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Introduction. Multiple myeloma represents a malignant skeleton condition, been considered the most frequent bone malignancy of primary type in people older than 70 years. Myeloma causes a particular deterioration of bone via bone loss which can be localized or diffuse. The skeletal anomalies may include osteoporosis and vertebral fractures as first sign of the condition which need to be differentiated from others types of osteoporosis. This is a case presentation. This is a 56-year old female who was diagnosed with a lumbar fracture 5 months ago and considered osteoporosis treated with alendronate. Bone pain continued in addition to hypoanabolic syndrome. Second opinion showed hypercalcemia with suppressed parathomone and high bone resorption marker CrossLaps in association with mild anaemia, highly increased ESR (erythrocyte sedimentation rate), and newly discovered renal failure, and large ostolytic lesions at computed tomography. A bone biopsy was necessary and confirmed multiple myeloma. Conclusion. Severe diagnosis like malignant bone conditions may be first diagnosed as osteoporosis.