A 70-year-old man presents with mid-back pain and has been losing weight. He has a history of smoking and chronic obstructive pulmonary disease. On physical examination, there is point tenderness in the thoracic spine. What are potential causes and next steps?
Given this patient's age, smoking history, and weight loss, there is a concern for malignancy, such as lung cancer metastasized to the spine. Other possibilities include osteoporotic compression fracture or infection. The next steps would involve laboratory tests to check for signs of infection or other systemic disease, and imaging (likely an MRI) to evaluate the spine.