BOF 89

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BOF: 89

A 74 year old male presents with backache. There has been no injury and the backache was of gradual onset. He is known to have hypertension well controlled on a thiazide diuretic. He does not smoke or drink. He lives with his wife; they have 2 children and manage independently. He is a retired bus driver.

Investigations

Hb 24.2 g/dL

WBC 6.4 x109 /L

ESR 25 mm in 1^st hour

Urea 8.6 mmol/L

Sodium 138 mmol/L

Potassium 3.9 mmol/L

Calcium 2.4 mmol/L

Phosphate 1.3 mmol/L

Alkaline phosphatase 800 U/L

Alanine aminotransferase 33 U/L

Bilirubin 25 µmol/L

X-ray of his lumbo sacral spine reveals sclerosis of the vertebrae

In this patient which one of the following would you use as definitive treatment?

a)      Melphalan

b)      Prednisolone

c)      Bisphosphonate

d)     NSAID

e)      Calcium and vitamin D

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