I read with interest CMAJ’s Decisions article describing a spontaneous rib fracture in a 66-year-old woman with a long-standing history of osteopenia.1
I venture that, in addition to breast cancer, careful consideration for the differential diagnosis should be given to possible bone cancer, specifically, multiple myeloma. Although multiple myeloma is more common in patients that are male and of certain ethnicities, the median age of onset is 66 years, and the rib fracture may represent a plasmacytoma: a proliferation of plasma cells distant from the primary of multiple myeloma.2
In a patient with long-standing osteopenia, it would be easy to miss multiple myeloma or another primary bone neoplasm, but it almost certainly needs to be ruled out with a complete assessment and appropriate testing as required (key among these being a complete blood count with a peripheral smear, serum protein electrophoresis for a specific diagnosis of multiple myeloma, and a skeletal survey with plain films and/or a bone scan to identify a primary site).
Thank you for sharing this most interesting case.
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