The main investigation is an X-ray, which may exclude the basic abnormalities and diseases such as osteoporosis and malignancy. If serious diseases such as malignancy or infection are suspected, and the plain X-ray is normal, a radionuclide bone scan may detect these disorders. Other investigations to consider are:

• full blood examination and ESR

• serum alkaline phosphatase

• serum electrophoresis for multiple myeloma

• Bence-Jones protein analysis

• brucella agglutination test

• blood culture for pyogenic infection and bacterial endocarditis

• tuberculosis studies

• HLA-B27 antigen for spondyloarthropathies

• ECG or ECG stress tests (suspected angina)

• gastroscopy or barium studies (peptic ulcer)

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