A 65 year old woman presents with persistent pain in her middle and lower back, which started around a month ago, after she attempted to pick up a potted plant. The pain is worsened by exertion, and relieved by lying down; it has progressively increased over time. There was no associated tingling, numbness or weakness. Her menopause was at 48 years of age. She has never been on hormone replacement therapy.
There is a compression wedge fracture of the L1 vertebral body. The L4/L5 and L5/S1 disk spaces are narrowed.
The DXA scan of the spine gives a T-Score of -2.7 VFA: Grade 1 stable vertebral wedge fracture deformity of the L1 vertebral body.
The ESR is 25 mm/1h (normal: 0-30)
S. Ca++: 9.2 mg/dl (8.9-10.1 mg/dL) S. PO4---: 3 mg/dl (2.5-4.5 mg/dL) Alkaline Phosphatase (ALP): 130 IU/L (44-147 IU/L)