Metabolic/endocrine
Paget’s disease is asymptomatic in 70-90% of cases but it can affect
the axial skeleton and cause back and pelvic pain. Enlargement of
vertebral bodies can cause compression of nerve roots, the cord, and the
cauda equina. Pagetic sarcoma is rare, but any prolonged change in pain
in a Paget’s disease patient demands investigation.64Hyperparathyroidism and renal osteodystrophy can cause pain due to
spinal involvement, pathological fractures, and development of a ”brown
tumor”.14 Osteomalacia causes generalized skeletal
pain, especially of the back and pelvis
65 Ochronosis causes disc calcifications and
herniation with generalized and advanced arthritic
changes.66