In a 70-year-old patient with back pain and no cardiovascular disease, which diagnosis remains a plausible consideration based on the clinical scenario?

• A. Multiple myeloma
• B. Lymphoma
• C. Leukemia
• D. Prostate cancer

Answer: (A)

Back pain in an older patient often points to bone pathology, and multiple myeloma is a classic cause because it frequently involves the spine with osteolytic lesions that weaken vertebrae and can lead to back pain or even compression fractures.

Multiple myeloma is a plasma cell cancer that grows in the bone marrow and disrupts normal bone remodeling, producing lytic lesions throughout the skeleton, especially in the spine. This helps explain persistent back pain in someone around 70 years old. In addition to pain, you’d look for clues like anemia, elevated calcium, and renal issues (the CRAB features), and imaging would typically show punched-out lesions. Laboratory tests may reveal an M-protein spike in serum or urine and other marrow abnormalities on biopsy.

While other cancers can metastasize to bone and cause back pain, multiple myeloma is the most characteristic consideration in an elderly patient presenting with back pain in the absence of cardiovascular disease, because its spinal involvement and age profile make it highly plausible. If suspected, pursue imaging of the spine and targeted labs (SPEP/UPEP, calcium, creatinine, CBC) to confirm.