Makindo Medical Notes

🦴 Bone Pain is a common but non-specific symptom with a wide differential diagnosis. It can arise from local pathology (fracture, infection, tumour), systemic disorders (osteoporosis, vitamin D deficiency, autoimmune disease), or referred pain. Understanding the underlying cause is crucial — ranging from benign to life-threatening conditions.

📊 Categories of Causes

• ⚙️ Mechanical/degenerative: Osteoarthritis, fractures.
• 🧬 Metabolic: Osteoporosis, osteomalacia, Paget’s disease.
• 🦠 Infective: Osteomyelitis.
• 🎯 Malignant: Bone metastases, multiple myeloma.
• 🔥 Inflammatory/autoimmune: Rheumatoid arthritis.
• 🧠 Central sensitisation: Fibromyalgia.

🩺 Clinical Toolkit: Causes, Tests, Management

🔬 Investigations in Bone Pain

• 📖 Basic Tests (first-line):
  • FBC → anaemia (myeloma, chronic disease), WCC (infection).
  • U&E, calcium, phosphate, ALP → metabolic and malignant clues.
  • CRP/ESR → infection, inflammatory disease, myeloma.
• 🩻 Imaging:
  • X-ray → first-line for fracture, lytic/sclerotic lesions.
  • DEXA → osteoporosis screening.
  • MRI → marrow infiltration, osteomyelitis, stress fractures.
  • Bone scan/PET → metastases, multifocal disease.
• 🧪 Specialist Tests:
  • Serum/urine electrophoresis → myeloma (M-protein, Bence Jones protein).
  • Autoantibodies → RF, anti-CCP (RA); ANA (SLE).
  • Bone biopsy → suspected malignancy, osteomyelitis.
  • 25(OH) vitamin D → osteomalacia.
• ❤️ Systemic Assessment: Since bone pain can be a “red flag” for systemic disease, always consider malignancy screen (CXR, PSA, breast exam, etc.) when appropriate.

⚠️ Red Flags in Bone Pain

• Night pain not relieved by rest.
• Weight loss, fever, or systemic symptoms.
• Pathological fractures.
• Focal bone tenderness with swelling.
• History of malignancy.

🧑‍⚕️ Case Examples

Case 1: 👩 A 68-year-old woman presents with hip pain after a minor fall. X-ray shows a femoral neck fracture and DEXA scan confirms osteoporosis (T-score –3.0). ✅ Managed with surgical fixation, bisphosphonate therapy, calcium/vit D supplementation, and fall-prevention strategies.

Case 2: 👨 A 55-year-old man with weight loss and back pain has lytic lesions on X-ray. Serum electrophoresis reveals an IgG paraprotein. Diagnosis: Multiple myeloma. ✅ Management: chemotherapy, bisphosphonates, and stem cell transplantation assessment.