Bone pain may result from a pathological fracture, either due to metabolic bone disease or malignancy, or from certain metabolic bone diseases in the absence of overt fracture, such as osteomalacia, hyperparathyroidism or Paget’s disease. Osteoporosis does not cause pain in the absence of fracture.
If the fracture has the characteristics of a fragility fracture, the bone scan shows a single focus, or other causes for fracture are excluded, osteoporosis should be considered and bone densitometry performed if uncertainty exists. Secondary causes of osteoporosis should be excluded if not already done so.
Unless there is no diagnostic uncertainty, routine biochemical analyses and isotope bone scan would be performed as a first line investigation in all patients.