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Osteoporosis vertebral fracture — SCE Rheumatology MCQ

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EasyMetabolic bone diseaseOsteoporosis vertebral fractureSCE Rheumatology

A 73-year-old postmenopausal woman develops sudden thoracic back pain while lifting a light shopping bag. She has focal thoracic vertebral tenderness and kyphosis. Plain radiography confirms a new anterior wedge compression fracture. There is no history of significant trauma, malignancy, weight loss or night sweats. Full blood count, renal function, corrected calcium, phosphate, alkaline phosphatase and 25-hydroxyvitamin D are normal. What is the most likely diagnosis?

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Correct answer: A — Osteoporotic vertebral fracture

This is an osteoporotic vertebral fragility fracture. Sudden focal pain after minimal loading, an anterior wedge compression fracture and kyphosis in an older postmenopausal woman are characteristic. Normal routine bone biochemistry is compatible with osteoporosis; osteoporosis is not diagnosed or excluded by calcium, phosphate or alkaline phosphatase alone. Myeloma and spinal metastasis can cause pathological vertebral collapse, but constitutional features, a malignancy history and relevant laboratory abnormalities are absent. Paget disease more often produces bone expansion, cortical thickening and a raised alkaline phosphatase. Osteomalacia usually causes diffuse bone pain and proximal muscle weakness, with abnormalities such as low phosphate, raised alkaline phosphatase or vitamin D deficiency rather than an isolated low-trauma wedge fracture.

Reference: National Institute for Health and Care Excellence. Artificial intelligence technologies to aid the opportunistic detection of vertebral fragility fractures: supporting documentation, section 3, Target conditions. 2025. https://www.nice.org.uk/guidance/htg760/documents/supporting-documentation