EpistemisDiffuse pressure-induced periosteal pain
Specialty: Musculoskeletal.
Why it occurs
- Severe Vitamin D deficiency (adult osteomalacia)
- Primary hyperparathyroidism or secondary to renal failure
- Myelofibrosis or myelodysplastic syndromes (bone marrow infiltration with cortical tension)
- Acute leukemia or bone infiltrative lymphoma
- Severe osteoporosis with generalized trabecular microfractures
- Chronic fluoride or vitamin A poisoning
Initial workup
Analysis with complete blood count and peripheral blood smear | Levels of ionic calcium, phosphorus, alkaline phosphatase (ALP), parathyroid hormone (PTH) and 25-OH-vitamin D | Bone marrow biopsy if lymphoproliferative syndrome or myelofibrosis is suspected | Bone scan.
red flags
Diffuse bone pain caused by mild pressure on the sternum, ribs or anterior aspect of the tibia, which is associated with extreme fatigue, easy bleeding or petechiae, generalized hard lymphadenopathy and recurrent infections (indicates malignant hematological neoplasia with marrow infiltration).
Standard management
- Cholecalciferol — vitamin D3, 50,000 IU orally once a week for 8 weeks for correction of severe osteomalacia
- Calcium carbonate — 1500 mg daily in divided doses with food
- Alendronate — 70 mg weekly orally for associated osteoporosis, once vitamin D is normalized
- Sodium phosphate or calcitriol if the defect is of renal or hypophosphatemic origin.
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