A 68-Year-Old Man Comes to the Office with a Deep

A 68-year-old man comes to the office with a deep headache throughout the day for the past 2 months.  He works as a construction foreman and says his hard hat has felt unusually tight during that time, which he believes may be contributing to his symptoms.  The patient has no associated muscle weakness, sensory changes, or eye symptoms.  Laboratory studies show an elevated serum alkaline phosphatase level of 656 U/L.  His other liver function tests are within normal limits, and serum calcium and phosphorus levels are normal.  Erythrocyte sedimentation rate and serum prostate-specific antigen are also normal.  CT scan of the head reveals no brain lesions, but the skull has thickened cortices with mixed lytic and osteoblastic lesions.  Nuclear bone scan reveals increased uptake in the skull and tibia.  In addition to optimization of vitamin D and calcium intake, which of the following is the most appropriate next step in management of this patient?

A) Alendronate
B) Calcitonin
C) Infliximab
D) Methotrexate
E) Prednisone
F) Testosterone

Correct Answer:

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