Differential Diagnosis for Vertebral Fracture with Severe Hip Pain

Single Most Likely Diagnosis

• Osteoporotic fracture with referred pain: This is the most likely diagnosis, as osteoporotic fractures can cause severe pain that may be referred to the hip area due to the proximity of the vertebral fracture to the hip joint. The pain could be exacerbated by movement or weight-bearing activities.

Other Likely Diagnoses

• Pathological fracture due to metastatic disease: Metastatic cancer can weaken bones, leading to pathological fractures. If the patient has a history of cancer, this diagnosis becomes more likely. The hip pain could be due to a fracture in the hip itself or referred pain from a vertebral fracture.
• Traumatic fracture: A recent trauma could have caused both the vertebral and hip fractures, especially if the patient was involved in a high-impact accident or a fall from a significant height.
• Degenerative disc disease or spinal stenosis: These conditions can cause severe back pain that radiates to the hip area, especially if there is nerve compression involved.

Do Not Miss Diagnoses

• Spinal cord compression or cauda equina syndrome: These are medical emergencies that require immediate attention. A vertebral fracture could potentially compress the spinal cord or cauda equina, leading to severe neurological deficits, including loss of bladder and bowel control, and paralysis.
• Infection (osteomyelitis or discitis): Infections of the bone or disc can cause severe pain and may be associated with systemic symptoms such as fever and chills. These conditions require prompt diagnosis and treatment to prevent serious complications.
• Aortic dissection or abdominal aortic aneurysm: Although less directly related to vertebral fracture and hip pain, these conditions can present with back pain and are life-threatening if not promptly diagnosed and treated.

Rare Diagnoses

• Paget's disease of bone: This condition can cause bones to become enlarged and deformed, leading to fractures. It's a rare cause of vertebral fractures but could potentially explain hip pain if the disease affects the pelvic bones.
• Multiple myeloma: A type of blood cancer that can cause multiple fractures due to bone weakening. It's less common but should be considered, especially in older adults with unexplained fractures.