Bone Pain

Bone pain is the most frequent presenting symptom. It may precede the diagnosis for months. It most commonly begins in the back and lower chest, less often in the ribs or extremities. Back pain is usually insidious, and is aggravated by weight bearing and movement. Acute exacerbation of back pain often occurs with compression fractures of the vertebrae. The chest pain from rib lesions is generally mild, aggravated by movement and position, but may be pleuritic and associated with dyspnea, particularly when rib fracture or pleural effusion develops. Bone pain may become severe when pathologic fracture occurs spontaneously or with trivial trauma. Physical examination may illicit bone tenderness of the affected regions. Radicular pain and paresthesia along the dermatome distribution may precede the onset of motor weakness or loss of sphincter control from spinal cord or nerve root compression, and are important warning signs to look for clinically.

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