An older man with low back pain and no acute injury

Case scenario

Sam is a 59-year-old abattoir worker who presented with low back pain that has been increasing over the past couple of years. He had decided to apply for the disability pension. There had been no acute back injury. Sam appeared to have a good range of lower spinal movement and he was not overweight, but he had been treated for hypertension and insulin dependent diabetes mellitus (type 1 diabetes). His diabetes was poorly controlled and apparently rarely monitored. A spinal x-ray reported only minor spondylitic changes, but the radiologist commented that there was increased bone density in the lumbar vertebrae. It was suggested that he could have renal osteodystrophy.