A 65 year old Caucasian man presents with bone pain in his back and chest. His primary care doctor ruled out coronary causes and referred him to you. The pain is induced by movement but does not wake him from sleep. His past medical history is significant for COPD, PTSD, and atherosclerosis. He takes a baby aspirin. His family history is noncontributory. His social history is significant for smoking 50 pack-years and drinking a beer a night. He is married, has two children, and is a retired auto mechanic. Review of systems is positive for fatigue and generalized weakness.
The laboratory values are: sodium 135, potassium 4, chloride 110, bicarbonate 24, BUN 10, Cr 1.6, glucose 95. Calcium, magnesium, phosphorus, and albumin are normal. The patient has a normocytic, normochronic anemia of Hgb 11 g/dL. WBC and platelets are normal. An X-ray is shown below.
Challenge: What's the diagnosis?
Image is shown under Fair Use.