Pathological Vertebral Fractures Misdiagnosed as Osteoporotic Vertebral Fractures: A Case Series of Four Patients and Diagnostic Strategies.

Nontraumatic vertebral fractures are common in the elderly, primarily caused by osteoporosis. However, pathological fractures (e.g., due to malignancy or infection) may exhibit clinical and radiological features similar to osteoporotic vertebral fractures (OVFs), leading to misdiagnosis. We report four cases of pathological vertebral fractures initially misdiagnosed as OVFs: one case of pyogenic spinal infection, one of tuberculous spondylitis, one of brucellar spondylitis, and one of multiple myeloma. These cases highlight the importance of considering further diagnostic evaluation, including biopsy, when laboratory abnormalities or atypical imaging features are present. Preoperative laboratory investigations, such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin/globulin (A/G) ratio, and immunofixation electrophoresis, can provide critical clues for identifying underlying etiologies. Additionally, vertebral bone marrow aspiration biopsy during percutaneous vertebroplasty (PVP) is a simple and effective method to exclude hematological disorders and infection.