A 75-year-old male, who is a heavy smoker and drinker, comes to the clinic complaining of sudden severe back pain after lifting a heavy object. Physical examination shows decreased height and a slight curvature of the upper back. What are the potential diagnoses and next steps?
The patient's history, physical examination, and the nature of the event suggest a possible vertebral compression fracture due to osteoporosis. Smoking and heavy alcohol intake are both risk factors for osteoporosis, even in males. The next steps would be to send him for imaging, like an X-ray or MRI, of the spine to confirm the diagnosis. If confirmed, pain management, possible bisphosphonate therapy, and lifestyle modifications including smoking and alcohol cessation should be initiated.