From the Guidelines
Yes, blood testing should be done for this 38-year-old male with multiple compression fractures without significant trauma. I recommend a comprehensive metabolic workup including complete blood count, comprehensive metabolic panel, calcium, phosphorus, parathyroid hormone, 25-hydroxyvitamin D, testosterone levels, and bone turnover markers (such as N-telopeptide and bone-specific alkaline phosphatase) as suggested by the expert consensus recommendations for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults 1. Additionally, serum protein electrophoresis, serum free light chains, and 24-hour urine protein electrophoresis should be ordered to rule out multiple myeloma. Thyroid function tests and cortisol levels would also be appropriate to evaluate for endocrine causes of bone loss. These tests are essential because multiple compression fractures in a young male without trauma suggest an underlying metabolic bone disease or malignancy. The patient's tall stature (6'4") raises concern for disorders like Marfan syndrome or homocystinuria, which can affect bone density. Early identification of conditions like hyperparathyroidism, vitamin D deficiency, hypogonadism, or malignancy would allow for targeted treatment to prevent further fractures and address the underlying cause of his chronic back pain. The management of vertebral compression fractures should also consider the patient's quality of life, as painful VCFs may cause a marked decline in physical activity and quality of life, leading to general physical deconditioning 1.
Some key points to consider in the workup include:
- A thorough clinical evaluation including history of initial and presenting complaints, full medical history and family history of autoinflammatory or autoimmune diseases in first-degree relatives 1
- Assessment for other inflammatory features and consideration of involvement from a dermatologist, ophthalmologist, and gastroenterologist depending on suspected features 1
- Review of whether there is fulfillment of classification criteria for axSpA or PsA, as this may have implications for clinical management 1
- Routine laboratory investigation with full blood and differential count, inflammatory markers, renal function, alkaline phosphatase, calcium, 25-hydroxy-vitamin D, parathyroid hormone levels, and phosphate 1
From the Research
Blood Testing for Workup
Given the patient's presentation of chronic back pain and compression fractures at multiple sites, blood testing may be necessary to rule out underlying conditions that could be contributing to these symptoms.
- The patient's height of 6'4" may be a risk factor for osteoporosis, which could be contributing to the compression fractures 2.
- Blood tests to assess bone metabolism, such as calcium and vitamin D levels, may be helpful in evaluating the patient's condition and guiding treatment decisions 2.
- Additionally, tests to rule out other conditions that could be contributing to the patient's symptoms, such as liver disease, may be necessary 3, 4.
- A basic metabolic panel, which includes tests for electrolytes, blood urea nitrogen, and creatinine, may also be helpful in evaluating the patient's overall health and identifying any potential underlying conditions 5.
Potential Underlying Conditions
- Osteoporosis: given the patient's age, height, and presence of compression fractures, osteoporosis is a potential underlying condition that should be considered 2.
- Liver disease: although there is no major history of trauma, liver disease could be a contributing factor to the patient's symptoms, particularly if there is a history of alcoholism or other liver conditions 3, 4.
- Other conditions, such as peripheral neuropathy or leg spasms, may also be contributing to the patient's symptoms, although these are not directly related to the compression fractures 6.