A 72-year-old man comes to the physician due to persistent dull pain in his right pelvis that has worsened over the past 6 months. He says the discomfort is present at rest and not related to physical activity. He denies recent trauma but reports that his hat size has increased over the past year. His medical history is notable for hypertension and hyperlipidemia, and he takes lisinopril and atorvastatin. On examination, there is mild bony enlargement and tenderness over the right pelvic region, and his hearing appears diminished during conversation. A CT of the head is shown.
Which of the following is the next best step in management?
A) Administer zoledronate
B) Check serum alkaline phosphatase levels
C) IV 0.9% NaCl
D) Scintigraphic bone assay
E) Skeletal survey
