Final answer:
The elderly patient with multiple myeloma and lytic bone lesions should be managed with a combination of pain control, possibly radiation therapy for lesion-induced pain or fracture risk, systemic multiple myeloma treatment, renal function assessment, and bone-strengthening agents.
Step-by-step explanation:
The most appropriate management for a 67-year-old female with multiple myeloma who is being evaluated for back pain and has restaging CT scans revealing lytic lesions in the lumbar spine and left iliac crest, would involve a multidisciplinary approach that includes pain management, potentially radiation therapy for the lytic lesions if they are causing significant pain or risk of fracture, and systemic therapy for the multiple myeloma. This could include a combination of chemotherapy, corticosteroids, and possibly newer agents such as immunotherapy or proteasome inhibitors depending on the specifics of her disease and previous treatments.
Further assessment of renal function would be important as multiple myeloma can cause chronic renal failure by various mechanisms, including hypercalcemia or cast nephropathy. Bone disease in multiple myeloma is typically managed with bisphosphonates or denosumab to prevent fractures and reduce bone pain. All management decisions should be made in collaboration with the patient's oncologist and based on the most updated clinical guidelines and the patient’s overall health status.