Differential Diagnosis for Chronic Back Pain with Compression Fractures
The patient's presentation of chronic back pain with compression fractures at multiple sites (T12, L1, and possibly L2) without a significant history of trauma, and being very tall (6'4"), suggests several potential diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Osteoporosis: Given the patient's tall stature and the presence of multiple compression fractures without significant trauma, osteoporosis is a strong consideration. Tall individuals may have a higher risk of osteoporosis due to their larger bone size and potentially lower bone density.
Other Likely Diagnoses
- Multiple Myeloma: This is a type of blood cancer that can cause bone lesions leading to compression fractures. The absence of trauma and the multiplicity of fractures raise suspicion for an underlying malignancy.
- Metastatic Cancer: Similar to multiple myeloma, cancers that metastasize to the bone (e.g., prostate, breast, lung) can cause compression fractures. The patient's age and sex, along with the lack of trauma history, make this a plausible diagnosis.
- Vitamin D Deficiency or Osteomalacia: Deficiencies in vitamin D or calcium can lead to softening of the bones (osteomalacia) in adults, increasing the risk of fractures.
Do Not Miss Diagnoses
- Spinal Cord Compression or Cauda Equina Syndrome: Although less likely given the chronic nature of the pain, any new neurological symptoms (e.g., numbness, weakness, bladder/bowel dysfunction) could indicate spinal cord or cauda equina compression, requiring immediate medical attention.
- Infection (Osteomyelitis or Discitis): Infections of the bone or disc can cause pain and fractures. While less common, these conditions are critical to identify due to their potential for serious complications.
Rare Diagnoses
- Paget's Disease of Bone: A condition characterized by an abnormal breakdown and regrowth of bone tissue, leading to bone deformities and potential fractures.
- Gaucher's Disease: A genetic disorder that can lead to bone fractures and other skeletal issues due to the accumulation of harmful quantities of a certain fat (lipid) in the body.
- Cushing's Syndrome: A hormonal disorder caused by prolonged exposure to high levels of cortisol, which can lead to osteoporosis and fractures.
Each of these diagnoses requires careful consideration of the patient's history, physical examination, and additional diagnostic tests (e.g., bone density scan, blood tests, MRI) to determine the underlying cause of the compression fractures.