1)      Persistent unexplained bone pain (FBC, X-ray, urea, electrolytes, liver and bone profile, PSA, ESR, CRP)

2)      Increasing, unexplained or persistent bone pain OR tenderness, particularly at rest

3)      Elderly, proximal muscle pain and weakness, malaise, weight loss, headache, raised ESR (exclude polymyalgia rheumatica)

4)      Temporal headaches and/or jaw claudication (temporal arteritis)

5)      Weight loss, malaise, anorexia, fever (connective tissue diseases)

6)      Hypercalcemia (metabolic, endocrine or malignant diseases)

7)      Elevated alkaline phosphatase (metabolic, endocrine or malignant diseases)

8)      Hyperuricemia (metabolic, endocrine or malignant diseases)

9)      Hypokalemia (metabolic, endocrine or malignant diseases)

10)    Diffuse bone pain predominantly in the hip girdle, bone tenderness (use moderate force on sternum or anterior tibia with thumb and if it elicits tenderness suggestive of osteomalacia), muscle weakness, particularly proximal muscle weakness with Tredelenburg gait, easy fatiguability, pathological fractures, perioral paresthesiae, acroparesthesiae, carpopedal spasms (Osteomalacia – confirm by low serum Vit D, varying levels of serum Ca and P )

11)    Family history of hemochromatosis, fatigue, weakness, weight loss, abdominal pain, joint pain, mild elevations of aminotransferase levels, asymptomatic hepatomegaly (See under MMSCs for hemochromatosis)

12)    Alcohol abuse, muscle overexertion, muscle compression, HMgCoA reductase inhibitors, cyclosporine, itraconazole, erythromycin, colchicine, zidovudine,  corticosteroids, muscle pain, tenderness, swelling, bruising, weakness, tea-colored urine, fever, malaise, nausea, vomiting, acute confusional state, complications like acute renal failure, DIC, hyperkalemia, hypocalcemia, cardiac arrest, (Rhabdomyolysis)

13)    Hypalgesia, paresthesia, dysesthesia in the limbs and trunk (painful electric shock-like sensations down the spine on neck flexion, painful leg spasms), particularly with a sensory level, loss of vibration sense, loss of positional sense, associated cerebellar signs (ataxia, intention tremor, ataxic gait), eye signs (irregular areas of visual loss in 1 eye, loss of color intensity, eye pain made worse with eye movements, these symptoms initially recurrent but later progressive, nystagmus, INO or MLF syndrome which causes diplopia on lateral gaze), spinal cord signs (manifested as incontinence, impotence, impairment of gait, incontinence initially in sleep and during sexual intercourse, recurrent episodes of retention of urine, finally total loss of control, psychosexual dysfunction include erectile dysfunction, loss of sexual desire, premature or retrograde ejaculation) (Multiple sclerosis)