A diagnostic dilemma in an elderly patient with bone pains

A 61-year-old patient presented with multiple bone pains. Biochemical, haematological and radiological investigations initially suggested a diagnosis of osteomalacia because of the presence of hypocalcaemia and looser zones. There were also multiple lytic bone lesions and bone scan showed multiple hot spots suggesting multiple bone secondaries. The key investigation in this case was examination of the bone marrow.