Bone Disorders - The Medical Cookbook

Differential Diagnoses

Below is a table showing clinical features that may help differentiate different bone disorders.

Bone disorder	Differentiating features
Osteoporosis	Asymptomatic until a pathological fracture occurs
Osteomalacia	Bony pain and tenderness are present from the onset of the disease
Hyperparathyroidism	Symptoms of hypercalcaemia are present – abdominal pain, nausea, constipation, depression etc.
Paget’s disease of bone	Most patients are asymptomatic May have bone pain in the spine, skull, pelvis, and femur

Bone disorder	Calcium	Phosphate	ALP	PTH
Osteoporosis	normal	normal	normal	Normal
Osteomalacia	decreased	decreased	increased	increased
Primary hyperparathyroidism	increased	decreased	increased	increased or normal
Secondary hyperparathyroidism	decreased	increased	increased	Increased
Tertiary hyperparathyroidism	increased or normal	decreased or normal	increased	increased
Paget’s disease of bone	normal	normal	increased	normal