Radiology may show only a reduction of overall bone density. More common is the presence of punched-out defects in more than one bone that is characteristic of this condition. The patient may present with a so-called "pepper pot skull". Lytic lesions are the consequence of osteoclast activating factors produced by the myeloma cells. Vertebral fractures are common.
Always suspect multiple myeloma when there is the combination of osteoporosis and a high ESR.
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