WORKUP IN SYMPTOMATIC DISEASE

Causes of symptomatic bone loss must be systematically excluded. The patient’s history may suggest bone loss secondary to hyperthyroidism, primary hyperparathyroidism, chronic glucocorticoid excess (hyperadrenalism or hypercorticism), myeloma, or osteomalacia. Therefore, a thorough history is essential in making the differential diagnosis and should include the following:

1. History of Acute Illness. Onset and duration of symptoms; location and radiation of pain; exacerbating and remitting factors; relationship of pain to posture, activity, time of day

2. Review of Related Symptoms. Malaise; recent weight loss or weight gain; loss of height; hot flashes; changes in visual fields; purpura or acne; amenorrhea; hypertension; goiter or neck swelling; change in voice, skin texture, or hair consistency; sensitivity to temperature change; palpitations; epigastric pain or burning, change in bowel habits, diarrhea, loose or bulky foul-smelling stools; dysuria, flank pain, fever, renal colic, nephrolithiasis; joint pain or swelling; generalized bone pain or muscle weakness; psychiatric problems

3. Medical and Personal History. Menstrual history, pregnancy, lactation, oophorectomy; thyroidectomy; pituitary surgery; ulcer or bowel surgery; surgery for cancer, spinal disorders (e.g., scoliosis), or bone or joint fractures