Differential Diagnosis for 46 yo Female with Elevated Lipoprotein(a) and Back Pain Worse at Night

• Single Most Likely Diagnosis
  • Osteoporotic vertebral compression fracture: Elevated lipoprotein(a) is a risk factor for atherosclerosis and osteoporosis. Back pain that worsens at night can be indicative of a vertebral compression fracture, which is a common complication of osteoporosis.
• Other Likely Diagnoses
  • Degenerative disc disease: This condition can cause back pain that worsens at night due to the increased pressure on the spine when lying down.
  • Spondylosis: A condition characterized by degenerative changes in the spine, which can cause back pain that worsens at night.
  • Hyperlipidemia-related musculoskeletal pain: Elevated lipoprotein(a) can contribute to inflammation and pain in the musculoskeletal system.
• Do Not Miss Diagnoses
  • Spinal metastasis: Although less likely, it is crucial to consider spinal metastasis, especially if the patient has a history of cancer. Night pain can be a red flag for malignancy.
  • Spinal infection (e.g., osteomyelitis, discitis): Infections of the spine can cause severe back pain that worsens at night and can be life-threatening if not promptly treated.
  • Multiple myeloma: A type of blood cancer that can cause bone pain, including back pain that worsens at night.
• Rare Diagnoses
  • Lipoprotein(a)-related amyloidosis: A rare condition where elevated lipoprotein(a) leads to the deposition of amyloid proteins in various tissues, including the spine, causing back pain.
  • Scheuermann's disease: A rare condition characterized by kyphosis and back pain, which can worsen at night due to the abnormal curvature of the spine.