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An unusual cause of back pain in osteoporosis: lessons from a spinal lesion

Case report #### Key points

A 77 year old woman was admitted with a three month history of worsening back pain, malaise, and anorexia. On direct questioning, she reported that she had suffered from back pain for four years. The thoracolumbar radiograph four years earlier showed T6/7 vertebral collapse, mild scoliosis, and degenerative change of the lumbar spine (fig 1); but other investigations at that time including the erythrocyte sedimentation rate (ESR) and protein electophoresis were normal. Bone mineral density then was 0.914 g/cm2 (T score = −2.4) at the lumbar spine, 0.776 g/cm2 (T score = −1.8) at the right femoral neck and 0.738 g/cm2 (T score = −1.7) at the left femoral neck. She was given cyclical etidronate after this vertebral collapse as she had suffered a previous fragility fracture of the left wrist.



Figure 1 
Lateral radiograph of the thoracic spine showing T6/7 vertebral collapse.



On admission, she was afebrile, but general examination was remarkable for pallor, dental caries, and cellulitis of the left leg. A pansystolic murmur was heard at the cardiac apex on auscultation; there were no other signs of bacterial endocarditis. She had kyphoscoliosis and there was diffuse tenderness of the thoracolumbar spine. Her neurological examination was unremarkable.

Laboratory investigations showed a marked normocytic anaemia (Hb, 6.6 g/dl, MCV, 80 fl), leucocytosis (TLC, 19.9 × 109/l, neutrophils, 12.1), ESR of 45 mm 1st hour, and C reactive protein (CRP) of 89.9 mg/l (normal<6 …