Multiple myeloma, what an unfamiliar name, but with the aging of our population, the incidence of this malignant tumor of the hematological system, which occurs in middle and old age, has been increasing year by year. However, the clinical manifestations of this disease are diverse and can invade many organs. Except for specialists, many patients and physicians lack subjective knowledge of this disease, resulting in a misdiagnosis rate of multiple myeloma of more than 60%, which causes many patients to go to the hematology department only after they have been transferred to several hospitals or many departments and finally be diagnosed. The pathogenesis of multiple myeloma is a clonal disease of plasma cells, caused by the uncontrolled proliferation of plasma cells and the secretion of large amounts of monoclonal immunoglobulins, and its clinical manifestations are diverse, mainly bone pain, anemia and renal function damage are the most common, followed by hyperviscosity syndrome and hypercalcemia. (1) Bone pain, bone destruction in multiple myeloma is mainly caused by the activation of osteoclasts by immunoglobulin secreted by plasma cells, resulting in local bone destruction or generalized osteoporosis, which mainly manifests as bone pain and multiple bone destruction, especially in the flat bones of the whole body, such as skull, ribs and pelvis, thoracic and lumbar vertebrae, but a few patients still show fractures of long bones of the limbs. We have treated many patients who were diagnosed with disc bulge at an early stage, who were ineffective in orthopedics or even in Chinese massage, and who ended up paralyzed in bed before they were seen in hematology. Especially low back pain, which is a common symptom in the elderly, osteoporosis, osteophytes, implemented osteoarthrosis, fractures, disc herniation and other common orthopedic diseases in the elderly can show the above symptoms, so it is very easy to lead to misdiagnosis when there is no bone destruction and other symptoms are ignored. (2) Renal insufficiency: kidney damage is a common symptom of this disease, mainly hypertension, swelling, oliguria and other renal insufficiency may appear, and some patients are not even found to be multiple myeloma until the uremic stage. (3) Anemia 90% of patients present with anemia at the first visit, and the degree of anemia is mainly mild to moderate. (4) Infection and bleeding, etc. Patients often present with unexplained fever, cough, frequent urination, malaise, bleeding gums, and excessive menstruation, etc. When routine blood changes are not obvious, they often do not visit the hematology department and are prone to omission and misdiagnosis. (5) Hyperviscosity syndrome mainly manifests as dizziness, numbness of hands and feet, weakness, chest tightness, memory loss, etc. Its symptoms are more lacking in specificity, and patients are mostly seen in neurology and cardiology departments. Conclusion: Therefore, for middle-aged and elderly patients with bone pain, proteinuria, renal insufficiency, anemia, recurrent infections, and those with poor results of conventional treatment, the possibility of multiple myeloma should be thought of, focusing on liver function and blood routine in the routine examination, which shows anemia in the blood routine, with white blood cells and platelets generally within the normal range. When liver disease, solid tumor, autoimmune disease, etc. are excluded, bone marrow cytology and M protein electrophoresis can be performed to confirm the diagnosis. He was diagnosed as “lumbar fracture” in a municipal hospital, and the pain gradually increased after treatment, and he was admitted to another municipal hospital in June 2009, Bone marrow cytology showed 7.5% primitive plasma cells, 9% naive plasma cells, 20% mature plasma cells, and was diagnosed as multiple myeloma. 11, 12 thoracic vertebrae, right 2nd, 3rd, 4th rib and rib cartilage junction, right 5th, 6th anterior rib, left 5th, 6th, 7th anterior rib with metabolic foci. The diagnosis of multiple myeloma (IgG-KAP type) was confirmed. The patient and his family were very anxious. Finally, an orthopedic surgeon found that the patient was anemic and his globulin was abnormally elevated during the routine examination, and only then did he consider the possibility of multiple myeloma and perform relevant tests to confirm the diagnosis. A bone scan also revealed the presence of multiple bone destruction.