Whenever a part of the body hurts, it’s usually due to muscle strains, ligament sprains, bursitis, maybe joint disease — but there could be something wrong with the bone. Bone diseases can be serious — they include Fractures, Infections & Cancer (either cancer that begins in bone, cancer spread from elsewhere, or a blood cancer Multiple Myeloma). There are also mild bone diseases, like cysts, which usually don’t hurt.
We suspect bone disease if there’s pain when we tap on one bone, in one spot. If it hurts all around the area, even when we press on other structures, then we’re not worried. If we can pound on a bone without it hurting, there’s no bone disease (and no need for x-ray). But if pounding further away on a bone causes pain in a spot we didn’t touch, bone disease is more concerning (vibrations can radiate down bone, to hurt at the area of disease).
It’s usually easy to see bone diseases on plain x-rays. If the x-ray is normal, but our exam still suggests bone disease, we may order a bone scan or an MRI to be sure. We worry especially in the elderly, who in general are more likely to have cancer.
Osteoporosis (thinning of bone) occurs in the elderly, especially women. It weakens bone, but does not cause pain unless there’s an actual fracture. Many people with known osteoporosis blame it for all their aches and pains, which is not the case. Osteomalacia (softening of bone) occurs from extreme vitamin D deficiency (levels under 10 ng/mL), and can cause low back pain. It is usually only seen in certain chronic diseases of parathyroid glands, kidneys, liver, and stomach or bowel.