01-03-2009, 06:53 PM
A 60-year-old man is evaluated for increasing fatigue, malaise, and bone pain over the past 2 years. His medical history is significant for chronic alcoholism, hypertension, and gout. He was started on pancreatic enzyme replacements 8 years ago when he developed steatorrhea and weight loss. He stopped drinking at that time. He suffered a Colles wrist fracture 18 months ago. A recent digital rectal examination showed a normal prostate gland, and his serum prostate-specific antigen level is 2.0 ng/mL. He does not have fevers, chills, or night sweats.
On physical examination, there is a generalized tenderness of the bones. Proximal muscle weakness is noted along with a waddling gait.
Laboratory Studies
Hematocrit
34%
Calcium
7.2 mg/dL (1.8 mmol/L)
Phosphorus
2.2 mg/dL (0.71 mmol/L)
Albumin
3.5 g/dL (35 g/L)
Alkaline phosphatase
290 U/L
Radiographs of the long bones reveal bilateral radiolucent bands on the inner aspects of the femur.
Which of the following is the most likely diagnosis?
A Osteoporosis
B Osteomalacia
C Paget's disease of bone
D Metastatic prostate cancer
E Paraneoplastic syndrome
On physical examination, there is a generalized tenderness of the bones. Proximal muscle weakness is noted along with a waddling gait.
Laboratory Studies
Hematocrit
34%
Calcium
7.2 mg/dL (1.8 mmol/L)
Phosphorus
2.2 mg/dL (0.71 mmol/L)
Albumin
3.5 g/dL (35 g/L)
Alkaline phosphatase
290 U/L
Radiographs of the long bones reveal bilateral radiolucent bands on the inner aspects of the femur.
Which of the following is the most likely diagnosis?
A Osteoporosis
B Osteomalacia
C Paget's disease of bone
D Metastatic prostate cancer
E Paraneoplastic syndrome