Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive bone pain, most commonly localized to the lumbar spine, ribs, or pelvis, exacerbated by movement. History significant for constitutional symptoms including fatigue, unexplained weight loss, and recurrent infections. Patient reports symptoms of hypercalcemia (nausea, constipation, polyuria, confusion) or signs of cord compression (radicular pain, motor weakness, sensory deficits).
Clinical Examination Findings
Physical examination reveals localized bony tenderness upon palpation, particularly over the axial skeleton. Neurological assessment shows intact motor and sensory function, or specific deficits consistent with vertebral involvement. General inspection notes pallor (anemia) and potential ecchymosis. Assessment of performance status (ECOG) is documented.
Treatment Protocol
Treatment plan includes systemic therapy (proteasome inhibitors, immunomodulatory agents, and corticosteroids). Bone-targeted therapy with bisphosphonates (e.g., Zoledronic acid) or RANK ligand inhibitors (e.g., Denosumab) initiated to prevent skeletal-related events. Radiation therapy considered for localized symptomatic lesions or impending pathological fractures. Orthopedic consultation for stabilization of unstable fractures.