Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive bone pain, most commonly localized to the lumbar spine, ribs, or pelvis. Reports associated symptoms including fatigue, unexplained weight loss, and history of pathological fractures. Denies recent trauma. Review of systems significant for symptoms of hypercalcemia (nausea, constipation, confusion) or renal impairment.
Clinical Examination Findings
Physical examination reveals localized bony tenderness, particularly over the axial skeleton. Assessment for spinal cord compression signs (motor weakness, sensory deficits, or hyperreflexia) is negative. No palpable masses noted. Performance status evaluated via ECOG scale.
Treatment Protocol
Initiate systemic therapy including proteasome inhibitors, immunomodulatory agents, and corticosteroids. Administer bone-modifying agents (bisphosphonates or denosumab) to reduce skeletal-related events. Consider palliative radiotherapy for localized symptomatic lesions or impending fractures. Monitor renal function and serum calcium levels closely.