LAUSR

Sir, We describe a 40‐year‐old male, a driver by occupation who presented to the orthopedic department with mechanical back pain of 4 months duration with no prior trauma. He also reported unintentional and significant weight loss of about 10 kg in the last 6 months. Clinical examination was unremarkable. An X‐ray of the spine was done, on which the vertebrae appeared to be sclerotic, and this was subsequently confirmed on a dual energy X‐ray Absorptiometry Scan (Z score of 6.8 at lumbar spine) [Figure 1a and b]. In the presence of severe sclerotic bone disease of recent onset in an adult male, the possibilities of renal osteodystrophy, renal tubular acidosis, Paget’s disease of bone and sclerotic metastasis due to an underlying malignancy were considered.