26th January 2024

A 78-year-old female presents to A&E after sustaining a fracture to her L3 vertebra after tripping over the pavement.

A 78-year-old female presents to A&E after sustaining a fracture to her L3 vertebra after tripping over the pavement. She has a past medical history of coeliac disease and has had no previous fractures. She does not drink alcohol and stopped smoking 1 year ago – prior to this, she had a 25-pack-year history. She is otherwise systemically well and has not had any recent history of joint pains.

Hb 133 g/L (130-180)

MCV 90 fL (80-96)

WCC 7.0 x 10⁹/L (4.0-11.0)

CRP 9 mg/L (<10)

Sodium 134 (133–146 mmol/L)

Potassium 4.3 (3.5–5.3 mmol/L)

Creatinine 73 (45–84 μmol/ L)

EGFR >90 

ESR 3

Serum adjusted calcium level 2.3 (2.2-2.6 mmol/L)

Serum phosphate level 0.90 (0.74 – 1.4 mmol/L)

Serum albumin 30 (35–50 g/L)

Serum alkaline phosphatase 100 (30–130 U/L)

Vitamin D 12 : (> 500 nmol/L)

X-ray spine: fracture of L3 vertebral body, with increased radiolucency and cortical thinning

What is the most likely underlying diagnosis? 

Select the SINGLE most appropriate option from the list below. Select ONE option only.