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Myeloma presenting as osteoporosis — SCE Rheumatology MCQ

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EasyMetabolic Bone DiseaseMyeloma presenting as osteoporosisSCE Rheumatology

A 78-year-old man has vertebral fractures despite near-normal DXA, anaemia, renal impairment, ESR 86 mm/hour and hypercalcaemia. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Serum protein electrophoresis and serum free light chains

Serum protein electrophoresis and serum free light chains is the single best answer because osteoporosis with anaemia, renal impairment and hypercalcaemia should raise concern for myeloma. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Osteomalacia is less suitable because it fits a different clinical pattern or a different treatment threshold; Multiple myeloma, Plain radiograph alone and Methotrexate do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NOGG osteoporosis guideline; NICE technology appraisals; BNF