Multiple myeloma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]

Overview

Multiple myeloma must be differentiated from monoclonal gammopathy of undetermined significance (MGUS), isolated plasmacytoma of the bone, and extramedullary plasmacytoma.

Differentiating Multiple Myeloma from other Diseases

• The table below summarizes how to differentiate multiple myeloma from other conditions that cause similar presentation:

Differential Diagnosis Causes Features Therapy Multiple myeloma Chromosomal aberrations or other genetic insults Malignant transformation of plasma cells Clonal plasma cell proliferation Diffuse bone pain and tenderness with osteolytic lesions Renal failure Hypercalcemia Anemia Induction chemotherapy with bortezomib, lenalidomide, and dexamethasone Bisphosphonates RANK ligand inhibitors (denosumab) Autologous stem cell transplantation Osteoporosis Imbalance between bone resorption and bone formation Preceded by osteopenia Decreased bone mineral density Acute musculoskletal pain if fracture develop Severe decrease in BMD on dual-energy X-ray absorptiometry (DEXA) test T score less than -2.5 on DEXA scan Calcium and vitamin D supplementation Bisphosphonates Weight-bearing exercise Teriparatide RANK ligand inhibitors (denosumab) Idiopathic transient osteoporosis of hip On physical examination, demonstrates acute hip pain On imaging studies, demonstrates sub-chondoral cortical loss and diffuse osteopenia of the femoral neck On history, demonstrates mostly involvement of pregnant women and young men On history, demonstrates to be self-limiting in 6-8 months Osteomalacia On physical examination, demonstrates diffuse bone pain, fatigue, and fractures are the common symptoms On imaging studies, demonstrates low bone mineral density (BMD) On imaging studies, demonstrate the brief bone mass loss in bones Scurvy On physical examination, demonstrates bone pain and frequent fractures due to brittle bone On imaging studies, demonstrates low bone mineral density (BMD) On physical examination, demonstrates other mucosal disruption symptoms, such as bleeding gums On imaging studies, demonstrates normal bone mineral density (BMD) Osteogenesis imperfecta On physical examination, demonstrates Short stature, scoliosis, and propensity for fractures On physical examination, demonstrates tooth defects, hearing defects, and blue sclera On laboratory studies, demonstrates near normal bone mineral density (BMD) Homocystinuria On physical examination, demonstrates diffuse bone pain and musculoskeletal symptoms On physical examination, demonstrates visual impairment On laboratory studies, demonstrates high amounts of homocysteine in urine

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