Diagnosis dilemma: Is it osteoporosis?

When a younger man presents with symptoms suggestive of osteoporosis, this doctor suspects something else is responsible for the pain

Adam is 38. He has worked in administration but is now receiving a disability pension for depression, for which he is taking sertraline 50mg/day. 

young man back pain

He attends with back pain, which he says is very sharp and started after a minor fall six months ago.

He localises the pain to the thoracolumbar region. The pain does not radiate but it is aggravated by coughing. 

All back movements are painful. There is no suggestion of bowel or bladder disturbance.

Apart from depression, he has no