MON-824 - A Case Of Multiple Myeloma Presenting As A Discrepancy In Vertebral And Hip T-Scores In A Postmenopausal Woman

The decision to pursue evaluation for secondary causes of osteoporosis is guided by the severity and pattern of bone mineral density loss, as well as clinical features suggestive of an underlying disorder. Among secondary etiologies, multiple myeloma is important to diagnose earlier on as early intervention leads to improved outcomes. We present the case of a 74-year-old woman with severe vertebral osteoporosis of the lumbar spine and a marked discrepancy between lumbar spine and femoral neck T-scores on initial screening (−4.8 and −2.49, respectively), who was ultimately diagnosed with multiple myeloma. Of note, the patient lacked the classical symptoms or lab findings suggestive of multiple myeloma, delaying her diagnosis for multiple years until she suffered disease-related vertebral fractures. This case highlights a potentially underrecognized clinical clue in the evaluation of osteoporosis: a significant discordance between vertebral and femoral neck bone mineral densitometry measurements. In the absence of overt clinical or biochemical indicators, such a discrepancy should warrant evaluation of secondary causes.  This case also identifies limitations of initial testing for secondary causes of osteoporosis and clinicians should continue to maintain a heightened suspicion if such discordance exists. Future studies should aim to investigate the prevalence of this discordance in those with multiple myeloma in relation to postmenopausal osteoporosis to avoid misdiagnosis or delayed diagnosis

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