebral tenderness? as far i know, these are osteomyelitis and compression fracture. is there any other ?
hi .. causes of vertebral tenderness - 1. osteoporosis leading to compression fracture , 2. metastatic bone cancer 3. potts spine 4. mutilple myeloma 5.IVDP 6.trauma7. after spinal anesthesia ... correct me if i have made mistakes
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