Bone fracture - pathological

Last updated: Saturday, 13, November, 2010
CausesAppropriate Tests

Careful clinical assessment and diagnostic imaging may indicate the likely underlying cause.
Calcium - plasma or serum, phosphate - plasma or serum, albumin - plasma or serum, protein (total), protein electrophoresis - serum, ALP; FBC, blood film; CRP; Bence Jones protein - urine.
FNAB, tissue biopsy, bone biopsy
(fracture site) or bone marrow aspiration and trephine biopsy, as appropriate.

Metastatic carcinoma, especially 

See also Leucoerythroblastic anaemia.
  • Breast
  • Lung
  • Prostate
Prostate specific antigen; acid phosphatase is less useful.
  • Thyroid
See under Thyroid nodule/cyst.
  • Kidney
See under Renal mass.

Multiple myeloma

Benign bone tumour, cyst

Sarcoma

  • Osteogenic sarcoma
  • Chondrosarcoma
  • Ewing's 'sarcoma'

Osteoporosis

Osteomalacia

Paget's disease (bone)

Renal osteodystrophy

Creatinine, urea, aluminium; parathyroid hormone.
See under Renal failure

Hyperparathyroidism

PTH

Osteogenesis imperfecta

Consult pathologist.

Hypophosphatasia

Amino acids (ethanolamine phosphate) - urine; ALP.