Point tenderness over a vertebra in an older woman. Most likely diagnosis?

Point tenderness over a vertebra in an older woman. Most likely diagnosis?

• A. Metastatic disease
• B. Discitis
• C. Osteoarthritis
• D. Osteoporosis (compression fracture)

Answer: (D)

A localized tenderness over a vertebra in an older woman most often points to a vertebral compression fracture from osteoporosis. In postmenopausal osteoporosis, bones thin and weaken, so even minor twists or stresses can compress a vertebral body, producing sharp, focal back pain right at the level of the fracture. That tenderness is typically the key clue. Other possibilities exist but fit less well. Metastatic disease can cause focal back pain, but that usually comes with a history of cancer or systemic symptoms such as weight loss and night pain. Discitis would present with fever and infection signs, often in the setting of immunosuppression or bacteremia. Osteoarthritis tends to cause generalized axial back pain with stiffness and facet joint involvement rather than a single, pinpoint vertebral tenderness. Imaging, like plain X-rays or MRI, would show the collapsed vertebral body in a compression fracture, supporting the osteoporosis-related diagnosis.

A localized tenderness over a vertebra in an older woman most often points to a vertebral compression fracture from osteoporosis. In postmenopausal osteoporosis, bones thin and weaken, so even minor twists or stresses can compress a vertebral body, producing sharp, focal back pain right at the level of the fracture. That tenderness is typically the key clue.

Other possibilities exist but fit less well. Metastatic disease can cause focal back pain, but that usually comes with a history of cancer or systemic symptoms such as weight loss and night pain. Discitis would present with fever and infection signs, often in the setting of immunosuppression or bacteremia. Osteoarthritis tends to cause generalized axial back pain with stiffness and facet joint involvement rather than a single, pinpoint vertebral tenderness.

Imaging, like plain X-rays or MRI, would show the collapsed vertebral body in a compression fracture, supporting the osteoporosis-related diagnosis.