A 70 year old African American male complains of low back pain and cardiovascular disease is ruled out. What condition is suspected?

The suspicion of multiple myeloma in a 70-year-old African American male with low back pain, especially after ruling out cardiovascular disease, has clinical rationale for several reasons. Multiple myeloma is a hematological malignancy characterized by the proliferation of abnormal plasma cells in the bone marrow, leading to bone pain and lesions, especially in older adults.

The demographic factors play a crucial role, as African American males are at a higher risk for multiple myeloma compared to other populations. The presentation of low back pain in an elderly patient, combined with systemic effects such as fatigue, hypercalcemia, or anemia, can further align with the typical clinical picture of multiple myeloma. Notably, back pain associated with multiple myeloma may not respond well to standard pain treatments, and it often indicates underlying bone involvement due to lesions or fractures caused by weakened bone structure.

In this case, while other conditions could also cause back pain, the combination of the patient's age, race, and the nature of the symptoms make multiple myeloma a highly plausible diagnosis.