EpistemisDeep non-articular bone pain
Specialty: Musculoskeletal.
Why it occurs
- Bone metastases (breast, prostate, lung, kidney, thyroid)
- Multiple myeloma (diffuse osteolytic lesions)
- Acute/chronic bacterial or fungal osteomyelitis
- Paget's disease of bone (accelerated abnormal bone remodeling)
- Osteomalacia or rickets due to severe vitamin D deficiency
- Avascular necrosis of bone tissue (osteonecrosis in early stages)
Initial workup
Plain x-ray of the affected bone area | Complete laboratory (total and bone alkaline phosphatase, ionic calcium, phosphorus, PTH, vitamin D levels, serum/urine protein electrophoresis) | Whole-body bone scan or local CT/MRI depending on findings.
red flags
Pain with dull, constant characteristics, which worsens significantly at night spontaneously unrelated to movement, accompanied by weight loss, night sweats and extreme fatigue (highly suspicious of primary or metastatic bone malignancy).
Standard management
- Zoledronic acid — 4 mg IV infused over 15 minutes once a year or every 3-4 weeks as indicated by metastasis or Paget
- Denosumab — 120 mg subcutaneously every 4 weeks for bone metastases, or 60 mg every 6 months for severe osteoporosis
- Fentanyl in transdermal patch — 12-25 mcg/hour every 72 hours for refractory cancer pain
- Calcium carbonate combined with Cholecalciferol (1200 mg / 800 IU daily).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4