A 58-year-old woman is seen in the clinic for complaints of severe back pain. Her chest x-ray demonstrates generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium levels. The most likely diagnosis is

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The combination of bone pain, bone demineralization, compression fractures, and elevated calcium levels are highly suggestive of plasma cell myeloma (also known as multiple myeloma), a cancer of plasma cells in the bone marrow. Leukemia would present with abnormal blood cell counts and would not necessarily cause bone pain or compression fractures. Hodgkin disease is a type of lymphoma, which typically presents with lymph node enlargement and systemic symptoms rather than bone pain. Back trauma may cause a fracture, but it would not explain the bone demineralization and elevated calcium levels.

A 58-Year-Old Woman Is Seen in the Clinic for Complaints