Bone pain & early diagnosis

Barring physical injuries, there can be multiple causes for bone pain: chronic illnesses or deficiencies can also be the underlying causes. In such cases, it is difficult to identify the exact site of pain. Often, patients complain of vague pain or fatigue, localised to a particular bone or joint. Sometimes the pain is identified only when the clinician palpates the affected parts, causing tenderness. It is important to identify the cause of this pain instead of taking over-the-counter pain relief medications or ignoring it and carrying out normal activities. It is always advisable to visit a healthcare provider when there is chronic bone pain. A detailed clinical history and initial clinical evaluation help in scheduling a few tests to identify the exact cause. The healthcare provider is likely to recommend radiological and blood tests depending on the symptoms. A few basic blood tests will help in the clinical diagnosis of bone pain. These include rheumatoid arthritis factor (RA factor), HLA B27, uric acid, vitamin D, calcium, phosphorus, alkaline phosphatase, and renal function tests. Other than blood tests, radiological investigations such as plain X-ray of the affected site, dual energy X-ray absorptiometry (DEXA scan), computed tomography (CT scan), Magnetic Resonance Imaging (MRI), electromyography, and nerve conduction studies will help in clinching a diagnosis. In cases where the exact cause cannot be determined by these non-invasive screening tests, a healthcare provider might perform invasive tests like bone marrow aspiration and biopsy, arthroscopy, or open biopsies from affected bones. These investigations help in identifying causes of bone pain like osteoarthritis, rheumatoid arthritis, osteoporosis, osteopenia, osteomalacia, vitamin D deficiency, osteomyelitis (infection of bone), bone cancers, and various other causes. Women in postmenopausal age group are more susceptible to developing osteoporosis and osteopenia. Only when the exact cause is identified, appropriate treatment can be prescribed. Most often, bone disorders can be treated if the cause is identified before irreversible damage sets in. Early diagnosis is therefore the key. (The author Dr V Kavita is the regional Chief of Lab and AVP Lab Operations, Metropolis Healthcare Ltd., Chennai.)