History A 72-year-old man is brought to the ED with severe back pain. The back pain initiated abruptly when he stepped awkwardly off his kitchen step. He refutes dropping or direct injury to his spine. Apart from some unclear discomfort in the back of his pelvis and hips for the last few months, he has not once had difficulties with his joints. When asked directly, he does admit to some weight loss and feeling tired and exhausted. Also, he has been thirstier than normal for a few weeks. Besides this, the patient also complains of urinary frequency and nocturia.
Examination This man is well but pale and in pain. He has marked bony tenderness over T11/12. His pelvis is not tender and his hips move freely. Neurological examination is normal. All other systems are also normal. INVESTIGATIONS: Normal range Haemoglobin 7.9 g/dL 13.3–17.7 g/dL Mean corpuscular volume (MCV) 88 fL 80–99 fL…
