Differentials
Multiple myeloma
SIGNS / SYMPTOMS
Bone pain and symptoms of anaemia and renal failure.
INVESTIGATIONS
Urine and serum electrophoresis reveals presence of monoclonal protein.
Osteomalacia
SIGNS / SYMPTOMS
This is difficult to differentiate clinically from osteoporosis.
INVESTIGATIONS
PTH levels elevated; bone biopsy standard for confirmation of poor mineralisation.
Chronic kidney disease-bone and mineral disorder
SIGNS / SYMPTOMS
This is difficult to differentiate clinically from osteoporosis. Patients may have history of renal failure, and may present with bone pain and diminished muscular strength.
INVESTIGATIONS
Serum creatinine and PTH elevated.
Primary hyperparathyroidism
SIGNS / SYMPTOMS
There may be signs of hypercalcaemia, including anorexia, nausea, constipation, and abdominal pain. However, primary hyperthyroidism is often asymptomatic.
INVESTIGATIONS
Serum PTH elevated.
Metastatic bone malignancy
SIGNS / SYMPTOMS
The patient may have history of cancer.
Symptoms of bone pain after minor injury may be the same as in cases of osteoporosis, but may also occur in atypical locations.
INVESTIGATIONS
Dual-energy x-ray absorptiometry may be normal.
CT may show tumour.
Bone scan shows multiple hot spots.
Definitive test is bone biopsy and appropriate investigations to determine primary.
Vertebral deformities
SIGNS / SYMPTOMS
This is difficult to differentiate clinically from osteoporosis.
Spinal deformities such as osteoarthritis and scoliosis may be mistaken for osteoporotic vertebral fractures.[3]
INVESTIGATIONS
X-ray and further imaging are required for diagnosis.
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